Underwriting
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  • October 2025

Eating Disorders: Solving complexities for underwriting and claims

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In Brief
The prevalence of eating disorders, especially in women and adolescents, remains a worldwide mental health concern. The complexities surrounding these conditions present risk assessment challenges for insurers. Updated guidelines can help alleviate many of these challenges in underwriting and claims.

Key takeaways

  • Eating disorders are complicated mental health conditions, with varying levels of severity and prognoses.
  • A steady rise in the number of eating disorder cases and their corresponding impact on mortality or morbidity are causes for concern.
  • RGA’s Global Underwriting Manual (GUM) addresses challenges observed during risk assessment and offers relevant insights on customized solutions.

 

This article aims to clarify different eating disorders while highlighting the latest updates to RGA’s Global Underwriting Manual (GUM), which supports not only better underwriting practices but also more effective claims management.

What is an eating disorder?

An eating disorder is a mental health condition characterized by abnormal consumption behavior that may also negatively impact physical and/or emotional health.1,2

Since the beginning of the COVID-19 pandemic, there has been an unprecedented rise in the number of eating disorder cases, which may be attributed to social isolation and stress. While eating disorders can impact individuals of any age or gender, they are more common among adolescents and women. Globally, these conditions rank among the top five mental disorders, affecting approximately 22% of children and adolescents. Girls (30%) are almost twice as likely to experience an eating disorder as boys (17%).3,4,5

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RGA recognizes the insurance industry’s opportunity to drive improvements in mental health inclusion, delivery, and support.

What are different types of eating disorders?

The Diagnostic and Statistical Manual of Mental Disorder (DSM), fifth edition, broadly covers variations of this impairment, including:6,7

  • Anorexia nervosa
  • Bulimia nervosa
  • Binge eating disorder
  • Avoidant/restrictive food intake disorder (ARFID)
  • Pica disorder
  • Rumination disorder
  • Unspecified feeding or eating disorder (UFED)
  • Other specified feeding and eating disorders (OSFED), also known as eating disorder not otherwise specified (EDNOS)
Table 1: Each is distinct and has different clinical courses, treatments, and prognoses

DSM offers clear explanations and relevant details that are carefully updated – a valuable resource for underwriters and claims managers to use in developing and applying guidelines on an ongoing basis.

What impact do eating disorders have on mortality or morbidity?

Eating disorders increase the risk of mortality. The all-cause mortality among individuals with eating disorders ranges from 125% to 200% compared to the general population.8,9

Anorexia nervosa has the greatest excess mortality, reaching as high as 400%; however, this could result from higher reporting among patients with severe cases and/or those under emergency care. For the remaining eating disorder types, excess mortality ranges from 50% to 150%, depending on symptom severity.10

The impact of eating disorders on morbidity is equally significant. Due to reduced quality of life, eating disorders significantly burden public health resources through disability, physical complications, and increased healthcare expenditures.

Individuals with eating disorders commonly report various cardiovascular events, although the effect on cancer incidence remains inconclusive as of this writing.11,12

Co-occurring non-eating psychiatric disorders are relatively common among individuals with eating disorders and can adversely impact an individual’s prognosis. Furthermore, a bidirectional correlation exists where co-morbid eating disorders may develop among those suffering from other mental health disorders.

Data projects that more than 50% of people suffering from an eating disorder will experience at least one co-morbid psychiatric condition in their lifetime. Some of the most commonly reported include:13,14,15

  • Major depressive disorder
  • Anxiety disorder
  • Obsessive-compulsive disorder
  • Post-traumatic stress disorder
  • Body dysmorphic disorder
  • Drug or substance abuse
  • Alcohol dependence
  • Suicidality and self-injury

Therefore, when assessing applicants with an eating disorder, underwriters may also need to consider the presence of multiple co-morbid physical and mental disorders and should use judgment best aligned with their company’s overall risk philosophy.

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Why are underwriting eating disorders so challenging, and how can updated guidelines help?

Underwriting eating disorders presents many challenges due to high levels of subjectivity. Further, eating disorders are chronic in nature, with varying spectrums of severity and fluctuating health statuses. The presence of co-morbid mental health disorders may worsen the condition.

Additionally, poor understanding and stigma around eating disorders may lead to diagnosis delays and incomplete documentation from healthcare providers. This may create difficulty securing the necessary information for a thorough risk assessment.

