Mental Health of Children and Young People in England, 2023 - wave 4 follow up to the 2017 survey

This section of the report presents findings on eating problems and disorders. It consists of two sections:

• prevalence and trends in possible eating problems, including an exploration of different types of difficulties such as feeling fat, or guilt if you believe that you have eaten too much
• prevalence and trends since 2017 in eating disorders such as anorexia or bulimia, or another eating disorder 

In this section, ‘possible eating problems’ refers to children and young people who had an increased likelihood of broader difficulties with eating, whereas ‘eating disorders’ refers to those who had a clinically impairing eating disorder such as anorexia or bulimia or another eating disorder according to the International Classification of Disease version 10 (ICD-10). Please see the Definitions for eating problems and eating disorders for further information on the important difference between these two terms. 

The different mode of data collection in 2017 (face to face) compared with subsequent waves (online or telephone) may result in modal effects in responses, particularly for sensitive questions such as eating problems and disorders. While it is not possible to quantify the effects of this, caution should be taken when comparing results over time.

This report focuses on differences that are statistically significant.

Young people aged 11 to 25 years and parents of children aged 8 to 16 years completed the 5 screening questions from the Development and Well-Being Assessment (DAWBA) Eating Disorders module. ‘Screening positive’ for a possible eating problem was defined as scoring above the threshold (answering yes to 2 or more items where a parent is reporting on a child and answering yes to 1 or more items where a young person is reporting on themselves) on these questions. The questions are available in the questionnaire and materials documentation.

‘Screening positive’ on the DAWBA Eating Disorders module does not mean that the child or young person had a clinically impairing eating disorder such as anorexia or bulimia but indicates an increased likelihood of broader problems or difficulties with eating, which we refer to as ‘possible eating problems’.

This section presents data on possible eating problems and responses to the 5 individual screening questions for children and young people aged 11 to 25 years in 2023. Comparisons with previous waves are also presented. These questions were not included in 2020.

For possible eating problems, this section presents data for 2017, 2021, 2022 and 2023. Comparisons are presented for children and young people aged 11 to 19 years for 2017 and subsequent waves, and for young people aged 20 to 23 years for 2021 and subsequent waves. 

For responses to the 5 individual screening questions, comparisons are presented with 2017 for children aged 11 to 16 years and young people aged 17 to 19 years. Data on responses for 20 to 25 year olds in 2023 is available in Table 5.3 of the Excel data tables.

For children aged 11 to 16 years, the figures reported are based on parent report. For young people aged 17 to 25 years, the figures are based on self-report.

The rate of possible eating problems in 2023 was 12.3% in children aged 11 to 16 years. This rose to 59.4% in young people aged 17 to 19 years. Rates for young people aged 20 to 25 years were similar to those aged 17 to 19 years; 57.2% screened positive for a possible eating problem in 2023. 

The rate of possible eating problems was similar in boys and girls aged 11 to 16 years, but higher in young women than in young men: 

• for young people aged 17 to 19 years, the rate was 77.5% in young women, compared with 42.3% in young men
• for young people aged 20 to 25 years, the rate was 72.3% in young women compared with 43.0% in young men

For more information see: Table 5.1 of the Excel data tables.
 

For children aged 11 to 16 years, the rate of possible eating problems rose from 6.7% in 2017 to 13.0% in 2021. Rates then remained stable over subsequent waves.

For girls, rates rose between 2017 (8.4%) and 2021 (17.8%) followed by stability over subsequent waves. For boys aged 11 to 16 years, rates remained stable between 2017 and 2021, and were similar in 2021, 2022 and 2023. However, for boys the rate in 2023 (9.8%) was an increase on the rate in 2017 (5.1%).

For more information see: Table 5.2 of the Excel data tables.
 

In young people aged 17 to 19 years, the prevalence of possible eating problems rose from 44.6% in 2017 to 58.2% in 2021. Rates remained stable over subsequent waves (2022 and 2023). This trend was evident for young women and young men aged 17 to 19 years.

