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Background
In a preface to the seminal text 'The Golden Cage', Bruch describes anorexia nervosa as a disease that 'affect(s) young and healthy girls who have been raised in privileged, even luxurious circumstances', highlighting the predominant view of the time that eating disorders (EDs) were the domain of the young upper-class and white female. Although it is now known within the ED field that this is not the case, this early perspective has had lasting implications for the classification and wider mental health literacy of EDs, as well as for the development of resources to prevent, detect, and treat EDs. Further, although we assume that EDs are now experienced across a range of groups, a deficit of population-based research has meant that the exact demographic profile of disordered eating remains unclear. Nonetheless, our perception of who in the population is affected by EDs has broadened. Research has shown that contrary to earlier views, males, middle-aged and older people, people of non-white ethnicity, and people from lower socio-economic backgrounds all experience disordered eating. An important question that remains unaddressed is whether the current prevalence of disordered eating within these groups is a stable phenomenon or has resulted from an increase in more recent times. Understanding temporal shifts in the prevalence of disordered eating in a community-based sample, as well as the specific demographic sectors within which these shifts are occurring, will enable an informed and targeted approach to the design and implementation of future prevention and treatment campaigns.
In a previous study we reported findings on the prevalence of ED behaviors from two sequential population surveys conducted in 1995 and 2005. In this study we found that the prevalence of current and regular binge eating and strict dieting had increased in both men and women. We also found that the mean age of participants who reported strict dieting and purging behaviors had increased. No comparison was made to ascertain statistical differences in the rate of increase in ED behaviors between men and women, and further work is also needed to clarify within which age groups the prevalence of ED behaviors may be changing. No studies as far as we are aware have assessed how disordered eating is changing across other demographic variables, such as socio-economic status, and urban residency.
In more recent work, we have also examined the level of impairment associated with ED behaviors. In sequential surveys conducted in 1998 and 2008 we found that participants who reported regular and current ED behaviors in 1998 and 2008 had similar levels of impairment in health-related quality of life. We have also found in a cross-sectional study that impairment in health-related quality of life is similar between men and women who report ED behaviors. It remains unknown whether changes over time in the impairment associated with ED behaviors differ according to sex or other demographic variables.
Aims
The aim of the current study was to examine the rate of increase of ED behaviors across the demographic features of sex, age, residency (i.e. metropolitan vs. regional), and household income. A secondary aim was to assess differences over time in health-related quality of life impairment associated with disordered eating, and whether this differed across demographic variables.
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