WellnessPulse’s latest study maps global sex gaps in eating disorders and explores their ties to other mental health conditions.
Eating disorders (EDs) are severe mental health conditions defined by persistent disturbances in eating behaviors, with anorexia nervosa and bulimia nervosa being among the most common examples of EDs.
Existing research suggests that EDs are more prevalent among women than men, which could be explained by multiple biological, psychological, and sociocultural aspects. For example, men are underrepresented in ED research and underdiagnosed in clinical practice.
A new analysis by the WellnessPulse research team evaluates the disparities in the prevalence of eating disorders in women and men across the globe, represented as a female:male (F:M) prevalence ratio by country.
The highest F:M eating disorder prevalence ratios are seen in Europe and Latin America, whereas the lowest F:M ratios are concentrated in Africa and Asia.
The top 18 nations with the highest ratios include 10 European countries, five Latin American countries, two Caribbean islands, and one northern African country, according to the analysis.
The research team selected data on ED prevalence globally and calculated the F:M ratio by dividing ED prevalence in females by ED prevalence in males.
Researchers also assessed how the F:M ratios in eating disorder prevalence correlate with F:M prevalence ratios in anxiety and depressive disorders — conditions commonly co-occurring with eating disorders.
Learn more about how the analysis was conducted here.
Findings: the overview
The WellnessPulse analysis found that European and Latin American countries have the highest sex gap in ED prevalence. These countries are Ecuador, Spain, Italy, Bolivia, France, Croatia, Cyprus, El Salvador, Guatemala, Hungary, Nicaragua, Portugal, Austria, Finland, and Sweden.
Two Caribbean islands, Cuba and Jamaica, and Morocco, a country in northern Africa, are also among countries with the highest F:M ratio for eating disorder prevalence.
The disparity may stem from cultural, economic, and healthcare factors. For instance, women in these regions tend to experience stronger societal pressures regarding body image, thinness, and dieting.
In Western countries, eating disorders are often stereotypically associated with women, leading to underdiagnosis in men, who are also more reluctant to seek treatment.
Meanwhile, Africa and Asia see the lowest F:M ratios in eating disorders prevalence, the analysis found.
Non-Western countries have generally lower rates of eating disorders compared to Western countries, which could be potentially influenced by underreporting due to limited healthcare access and cultural factors.
For example, some data indicates that EDs in African women may present atypically, with less weight concern. Eating disorders are also emerging in Asian countries, partly due to exposure to Western ideals.
Top countries with the highest F:M ratios for ED
Below, you can find the list of countries with the highest sex disparities in eating disorder prevalence. In cases where countries have the same F:M ratio, they are ranked alphabetically.
Countries with high F:M ratios in eating disorder prevalence may also have high F:M ratios in anxiety (AD) and depressive disorders (DD). Read more about the relationship between ED, AD, and DD in terms of sex disparities here.
#1 Ecuador
Along with Spain, Ecuador, a country in South America, has the largest sex gap in EDs. The ED prevalence in Ecuadorian women is five times higher than in men. Cultural and social pressures, such as the idolization of thin bodies in the media, may play a role in ED development in the country.
At the same time, mental health disorders are stigmatized — about 30% of Ecuadorians consider mental and neurological conditions as punishments of nature. Those who want to seek help have limited opportunities to do so — access to mental health services is limited to about 25% of the population.
#2 Spain
Spain, a popular European holiday destination, shares the first place for the highest ED F:M ratio with Ecuador, with the ED prevalence in women five times higher than in men.
Research shows disparities between sexes in Spanish samples, with one study suggesting that as many as 14.9% of adolescent boys and 20.8% of adolescent girls may be at risk for developing an ED. Moreover, different sexes appear to be affected by these disorders differently. The same study suggests that Spanish women are more likely to engage in dieting, laxative use, or self-induced vomiting, while a higher proportion of men take part in binge eating.
- Ranks 2nd for the highest anxiety disorder sex prevalence ratio
- Ranks 10th for the highest depressive disorder sex prevalence ratio
#3 Italy
Italy, a country stretched along the Mediterranean Sea, is a paradise for food lovers. But it is also a country with the 3rd highest ED sex gap, with the ED prevalence being 4.5 times higher in women than in men.
Data in Italian adolescents suggests that 44.6% of girls and 19.4% of boys may be at risk for developing an ED. Eating disorders among Italian women may be partly associated with cultural transitions. The challenge posed by an increased sense of autonomy and the pursuit of personal goals may generate insecurity, which may result in adopting maladaptive eating habits.