Figure 5.1 base: 11 to 19 year olds.

For 20 to 23 year olds, rates of possible eating problems were similar in 2021, 2022 and 2023. There was no 2017 data for this age group.

For more information see: Table 5.2 of the Excel data tables.
 

In 2023, based on parent report for children aged 11 to 16 years the following responses to the screening questions were reported:

• 27.9% of children had parents who said that their child had ever thought they were fat when others said they were thin
• 11.0% of children had parents who said that worries about eating really interfered with their child’s life
• 8.5% of children had parents who said that their child would be ashamed if others knew how much they ate
• 6.5% of children had parents who said that if their child ate too much, their child blamed themselves a lot
• 1.6% of children had parents who said that their child had ever made themselves vomit

Responses were similar for boys and girls.

There was an increase between 2017 and 2023 in the proportion of children aged 11 to 16 years whose parents responded ‘yes’ for 3 of the 5 screening questions:

• in 2023, 27.9% of children had parents who said that their child had ever thought they were fat when others said they were thin, compared with 22.8% in 2017
• children in 2023 were more than twice as likely as children in 2017 to have parents who said that worries about eating really interfered with their child’s life (11.0% compared with 4.4%) 
• children in 2023 were almost twice as likely as children in 2017 to have parents who said that if their child ate too much, their child blamed themselves a lot (6.5% compared with 3.3%)

For more information see: Table 5.3 of the Excel data tables.

Figure 5.2 base: 11 to 16 year olds.

In 2023, young people aged 17 to 19 years reported the following responses to the screening questions:

• 42.6% said that they had ever thought they were fat when others said they were thin
• 35.5% said that if they ate too much, they blamed themselves a lot
• 31.2% said that worries about eating really interfered with their life
• 24.3% said that they would be ashamed if others knew how much they ate
• 14.5% said that they had ever made themselves vomit

Young women aged 17 to 19 years were more likely than young men to respond 'yes' to many of the screening questions:

• young women were 3 times as likely as young men to say that they had ever thought they were fat when others said that they were thin (64.7% compared with 21.7%)
• young women were 3 times as likely as young men to say that if they ate too much, they blamed themselves a lot (54.9% compared with 17.1%)
• young women were more than 3 times as likely as young men to say that worries about eating really interfered with their life (49.5% compared with 13.9%), and that they would be ashamed if others knew how much they ate (39.0% compared with 10.3%)

There was an increase between 2017 and 2023 in the proportion of young people aged 17 to 19 years responding ‘yes’ for 4 of the 5 screening questions. Young people in 2023 were more likely than those in 2017 to say that:

• if they ate too much, they blamed themselves a lot (35.5% compared with 16.6%)
• worries about eating really interfered with their lives (31.2% compared with 10.4%) 
• they would be ashamed if others knew how much they ate (24.3% compared with 9.0%) 
• they had ever made themselves vomit (14.5% compared with 7.3%)

For more information, and for data for 20 to 25 year olds see: Table 5.3 of the Excel data tables.

Figure 5.3 base: 17 to 19 year olds.

For young men aged 17 to 19 years, responses to the screening questions were similar in 2017 and 2023. For young women, the proportion responding ‘yes’ to each of the 5 screening questions increased between 2017 and 2023 (see Table 5.3 of the Excel data tables).  

Children aged 11 to 16 years and their parents, and young people aged 17 to 25 years who were ‘screen positive’ on the Development and Well-Being Assessment (DAWBA) eating disorder screening questions described in the possible eating problems section were invited to complete the full DAWBA eating disorder module as part of the second stage of the study. The DAWBA is a multi-informant standardised diagnostic assessment covering common mental health conditions, which was also included in the MHCYP 2017 survey.

The eating disorder module includes questions about the child or young person’s feelings about eating, their eating behaviours and any concerns the parent or child/young person might have. Questions about the child’s/young person’s height and weight, how they might have been feeling or acting recently, and for girls and young women, questions about their menstrual cycle were also included. 

