Eating Disorders: Anorexia, Bulimia, and Evidence-Based Care

When someone says they’re just trying to eat healthier, they might not realize how easily that thought can spiral into something life-threatening. Eating disorders aren’t about willpower. They’re serious mental illnesses with physical consequences that kill more people than almost any other psychiatric condition. Anorexia nervosa alone claims one life every 52 minutes in the U.S. - and most of those deaths are preventable with the right care.

What Anorexia and Bulimia Really Look Like

Anorexia nervosa isn’t just being thin. It’s a relentless fear of gaining weight, even when you’re dangerously underweight. People with anorexia often restrict food to extreme levels, exercise compulsively, or use laxatives. Their body image is shattered - they see themselves as fat in the mirror, even when their ribs stick out. About 1% of the population develops anorexia, and it’s 10 times more common in women than men - though that gap is closing. Young people are especially vulnerable. Hospital admissions for kids under 12 have jumped 119% since 2012.

Bulimia nervosa looks different. People with bulimia binge - eating huge amounts of food in a short time - then try to undo it. They vomit, take laxatives, fast, or over-exercise. One in ten people with bulimia ends up with swollen cheeks from repeated vomiting. Unlike anorexia, many with bulimia maintain a normal weight, which makes the illness invisible to others. About 1.5% of women and 0.5% of men will experience bulimia in their lifetime. The shame keeps them silent. Less than half ever seek help.

Here’s what most people don’t know: fewer than 6% of people with eating disorders are medically underweight. You can’t tell who’s struggling by looking at them. That’s why so many go undiagnosed - even by doctors.

The Hidden Cost: Mortality and Mental Health

Eating disorders have the highest death rate of any mental illness. Anorexia’s mortality rate is 5.1 deaths per 1,000 person-years - nearly six times higher than people without it. Bulimia isn’t far behind, with a mortality rate almost double that of the general population. Every year, over 10,200 people die from complications like heart failure, organ shutdown, or suicide.

And suicide is a massive part of the crisis. One in three people with anorexia, bulimia, or binge eating disorder has attempted suicide. For those with anorexia, the risk is 18 times higher than in the general population. Depression hits hardest in bulimia - 76% of people with it also struggle with major depression. Substance abuse is common too. Up to half of all eating disorder patients misuse alcohol or drugs, five times the rate of the general population.

These aren’t just statistics. They’re real people - teenagers skipping meals, college students hiding vomit, adults hiding pills in their pockets. The silence around these illnesses kills.

What Actually Works: Evidence-Based Treatments

Treatment isn’t one-size-fits-all. But science has identified what works - and what doesn’t.

For adolescents with anorexia, Family-Based Treatment (FBT) is the gold standard. Parents take charge of meals, help restore weight, and slowly hand control back to their child. After 12 months, 40-50% of teens recover - compared to just 20-30% with individual therapy alone. FBT doesn’t blame parents. It empowers them.

For adults with bulimia or binge eating disorder, Enhanced Cognitive Behavioral Therapy (CBT-E) is the most effective. It targets the core thoughts driving the behavior: the fear of weight gain, the obsession with food, the belief that self-worth depends on appearance. After 20 sessions, 60-70% of people stop bingeing and purging. Even better - CBT-E works across diagnoses. Someone with anorexia, bulimia, or binge eating can all benefit from the same core approach.

And now, for the first time, there’s a medication approved specifically for an eating disorder. In 2023, the FDA approved lisdexamfetamine (Vyvanse) for binge eating disorder. In clinical trials, it cut binge episodes in half - far better than placebo. It’s not a cure, but it’s a powerful tool when combined with therapy.

Why People Don’t Get Help - and What’s Holding Treatment Back

Even when people know they need help, the system fails them.

Insurance denials are the #1 barrier. In a 2022 survey, 68% of people with eating disorders had at least one insurance claim denied. One woman spent 27 months waiting for care - nine months for outpatient therapy, another 18 for an intensive program. Her insurance denied every request. She had to raise $78,000 on GoFundMe to get 90 days of residential treatment.

There are only 35 specialized residential treatment centers in the entire U.S. - with just 1,200 beds total. That’s less than 0.004% of the 30 million Americans living with eating disorders. Wait times for outpatient care average 68 days. For intensive programs? Over four months.

Even when people get in, care quality varies wildly. Only 38% of treatment centers meet basic standards for clinical documentation. Only 12% use standardized tools like the Eating Disorder Examination Questionnaire (EDE-Q) to track progress. And 97% of patients have at least one medical complication - low heart rate, electrolyte imbalances, bone loss - that must be treated before therapy can even begin.

What Recovery Actually Looks Like

Recovery isn’t linear. It’s messy. It’s crying during meals. It’s relearning how to eat without guilt. It’s sitting with discomfort instead of controlling it.

One woman on HealthUnlocked shared that after seven years of bulimia, 12 sessions of CBT-E cut her binge-purge episodes from 14 a week to just two. Another, in a Monte Nido residential program, gained 15 pounds under medical supervision and learned DBT skills to manage emotions without food. These aren’t miracles - they’re results of proper treatment.

But recovery needs time, support, and access. The most critical factor? Getting help within three years of symptoms starting. People who start treatment early have a 65% chance of full remission. After five years? That drops sharply.

What You Can Do - Even If You’re Not the Patient

If you’re worried about someone - a friend, a sibling, a coworker - don’t wait for them to ask for help. Say something. Be direct. Say: “I’ve noticed you’re skipping meals. I care about you. Is there something going on?”

If you’re a parent, learn about FBT. Don’t assume your child will outgrow this. Early intervention saves lives.

If you’re a clinician, get trained. FBT and CBT-E require 120-180 hours of specialized training. Don’t guess. Don’t wing it. Use the tools that work.

If you’re fighting insurance, document everything. Appeal every denial. Use the Mental Health Parity and Addiction Equity Act. In 2023, the Department of Labor fined 17 health plans $3.2 million for denying eating disorder care. You have rights.

And if you’re the one suffering - you are not broken. You are not weak. You are sick. And you deserve care that treats the whole person - body and mind.

What’s Next

The future is starting to shift. The NIH is tracking 7,500 children from birth to find early biological signs of eating disorders - results expected in late 2025. Telehealth is expanding, especially in rural areas where specialists are scarce. Military hospitals now screen for eating disorders, recognizing that service members are 2.3 times more likely to develop them.

But progress depends on funding, awareness, and action. Without it, the 93% spike in youth medical visits in 2023 will overwhelm a system already at breaking point.

Eating disorders don’t disappear because we ignore them. They grow louder. More deadly. More hidden. The only way forward is to see them clearly - and treat them with the urgency they demand.