- Ranks 7th for the highest anxiety disorder sex prevalence ratio
- Ranks 20th for the highest depressive disorder sex prevalence ratio
#4 Bolivia
Bolivia, a landlocked country located in central South America, has the 4th largest sex gap in eating disorder prevalence, which is four times higher in women than in men.
One study in Bolivian adolescents found that 66% of cases of ED were diagnosed with depression and 54% with anxiety, indicating frequent comorbidity between these conditions. At the same time, access to mental health care in Bolivia is extremely limited. In a country of 11.5 million people, there are only 80 mental health professionals, according to 2020 data.
#5 France
France, with its capital Paris being the epitome of fashion, banned extremely thin models in 2017 in an effort to fight eating disorders and inaccessible ideals of beauty. However, the prevalence of EDs in the country remains high — a 2020 study found that nearly 25% of college students screened positive for an eating disorder. Moreover, students with EDs reported having stress and anxiety more often than their peers without these conditions.
According to the same study, around 22% of students with ED, especially those with bulimia, reject health care. This highlights the potential lack of help-seeking and underdiagnosis. In France, the ED prevalence in women is four times higher than in men.
- Ranks 4th for the highest anxiety disorder sex prevalence ratio
#6 Croatia
With the ED prevalence in women three times higher than in men, Croatia, a Balkan country with a population of 3.8 million, ranks 6th. Social pressure from family and friends, weight-related teasing, and social standards of the thin ideal contribute to the development of EDs among Croatian adolescent girls, according to a 2013 study.
There appear to be sex differences in how EDs are expressed. A research study suggested that girls report most dissatisfaction with the abdominal region, thighs, and breasts, while boys are more likely to be dissatisfied with their abdomen, chest, legs, and calves. Moreover, results showed significant comorbidity of ED with depression.
- Ranks 14th for the highest anxiety disorder sex prevalence ratio
#7 Cuba
In Cuba, the largest island country in the Caribbean, the ED prevalence in women is three times higher than in men. As commercial advertising is non-existent in Cuba and women are less exposed to a thin ideal of beauty, they have more positive attitudes about their appearance than their neighbors.
However, Cubans have been living under food rationing since the 1960s, with food security deteriorating even more sharply in recent years. Studies indicate that people who experience food insecurity are more prone to disordered eating behaviors, such as binge eating, and compensatory behaviors, like purging and laxative use.
#8 Cyprus
The ED prevalence is three times higher in women than in men, putting Cyprus, an island country in the Mediterranean Sea, in 8th place in the ranking. Different approaches to eating may partly explain the gap.
For example, a 2022 study in Greek Cypriots showed that men report significantly higher intuitive eating than women. Intuitive eating, which is guided by internal physiological hunger and satiety signals, has been shown to be protective against eating disorders. However, another study from Cyprus found that gay men were more likely to have disordered eating habits than straight men due to higher societal pressures and appearance-related anxiety.
- Ranks 19th for the highest depressive disorder sex prevalence ratio
#9 El Salvador
The smallest country in Central America, El Salvador, is among the nations with the largest sex gaps in ED prevalence, which is three times higher in women than in men. A study on Salvadoran teenagers suggests that girls have better mental health literacy and less stigma about mental health disorders, which could potentially make them more aware of EDs and seek help.
Moreover, Salvadorans have a relatively recent memory of a brutal civil war, followed by years of gang violence, which had a considerable impact on their mental health. Research has associated trauma exposure with the development of eating disorders.
#10 Guatemala
With EDs being three times more common in women than in men, Guatemala, a country in Central America, has one of the largest sex gaps in ED prevalence globally. Data shows that in developing countries like Guatemala, exposure to Western ideals of appearance may lead to the internalization of thinness, resulting in body dissatisfaction and increasing the risk of eating disorders.
However, it may also be food scarcity that shapes attitudes toward the body. A small study in a Guatemalan community with chronically low food security found that women had more positive views toward body sizes that fall within the clinically normal and overweight categories and stigmatized extremely thin and large bodies.
#11 Hungary
A central European country, Hungary, has an ED prevalence three times higher in women than in men. A study of Hungarian women aged 15 to 24 showed that 6.3% of them were dieting daily, 0.9% reported taking diet pills, and 0.7% used laxatives for weight loss.
While Hungarian men have lower rates of ED, it doesn’t mean they don’t have concerns about their weight. According to one study, men who are overweight and have obesity are more likely to report high gender role stress and stress related to sexual arousal and sexual performance.
