Profiling disordered eating patterns and body mass index (BMI) in the English general population

  • Orla McBrideEmail author
  • Sally McManus
  • Joanne Thompson
  • Robert L. Palmer
  • Traolach Brugha
Original Paper



Little national evidence exists on disordered eating patterns in the UK. This study examined the prevalence and nature of disordered eating patterns in the National Adult Psychiatric Morbidity Survey 2007.


Responses to the screening tool for eating disorders (SCOFF) and body mass index (BMI) were analysed using latent class analysis (n = 7,001). Multinomial logistic regression explored the associations between latent classes and mental health comorbidities.


The prevalence of possible eating disorders in England using the SCOFF was 6.3 %; this decreased to 1.6 % when accounting for the negative impact feelings about food had on the respondent’s life. Five latent classes were identified: classes 1 and 2 resembled known eating disorders (‘marginal anorexia’ relating to anorexia nervosa and ‘binge eaters’ relating to bulimia nervosa/binge eating disorder); class 3 consisted of people who were obese, but did not experience eating problems; class 4 was morbidly obese, with an elevated risk of anxiety disorders; class 5 was labelled as ‘normal eaters’, with a low probability of eating problems and a normal BMI.


Adults assigned to eating disorder type classes are at increased risk for mental health comorbidities and poorer social functioning. Information presented herein on clustering of disordered eating patterns may help clinicians identify those men and women risk for an eating disorder.


Disordered eating patterns General population survey SCOFF Adults Eating disorders 


