Gender inequality and eating disorders in Europe: insights from the Global Burden of Disease Study

Abstract Background Eating disorders (EDs) are a major source of non-fatal health burden globally. This study analyzed the impact of gender inequality on Years Lived with Disability (YLDs) from anorexia nervosa (AN) and bulimia nervosa (BN) across Western, Central, and Eastern Europe between 1990 and 2022. Methods YLD estimates were obtained from the Global Burden of Disease Study 2023, focusing on individuals aged 10-39 years, grouped into five-year intervals, across 35 countries. Gender Inequality Index (GII) data were sourced from United Nations Development Programme reports, with 2022 as the latest year available. We applied a linear mixed-effects model, including fixed effects for age group, sex, year, GII, and their interactions, and random intercepts by country. YLDs were reported as rates per 100,000 population. Results YLDs from both AN and BN increased steadily over time, with Western Europe consistently showing the highest burden. Females showed higher YLD rates than males across all age groups, with peaks between 20-29 years. Higher GII values were associated with a lower AN and BN burden among males (β = -3,632 for AN; β = -11,200 for BN), but a significantly higher AN burden among females (interaction β = 4,708), particularly during adolescence and early adulthood. Between-country variability was considerable, with the country-level standard deviation reaching 16.2 for AN and 40.5 for BN. Conclusions Gender inequality significantly shapes the non-fatal burden of EDs among young people in Europe. Although gender disparities have narrowed over time, persistent inequalities continue to drive health differences, underscoring the need for targeted policies and healthcare strategies. Key messages • Gender inequality lowers eating disorder burden in males but amplifies anorexia nervosa burden in young females. • Despite improvements in gender equality, substantial sex- and country-level disparities in EDs burden persist across Europe.