- Ranks 15th for the highest anxiety disorder sex prevalence ratio
#12 Jamaica
A Caribbean island, Jamaica, has the prevalence of EDs three times higher in women than in men. While eating disorders are understudied among adolescent males, they are even less so among those of African descent.
However, a study of Jamaican boys aged 11 to 19 found that 16.2% scored significantly high in the ED assessment questionnaire. Another study discovered that Jamaican adolescents — both males and females — with higher ED scores desired being thinner and having a lighter skin complexion. Moreover, high ED scores correlated with engaging in self-harm and a history of sexual abuse.
#13 Morocco
Officially called the Kingdom of Morocco, the country of western North Africa ranks 13th for the largest ED sex gap, with the ED prevalence three times higher in women than in men. About 2.1% of Moroccan university students may have an eating disorder, according to a 2024 study, with higher rates among those with a medical history of being treated for anxiety, depression, addiction, as well as experience of sexual violence.
The disparity between men and women may be partly rooted in their differing attitudes. Moroccan men, especially young and Muslim, may have significantly more stigmatizing perceptions about people with mental illness.
#14 Nicaragua
Nicaragua is the largest country in Central America, with a population of 6.8 million, and where EDs are three times more common in women than in men. There is data to suggest that increasing access to globalized media raises the risk of internalizing Western body ideas, leading to body dissatisfaction and eating disorder risk, similar to high-income nations. For example, a study found that rural Nicaraguan women who watch more TV are more likely to seek to lose weight to achieve a particular body shape.
#15 Portugal
Portugal is a southern European country, the coast of which is washed by the Atlantic Ocean. According to the WellnessPulse analysis, it has the 15th largest sex gap in ED prevalence, which is three times higher in women than men, and the 9th highest depressive disorder ratio.
One study in Portuguese adolescents found that those with higher body mass index (BMI) and stronger depressive symptoms also have more severe ED symptoms. Another study on Portuguese teenagers associates high levels of perfectionism with maladaptive eating behaviors.
- Ranks 9th for the highest depressive disorder sex prevalence ratio
#16 Austria
Austrians, a nation in Central Europe, enjoy a high quality of life, but it doesn’t spare them from the burden of mental health issues. With the ED prevalence 2.7 times higher in women than in men, the country ranks 16th.
A 2017 study on Austrian teenagers found that girls were more likely to have internalizing mental health disorders, such as bulimia and anorexia, while boys more often have disruptive, impulse control, and conduct disorders. A study comparing beauty ideals found that thinness was preferred in Austria compared to countries of lower socioeconomic status, likely because of exposure to Western media.
#17 Finland
Eating disorders are a public health concern even in the happiest country in the world, Finland, where they are 2.7 times more common in women than in men. A large study on twins indicates that the prevalence of EDs in the country is 17.9% for women and 2.4% for men.
Eating disorders often go with other mental health issues. According to a 2014 study, nearly 68% of Finnish women with a lifetime eating disorder had at least one comorbid psychiatric disorder, primarily depression.
#18 Sweden
Sweden, a northern European nation, ranks 18th, as ED prevalence in women is 2.7 times higher than in men. In a country with some of the highest levels of gender equality, women are found to display higher levels of bulimia, perfectionism, and individualism. Such findings support the hypothesis linking EDs to modern values of autonomy and independence.
Some data suggests that Swedish girls who have a higher drive for thinness are more likely to be dissatisfied with their bodies than boys, potentially explaining the sex gap in ED prevalence.
- Ranks 5th for the highest depressive disorder sex prevalence ratio
A global analysis of ED comorbidities
Previous research suggests that people with EDs have a high rate of comorbidity, which refers to conditions or illnesses that co-occur with another condition. Identifying psychiatric comorbidities is vital because they may make eating disorder symptoms more severe and affect treatment effectiveness if left unaddressed.
The WellnessPulse analysis looked into the presence of anxiety disorder (AD) and depressive disorder (DD), the two common examples of comorbid conditions in people with EDs.
Data suggests that as many as 65% of women with EDs may also have an anxiety disorder, while depression has been shown to affect 51.5% of adolescents with anorexia and 54% with bulimia.
The WellnessPulse research team conducted a correlation analysis to determine associations between F:M prevalence ratios in ED and comorbid conditions, depressive disorder, and anxiety disorder across countries.
According to the analysis, a statistically significant moderate positive correlation was found between F:M ratios of ED and AD prevalence. In other words, when the female:male ratio for ED prevalence increases across countries, the same trend can be seen for AD.
Moreover, a statistically significant but weak positive correlation was found between female:male ratios of ED and DD prevalence. This means that countries with larger ED prevalence sex gaps may have greater sex disparities in the prevalence of depressive disorder.