Responses from parents, young people and children to the DAWBA eating disorder module were reviewed by a small team of clinical raters who assigned diagnoses of eating disorder according to ICD-10 criteria. Further information on this process (along with all details and methods relating to the second stage of the study) is available in the Eating Disorders section of the Technical Appendix, which mirrored the 2017 survey as far as possible. 

While the study design aimed to mirror the 2017 survey as far as possible, caution should be taken when comparing over time due to some unavoidable differences in the methods. This includes differences in mode, 2023 data being collected as part of a second stage study rather than part of the main survey, and only the eating disorder module of the DAWBA being completed in 2023 rather than the full DAWBA questionnaire. More details are available in the Eating Disorders section of the Technical Appendix.

This section presents the prevalence of children and young people meeting criteria for any eating disorder. It also provides estimates of the prevalence of anorexia, bulimia, and other eating disorders which includes conditions such as atypical anorexia or atypical bulimia.

For eating disorders, prevalence is presented for 2023 for 11 to 25 year olds. Comparison with 2017 is presented for children and young people aged 11 to 19 years, as 20 to 25 year olds were not included in the 2017 survey. The eating disorders DAWBA module was not included in 2020, 2021 or 2022. Please note that the prevalence figures for 2017 differ slightly from those presented in the MHCYP 2017 report due to slight differences in the weighting of the data. See the Eating Disorders section of the Technical Appendix for further information.

These findings are based on a sample and whilst the eating disorder prevalence figures in this report are estimates weighted to represent the entire population of children and young people in England, an estimate of 0% does not necessarily mean that no-one in that subgroup of the population has an eating disorder. However, it indicates that rates for that subgroup are likely to be very low and therefore difficult to detect.

Data from NHS England until 2022-23, on the number of children and young people who have accessed, or are waiting for treatment following a routine or urgent referral for a suspected eating disorder can be found in the Children and Young People with an Eating Disorder Waiting Times publication. Data since April 2023 is available in the NHS England Mental Health Services Monthly Statistics. NHS England are currently reviewing the eating disorder clinical standard and technical guidance which may mean these measures are updated in due course.

In 2023, the prevalence of any eating disorder was:

• 2.6% in 11 to 16 year olds
• 12.5% in 17 to 19 year olds
• 5.9% in 20 to 25 year olds

Rates of eating disorder were higher in 17 to 19 year olds than in 11 to 16 year olds.

In 11 to 16 year olds, the prevalence of any eating disorder in 2023 was 4 times higher in girls compared with boys (4.3% compared with 1.0%). For young people aged 17 to 19 years, rates of eating disorders were also 4 times higher in young women than in young men (20.8% compared with 5.1%). Rates were similar for young women and young men aged 20 to 25 years.

For more information see: Table 5.4 of the Excel data tables.
 

Figure 5.4 base: 11 to 25 year olds.

The prevalence of different types of eating disorder was as follows:

For 11 to 16 year olds:

• 0.2% met criteria for anorexia
• 0.5% met criteria for bulimia
• 1.8% met criteria for other eating disorder

For 17 to 19 year olds:

• 3.3% met criteria for anorexia
• 1.7% met criteria for bulimia
• 7.8% met criteria for other eating disorder

For 20 to 25 year olds:

• 0.3% met criteria for anorexia
• 1.8% met criteria for bulimia
• 4.2% met criteria for other eating disorder

For more information see: Table 5.4 of the Excel data tables.

The prevalence of any eating disorder in 11 to 16 year olds increased from 0.5% in 2017 to 2.6% in 2023. This rise was evident in girls (a rise from 0.9% in 2017 to 4.3% in 2023) but not in boys.

Rates rose both in young women (from 1.6% to 20.8%) and young men (from 0.0% to 5.1%),

For more information see: Table 5.4 of the Excel data tables.