  1. 1.
    Pallister E, Waller G (2008) Anxiety in the eating disorders: understanding the overlap. Clin Psychol Rev 28:366–386PubMedCrossRefGoogle Scholar
  2. 2.
    Hilbert A, Pike KM, Wilfley DE, Fairburn CG, Dohm FA, Striegel-Moore RH (2010) Clarifying boundaries of binge eating disorder and psychiatric comorbidity: a latent structure analysis behaviour research and therapy. Psychiatr Clin North Am 33(3):611–627CrossRefGoogle Scholar
  3. 3.
    Swanson S, Crow S, Le Grange D, Swendsen J, Merikangas K (2011) Prevalence and correlates of eating disorders in adolescents: results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry 68(7):714–723PubMedCrossRefGoogle Scholar
  4. 4.
    Brietzke E, Moreira CLR, Toniolo RA, Lafer B (2010) Clinical correlates of eating disorder comorbidity in women with bipolar disorder type I. J Affect Disord 130(1–2):162–165PubMedGoogle Scholar
  5. 5.
    Hudson JI, Hiripi E, Pope HG Jr, Kessler RC (2007) The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 61:348–358PubMedCrossRefGoogle Scholar
  6. 6.
    Krug I, Treasure J, Anderluh M, Bellodi L, Cellini E, Di Bernardo M, Granero R, Karwautz A, Nacmias B, Penelo E (2008) Present and lifetime comorbidity of tobacco, alcohol and drug use in eating disorders: a European multicenter study. Drug Alcohol Depend 97:169–179PubMedCrossRefGoogle Scholar
  7. 7.
    Harrop EN, Marlatt GA (2010) The comorbidity of substance use disorders and eating disorders in women: prevalence, etiology, and treatment. Addict Behav 35:392–398PubMedCrossRefGoogle Scholar
  8. 8.
    Bulik CM, Klump KL, Thornton L, Kaplan AS, Devlin B, Fichter MM, Halmi KA, Strober M, Woodside DB, Crow S (2004) Alcohol use disorder comorbidity in eating disorders: a multicenter study. J Clin Psychiatry 65(7):1000–1006PubMedCrossRefGoogle Scholar
  9. 9.
    Franko DL, Dorer DJ, Keel PK, Jackson S, Manzo MP, Herzog DB (2008) Interactions between eating disorders and drug abuse. J Nerv Ment Dis 196:556PubMedCrossRefGoogle Scholar
  10. 10.
    Currin L, Schmidt U, Treasure J, Jick H (2005) Time trends in eating disorder incidence. Br J Psychiatry 186:132–135. doi: 10.1192/bjp.186.2.132 PubMedCrossRefGoogle Scholar
  11. 11.
    Turnbull S, Ward A, Treasure J, Jick H, Derby L (1996) The demand for eating disorder care. An epidemiological study using the general practice research database. Br J Psychiatry 169:705–712PubMedCrossRefGoogle Scholar
  12. 12.
    Sim LA, McAlpine DE, Grothe KB, Himes SM, Cockerill RG, Clark MM (2010) Identification and treatment of eating disorders in the primary care setting. Mayo Clin Proc 85:746–751Google Scholar
  13. 13.
    Walsh JME, Wheat ME, Freund K (2001) Detection, evaluation, and treatment of eating disorders. J Gen Intern Med 15:577–590CrossRefGoogle Scholar
  14. 14.
    Preti A, Girolamo G, Vilagut G, Alonso J, Graaf R, Bruffaerts R, Demyttenaere K, Pinto-Meza A, Haro JM, Morosini P (2009) The epidemiology of eating disorders in six European countries: results of the ESEMeD-WMH project. J Psychiatr Res 43:1125–1132PubMedCrossRefGoogle Scholar
  15. 15.
    Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Sihvola E, Raevuori A, Bulik CM, Kaprio J, Rissanen A (2007) Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry 164:1259–1265PubMedCrossRefGoogle Scholar
  16. 16.
    National Institute for Clinical Excellence (2004) Eating disorders: core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. Clinical Guideline, LondonGoogle Scholar
  17. 17.
    McManus S, Meltzer H, Brugha T, Bebbington P, Jenkins R (2009) Adult psychiatric morbidity in England, 2007: results of a household survey. National Centre for Social Research, LondonGoogle Scholar
  18. 18.
    Morgan J, Reid F, Lacey J (1999) The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ 319:1467PubMedCrossRefGoogle Scholar
  19. 19.
    McCutcheon AL (1987) Latent class analysis, vol 64. Sage, LondonGoogle Scholar
  20. 20.
    Garcia-Campayo J, Sanz-Carrillo C, Ibáñez J, Lou S, Solano V, Alda M (2005) Validation of the Spanish version of the SCOFF questionnaire for the screening of eating disorders in primary care. J Psychosom Res 59:51–55PubMedCrossRefGoogle Scholar
  21. 21.
    Luck A, MorganLuck J, Reid F, O’Brien A, Brunton J, Price C, Perry L, Lacey J (2002) The SCOFF questionnaire and clinical interview for eating disorders in general practice: comparative study. Br Med J 325:755CrossRefGoogle Scholar
  22. 22.
    Sedgwick P (2011) Screening tests: indices of performance. BMJ 342:6483CrossRefGoogle Scholar
  23. 23.
    Favaro A, Ferrara S, Santonastaso P (2003) The spectrum of eating disorders in young women: a prevalence study in a general population sample. Psychosom Med 65:701PubMedCrossRefGoogle Scholar
  24. 24.
    Fairburn CG, Cooper Z, Bohn K, O’Connor ME, Doll HA, Palmer RL (2007) The severity and status of eating disorder NOS: implications for DSM-V. Behav Res Ther 45:1705–1715PubMedCrossRefGoogle Scholar
  25. 25.
    Little P (1998) GP documentation of obesity: what does it achieve? Br J Gen Pract 48:890PubMedGoogle Scholar
  26. 26.
    Osborne JW, Overbay A (2004) The power of outliers (and why researchers should always check for them). Pract Assess Res Eval 9:1–12Google Scholar
  27. 27.
    Lewis G, Pelosi AJ, Araya R, Dunn G (1992) Measuring psychiatric disorder in the community: a standardized assessment for use by lay interviewers. Psychol Med 22:465–486PubMedCrossRefGoogle Scholar