It is noteworthy that statistically significant moderate and weak positive correlations mean that there is some association, but other factors may influence the connection.
Of the top 18 countries with the highest F:M ratios for ED prevalence, five — Spain, France, Italy, Croatia, and Hungary — also fall in the top 20 countries with the highest F:M ratio for AD prevalence, meaning these countries have a comparatively high sex prevalence ratio in both eating disorders and anxiety disorders.
Moreover, five of the 18 countries with the highest F:M ratios for eating disorder prevalence — Sweden, Portugal, Spain, Cyprus, and Italy — also have some of the highest F:M ratios for DD prevalence.
The takeaway
Ten European countries and six Latin American countries are among those with the highest F:M ratio for eating disorder prevalence, according to the WellnessPulse analysis. This could be partly explained by social pressures, such as exposure to thin body ideals via Western media.
Meanwhile, Africa and Asia see the lowest F:M ratios in eating disorders prevalence, the analysis found. However, the actual rates of eating disorders in these countries may be higher due to underreporting, as access to healthcare is limited, and cultural factors are at play.
The analysis also proved the hypothesis suggesting that a higher sex ratio in eating disorder prevalence may go with higher sex ratios for anxiety disorder and depressive disorder prevalence across countries.
Methodology
Researcher Paula Vaidelauskaitė used data on eating disorders (EDs) from the Our World in Data source, which included 2021 global statistics on population size and collected shares of males and females (see Table 1).
Countries without data on ED prevalence and those with a population size of less than one million were excluded from the analysis, resulting in 158 countries being included in the study.
Additional data was extracted from Our World in Data on comorbid mental conditions. Data on global prevalence in males and females were collected on anxiety disorders (ADs) and depressive disorders (DDs) (see Table 1).
After data processing, the sex prevalence ratio was calculated by dividing ED prevalence in females by ED prevalence in males. These ratios were also produced for AD and DD data. This number, showing the disparities between sexes, was the focus of this analysis. The top 18 countries with a ratio higher than 2.5 were selected for further analysis.
Furthermore, Spearman’s correlation was performed to investigate associations between the prevalence ratios of ED and comorbid conditions.
Table 1 data collected.
| Data | Description | Publication date | Source |
| Eating disorder prevalence, males vs. females | Estimated share of individuals who had anorexia nervosa and bulimia nervosa in the past year, regardless of whether they have an official diagnosis | 2021 | Our World in Data |
| Anxiety disorder prevalence, males vs. females | Estimated share of individuals with anxiety disorders, regardless of whether they have an official diagnosis | 2021 | Our World in Data |
| Depressive disorder prevalence, males vs. females | Estimated share of individuals who had depressive disorders, regardless of whether they had an official diagnosis | 2021 | Our World in Data |
Limitations and other important considerations
The analysis is subject to multiple limitations that can influence the interpretation or generalization of its findings.
Population size and distribution
Countries with a low prevalence of the analyzed conditions or smaller populations may yield less accurate results because the limited data may not be as reliable as in countries with higher prevalence rates or larger populations, which provide more representative sample sizes.
Types of eating disorders
The two common examples of eating disorders, anorexia nervosa and bulimia nervosa, were included in the analysis. However, other eating disorders, like binge eating disorder, may have varying sex distributions that may have affected the F:M prevalence ratio.
Sex disparities in research
Males have historically been underrepresented in eating disorder research. Many studies predominantly feature female participants, which may limit the generalizability of findings to men. This bias could impact the accuracy of male-specific prevalence rates and the understanding of gender differences in eating disorders.
Data recency and sociopolitical context
The data utilized in this report is from 2021. Since then, global sociopolitical changes, economic instability, and public health crises may have influenced the prevalence and severity of mental health conditions, including eating disorders, depression, and anxiety. Future research is needed to assess recent trends and developments.
Gender inclusivity
The majority of large-scale epidemiological studies categorize participants based on binary biological sex (male/female), which limits the inclusivity of non-binary and transgender individuals in the analysis. Emerging research highlights the need for more inclusive methodologies to better understand eating disorders in diverse gender identities.
For example, a recent review underscores the higher prevalence of disordered eating in transgender populations. More inclusive research practices are necessary to address these gaps.
Correlation does not imply causation
While weak or moderate associations exist between eating disorders, depressive disorders, and anxiety disorders, these relationships are complex and influenced by multiple biological, psychological, and social factors. Future longitudinal and experimental studies are needed to clarify causal mechanisms.
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