Does Ireland “top the anorexia poll”?

On Friday 2nd March 2012 the Irish Independent put out the headline “Call to ban skinny models as Ireland tops anorexia poll”. They continued, “IRELAND has the highest rates of anorexia in Europe along with Italy and Austria, the first ever economic analysis of the condition has found.”

Looking at the paper in question, “Anorexia, Body Image and Peer Effects: Evidence from a Sample of European Women”, we find on page 10 that,

The country with the highest prevalence of female anorexia (column 4) was Austria (1.55%), followed by France and Ireland.

So the headline on this piece is misleading – it would lead the casual reader to assume that Ireland had the highest rate of anorexia in Europe.

However reading further there are other questions regarding the paper. The information it uses is taken from a survey carried out by the European Opinion Research Group, specifically the Eurobarometer 59.0, a special issue dealing with health questions carried out in 2003. If we look at Column 4 on table 2 we see it headed “BMI<17.5 and Fine or Too Fat". In other words all those who have a BMI under 17.5, and have the attitude towards their weight that they are "fine" or "too fat", are being marked as anorexic in this report.

The problem is that a low BMI is only one diagnostic criterion of Anorexia Nervosa. There are four in total (quote from Irish Medical News)

DSM IV Diagnostic Criteria for Anorexia Nervosa
A. Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85 per cent).
B. Intense fear of gaining weight or becoming fat, even though underweight.
C. Disturbance in the way in which one’s body weight or shape is experienced.
D. In postmenarchal females, amenorrhoea, i.e., the absence of at least three consecutive menstrual cycles.

The last three are not captured at all by the data, and the first is not captured by the BMI and attitude data since the total may include women who think they are “fine” but would be willing to gain weight. So what is being reported as levels of anorexia may be nothing of the sort.

BodyWhys, the national voluntary organisation supporting people affected by eating disorders, outline with citations the information available on Anorexia in Ireland

The Department of Health estimates that up to 200,000 people in Ireland may be affected by eating disorders. An estimated 400 new cases emerge each year, representing 80 deaths annually.

According to a 2007 study of Irish children and adolescents, 1.2% of Irish girls may be at risk of developing anorexia nervosa, with 2% at risk of developing bulimia nervosa.

We should not be blase about the level of Anorexia Nervosa in Ireland. But it is far from clear that this survey gives useful information about levels of Anorexia in the countries of Europe.

Note: this story was also covered by the Guardian, the Daily Mail and the Telegraph, along with other news outlets worldwide.