  28. 28.
    Saunders JB, Aasland OG, Babor TF, Fuente JR, Grant M (1993) Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption II. Addiction 88:791–804PubMedCrossRefGoogle Scholar
  29. 29.
    Stockwell T, Sitharthan T, McGrath D, Lang E (1994) The measurement of alcohol dependence and impaired control in community samples. Addiction 89:167–174PubMedCrossRefGoogle Scholar
  30. 30.
    Malgady RG, Rogler LH, Tryon WW (1992) Issues of validity in the diagnostic interview schedule. J Psychiatr Res 26:59–67PubMedCrossRefGoogle Scholar
  31. 31.
    Brewin CR, Rose S, Andrews B, Green J, Tata P, McEvedy C, Turner S, Foa EB (2002) Brief screening instrument for post-traumatic stress disorder. Br J Psychiatry 181:158PubMedGoogle Scholar
  32. 32.
    Tyrer P, Nur U, Crawford M, Karlsen S, MacLean C, Rao B, Johnson T (2005) The Social functioning questionnaire: a rapid and robust measure of perceived functioning. Int J Soc Psychiatry 51:265PubMedCrossRefGoogle Scholar
  33. 33.
    Hagenaars JA, McCutcheon AL (2002) Applied latent class analysis. Cambridge University Press, UKCrossRefGoogle Scholar
  34. 34.
    Breslau N, Reboussin B, Anthony J, Storr C (2005) The structure of posttraumatic stress disorder: latent class analysis in 2 community samples. Arch Gen Psychiatry 62:1343PubMedCrossRefGoogle Scholar
  35. 35.
    Akaike H (1987) Factor analysis and AIC. Psychometrika 52:317–332CrossRefGoogle Scholar
  36. 36.
    Schwarz G (1978) Estimating the dimension of a model. Ann Stat 6:461–464CrossRefGoogle Scholar
  37. 37.
    Sclove SL (1987) Application of model-selection criteria to some problems in multivariate analysis. Psychometrika 52:333–343CrossRefGoogle Scholar
  38. 38.
    Lo Y, Mendell NR, Rubin DB (2001) Testing the number of components in a normal mixture. Biometrika 88:767–778CrossRefGoogle Scholar
  39. 39.
    Ramaswamy V, DeSarbo WS, Reibstein DJ, Robinson WT (1993) An empirical pooling approach for estimating marketing mix elasticities with PIMS data. Mark Sci 12(1):103–124CrossRefGoogle Scholar
  40. 40.
    Nylund KL, Asparouhov T, Muthén BO (2007) Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Model Multidiscip J 14:535–569CrossRefGoogle Scholar
  41. 41.
    Muthén L, Muthén B (1998) Mplus user’s guide. Muthén and Muthén (2007), Los AngelesGoogle Scholar
  42. 42.
    Brugha TS, McManus S, Bankart J, Scott F, Purdon S, Smith J, Bebbington P, Jenkins R, Meltzer H (2011) Epidemiology of autism spectrum disorders in adults in the community in England. Arch Gen Psychiatry 68:459PubMedCrossRefGoogle Scholar
  43. 43.
    McCabe RE, McFarlane T, Polivy J, Olmsted MP (2001) Eating disorders, dieting, and the accuracy of self reported weight. Int J Eat Disord 29:59–64PubMedCrossRefGoogle Scholar
  44. 44.
    Bolton-Smith C, Woodward M, Tunstall-Pedoe H, Morrison C (2000) Accuracy of the estimated prevalence of obesity from self reported height and weight in an adult Scottish population. J Epidemiol Community Health 54:143PubMedCrossRefGoogle Scholar
  45. 45.
    Kempf A, Remington P (2007) New challenges for telephone survey research in the twenty-first century. Public Health 28:113–126CrossRefGoogle Scholar
  46. 46.
    Groves RM (2006) Nonresponse rates and nonresponse bias in household surveys. Public Opin Quart 70:646–675CrossRefGoogle Scholar
  47. 47.
    Jonas S, Bebbington P, McManus S, Meltzer H, Jenkins R, Kuipers E, Cooper C, King M, Brugha T (2011) Sexual abuse and psychiatric disorder in England: results from the 2007 Adult Psychiatric Morbidity Survey. Psychol Med 41:709–719PubMedCrossRefGoogle Scholar
  48. 48.
    Andersen AE (2002) Eating disorders in males. Eating disorders and obesity: A comprehensive handbook. Guilford press, New YorkGoogle Scholar
  49. 49.
    O’Brien KM, Vincent NK (2003) Psychiatric comorbidity in anorexia and bulimia nervosa: nature, prevalence, and causal relationships. Clin Psychol Rev 23:57–74PubMedCrossRefGoogle Scholar
  50. 50.
    Haapea M, Miettunen J, Läärä E, Joukamaa MI, Järvelin MR, Isohanni MK, Veijola JM (2008) Non-participation in a field survey with respect to psychiatric disorders. Scand J Public Health 36:728PubMedCrossRefGoogle Scholar
  51. 51.
    Hudson JI, Hiripi E, Pope HG Jr, Kessler RC (2007) The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 61:348–358. doi: 10.1016/j.biopsych.2006.03.040 PubMedCrossRefGoogle Scholar
  52. 52.
    van Son GE, van Hoeken D, van Furth EF, Donker GA, Hoek HW (2010) Course and outcome of eating disorders in a primary care-based cohort. Int J Eat Disord 43:130–138PubMedGoogle Scholar
  53. 53.
    Striegel Moore RH, Franko DL (2003) Epidemiology of binge eating disorder. Int J Eat Disord 34:S19–S29PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2012

Authors and Affiliations

  • Orla McBride
    • 1
    Email author
  • Sally McManus
    • 2
  • Joanne Thompson
    • 2
  • Robert L. Palmer
    • 3
    • 4
  • Traolach Brugha
    • 4
  1. 1.School of PsychologyUniversity of UlsterCo. LondonderryNorthern Ireland, UK
  2. 2.National Centre for Social ResearchLondonUK
  3. 3.Eating Disorders Service, Brandon UnitLeicester General Hospital, Leicestershire Partnership NHS TrustLeicesterUK
  4. 4.Department of Health SciencesLeicester General Hospital, University of LeicesterLeicesterUK

Personalised recommendations