Shedding light on eating disorders: Insurance data shows who suffers

The upcoming holidays can be challenging for people with eating disorders, as the seasons emphasis on food and the potential for stress at family gatherings can exacerbate symptoms.

Along with the difficulties, much remains unknown about eating disorders, including their exact cause, and research has indicated an increase in eating disorders during the COVID-19 pandemic. To help shed light on this diverse group of mental health conditions associated with severe eating behavior disorders, FAIR Health accessed its repository of over 43 billion private health claims records.

These are some of our key findings, also published in the new white paper.

An increase in the proportion of claims for eating disorders

Eating disorder claim lines grew 65% nationally as a percentage of all treatment claim lines from 2018 to 2022. (A claim line is a single service or procedure listed on an insurance claim; multiple claim lines may be related to one diagnosis.) The largest. the increase occurred from 2019 to 2020, the first year of the COVID-19 pandemic, when claims for eating disorders increased by 39%. Further but smaller increases occurred in 2021 and 2022.

Rows for eating disorder claims as a percentage of all medical claims, 2018-2022(FAIR Health)

All eating disorders we studied increased their share from 2018 to 2022, but at different rates. Avoidant/restrictive food intake disorder, or ARFID, which involves extremely selective eating, often among children, rose 305% as a share of all lines of medical claims, while binge eating disorder rose 81%, anorexia nervosa (anorexia) 73% and bulimia nervousness (bulimia) by 3%.

For context, the diagnostic code for ARFID was introduced relatively recently in 2017, so its lower starting point means a higher percentage increase.

The most common eating disorders

Binge eating disorder was the eating disorder most commonly diagnosed without another co-occurring eating disorder in 2022. Among all eating disorder patients, 24.3% were diagnosed with binge eating disorder as the only eating disorder, followed by anorexia patients with 24, 1%.

Bulimia alone accounts for 6.2% of all eating disorder diagnoses, and ARFID for 5.3%. About 10% of patients are diagnosed with multiple eating disorders, and another 30% are diagnosed with only other eating disorders, such as atypical anorexia nervosa, a condition in which not all criteria for anorexia nervosa are met.

Distribution of eating disorders by percentage of patients with an eating disorder, 2022(FAIR Health)

Co-occurring mental health conditions

Nearly three-quarters of patients with eating disorders from 2018 to 2022 were also diagnosed with at least one co-occurring mental health condition other than an eating disorder, including 78% of patients with bulimia. 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 patients with an eating disorder also had a diagnosis of generalized anxiety disorder, and 39% had a diagnosis of major depressive disorder. In particular, one person can have both diagnoses.

Overall, patients with eating disorders were more than five times more likely to have a non-eating disorder mental health condition and more than four times more likely to have a substance use disorder than all patients receiving medical services.

While eating disorders can affect people of all ages, the age distribution of eating disorder claims changed over the four-year period we studied. In 2018, 19- to 24-year-olds accounted for the largest share of eating disorder reporting queues, followed by 14- to 18-year-olds. Those positions changed in 2022: the largest share was associated with 14- to 18-year-olds, and the second largest was with 19- to 24-year-olds.

Different eating disorders also affected 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), while binge eating disorder was most prevalent among the older age groups (31 to 40, 41 to 50 years). and 51 to 65).

Distribution of anorexia reporting lines by age, 2018-2022(FAIR Health)

Among patients diagnosed with anorexia, teenagers aged 14 to 18 accounted for 30% of such lines in 2018 before rising to 41.8% in 2021 and falling slightly to 40.1% in 2022.

Eating disorders were strongly associated with patients, although not exclusively. Every year from 2018 to 2022, women accounted for more than 89% of eating disorder reporting lines. Gender disparities in 2022 ranged from 94% female to 6% male for anorexia to 68% female to 32% male for ARFID.

The 0-9 age group was the only group that had more males than females associated with eating disorder claim lines.

The increase in eating disorder claims as a percentage of all medical claims from 2018 to 2022 varied by geographic region. The South, where eating disorders accounted for the lowest percentage of medical claims lines among all regions in 2018 and 2022, saw the largest increase of 84%, while the Northeast saw the smallest increase of 51%. In that region, eating disorders accounted for the largest percentage of medical claims orders in 2018, but the second largest percentage in 2022, when the West had the largest share.

The ranks of eating disorder claims as a percentage of all medical claims also varied by state. From highest to lowest, the five states with the highest share in 2022 were all in the northern half of the country: Rhode Island, Massachusetts, Minnesota, Montana and Oregon.

Telehealth became the most common site for eating disorder services in 2022, with requests for its use up more than 10,000% from 2018 to 2022. Office-based health care use for eating disorders fell 55% over the same period .

Our findings on eating disorders have implications for stakeholders across the health care spectrum, including patients and providers who treat them, as well as payers and policy makers. We hope that these findings will also serve as starting points for further research into eating disorders.

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