Amid worries about an increase in eating disorders brought on by the pandemic, diagnosis data and health care claim lines help highlight the serious illnesses.
People with eating disorders may find the approaching holidays difficult because of the season’s focus on food and the possibility of stress at family get-togethers exacerbating symptoms
The fact that there is still much to learn about eating disorders, including their precise causes, makes matters more difficult. Additionally, research has indicated a rise in eating disorders during the COVID-19 pandemic. Fair Health searched through its database of over 43 billion private health care claim records in an effort to provide more insight into this broad range of mental health issues linked to severe disruptions in eating behaviors.
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Some of our most important conclusions are included in a recently released white paper.
An increase in the share of eating disorder claim lines
Eating disorder claim lines increased 65% nationally as a percentage of all medical claim lines from 2018 to 2022. (A claim line is an individual service or procedure listed on an insurance claim; multiple claim lines can be tied to one diagnosis.) The greatest increase occurred from 2019 to 2020—the first year of the COVID-19 pandemic—when eating disorder claim lines as a share of all claim lines rose by 39%. Further, but smaller, increases occurred in both 2021 and 2022.
The prevalence of every eating disorder that we looked at rose between 2018 and 2022, albeit at different rates. As a percentage of all medical claim lines, avoidant/restrictive food intake disorder, or ARFID, which involves extremely selective eating, frequently in children, increased by 305%. In contrast, binge-eating disorder, anorexia nervosa (anorexia), and bulimia nervosa (bulimia) increased by 81%, 73%, and 3%, respectively.
To put things in perspective, the ARFID diagnosis code was only introduced in 2017, which means that a higher percentage increase corresponds to a lower starting point.
The most common eating disorders
In 2022, binge-eating disorder was the most frequently diagnosed eating disorder when there was no co-occurring eating disorder. The only eating disorder diagnosed in 24.3% of all patients was binge-eating disorder, closely followed by anorexic patients in 24.1%.
ARFID accounted for 5.3% of eating disorder diagnoses, and bulimia alone accounted for 6.2%. A third of patients were diagnosed with “other” eating disorders only, such as atypical anorexia nervosa, a condition in which not all of the criteria for anorexia nervosa are met. Approximately 10% of patients had multiple eating disorders diagnosed.
Co-occurring mental health conditions
Nearly three-fourths of patients with eating disorders from 2018 to 2022 were also diagnosed with at least one co-occurring mental health condition that was not an eating disorder, including 78% of bulimia patients. More than 1 in 5 patients with an eating disorder also had a substance use disorder.
These other mental health conditions varied. For example, 41% of eating disorder patients also had a diagnosis of generalized anxiety disorder, and 39% had a diagnosis of major depressive disorder. Notably, one person could have both diagnoses.
Overall, patients with eating disorders were more than five times as likely to have a mental health condition that was not an eating disorder and more than four times as likely to have a substance use disorder as all patients who received medical services.
Age and gender
While eating disorders can affect people of all ages, the age distribution of eating disorder claim lines changed during the four-year period we studied. In 2018, those 19 to 24 years old accounted for the largest share of eating disorder claim lines, followed by those 14 to 18 years old. Those positions flipped in 2022: the largest share was associated with 14- to 18-year-olds and the second-largest with those 19 to 24.
Different eating disorders also affect different age groups more. ARFID, for example, was the most prevalent eating disorder diagnosis among the youngest age groups (0 to 9 and 10 to 13 years old), while binge-eating disorder was the most prevalent among the older age groups (31 to 40, 41 to 50, and 51 to 65).
Geographic differences
Increases in eating disorder claim lines as a percentage of all medical claim lines from 2018 to 2022 varied by geographic region. The South, where eating disorders accounted for the lowest percentage of medical claim lines among all regions in both 2018 and 2022, saw the largest increase at 84%, while the Northeast saw the smallest increase at 51%. In that region, eating disorders accounted for the highest percentage of medical claim lines in 2018, but the second-highest percentage in 2022, when the West had the highest share.
Telehealth treatment
With claim lines for its utilization rising by more than 10,000% between 2018 and 2022, telehealth emerged as the most popular setting for receiving treatment for eating disorders in 2022. During that time, the number of people seeking treatment for eating disorders in offices decreased by 55%.
Our research on eating disorders has consequences for all parties involved in the delivery of healthcare, including payers, legislators, patients, and the medical professionals who treat them. It is our hope that these results will serve as a springboard for additional eating disorder research.
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Disclaimer: The opinions and suggestions expressed in this article are solely those of the individual analysts. These are not the opinions of HNN. For more, please consult with your doctor.