RGA’s Global Underwriting Manual addresses these concerns. Recent updates include:

  • Evidence-based guidelines
    • The guidelines have been updated with new research data and presented in a simple format, with easy navigation across different types of eating disorders.
    • This helps improve underwriting practices by allowing for more prudent risk assessment and inclusive terms across all benefits.
  • Mental health questionnaire (MHQ)
    • The updated MHQ applies behavioral science to simplify language and allow each question’s objective to be clearly understood.
    • This enables underwriters to more readily secure correct, relevant information in as much detail as possible.
  • Legally vetted exclusion wording
    • Using exclusions, specifically for living benefits such as disability income or long-term care, may be difficult if the wording is ambiguous.
    • The introduction of comprehensive yet concise exclusion wording that is easily interpretable empowers both underwriters and claims assessors.

Conclusion

Amid ever-evolving regulatory norms around mental health conditions, RGA is working to ease the challenges of assessing risks associated with eating disorders by developing practical, user-friendly guidelines to assist underwriters and claims experts. Together with our client partners, we are committed to providing sustainable insurance solutions to serve all those suffering from these debilitating conditions.


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Meet the Authors & Experts

Akhilesh Pandey
Author
Akhilesh Pandey
Associate Director, Global Underwriting Philosophy

References

  1. Electronic material: eating disorders. Available at https://www.nimh.nih.gov/
  2. Electronic material: what are eating disorders (American Psychiatric Association). Available at https://www.psychiatry.org/
  3. Journal article: Mao, Qing-Song, et al. “Global burden of mental disorders in 204 countries and territories results from the Global Burden of Disease Study 2021.” World Journal of Psychiatry 15.8 (2025): 106887. Available at https://pubmed.ncbi.nlm.nih.gov/40837810/
  4. Journal article: Hoek, Hans W. “The Incidence and Prevalence of Eating Disorders Between 1975 and 2024: A Commentary on Lee and Chi (2025).” International Journal of Eating Disorders (2025). Available at https://pubmed.ncbi.nlm.nih.gov/40605392/
  5. Journal article: López-Gil, José Francisco, et al. “Global proportion of disordered eating in children and adolescents: A systematic review and meta-analysis.” JAMA pediatrics 177.4 (2023): 363–372. Available at https://europepmc.org/article/pmc/pmc9941974
  6. Electronic material: Types of eating disorders (Anxiety and Depression Association of America). Available at https://adaa.org/eating-disorders/types-of-eating-disorders
  7. Electronic material: Eating disorders: What you need to know? (National Institute of Mental Health). Available at https://www.nimh.nih.gov/health/publications/eating-disorders
  8. Journal article: Jeffery, Annie, et al. “Mortality and hospital admissions in people with eating disorders: longitudinal cohort study in secondary care-linked English primary care records.” The British Journal of Psychiatry (2025): 1–9. Available at https://pmc.ncbi.nlm.nih.gov/articles/PMC7617822/
  9. Journal article: Krug, Isabel, et al. “A meta-analysis of mortality rates in eating disorders: an update of the literature from 2010 to 2024.” Clinical psychology review 116 (2025): 102547. Available at https://pubmed.ncbi.nlm.nih.gov/39889307/
  10. Journal article: Krug, Isabel, et al. “A meta-analysis of mortality rates in eating disorders: An update of the literature from 2010 to 2024.” Clinical Psychology Review (2025): 102547. Available at https://pubmed.ncbi.nlm.nih.gov/39889307/
  11. Journal article: Springall, Gabriella AC, et al. “Long-term cardiovascular consequences of adolescent anorexia nervosa.” Pediatric research 94.4 (2023): 1457–1464. Available at https://pmc.ncbi.nlm.nih.gov/articles/PMC10589084/
  12. Journal article: Tith, Rasmi M, et al. “Association of bulimia nervosa with long-term risk of cardiovascular disease and mortality among women.” JAMA psychiatry 77.1 (2020): 44–51. Available at https://europepmc.org/article/pmc/pmc6802370
  13. Electronic material: Co-occurring conditions (National Eating Disorders Collaboration). Available at https://nedc.com.au/eating-disorders/types/co-occurring-conditions
  14. Journal article: Hambleton, Ashlea, et al. “Psychiatric and medical comorbidities of eating disorders: findings from a rapid review of the literature.” Journal of eating disorders 10.1 (2022): 132. Available at https://pubmed.ncbi.nlm.nih.gov/36064606/
  15. Journal article: Ferrell, Emily L, Sarah E Russin, and Daniel D Flint. “Prevalence estimates of comorbid eating disorders and posttraumatic stress disorder: a quantitative synthesis.” Journal of Aggression, Maltreatment & Trauma 31.2 (2022): 264–282. Available at https://www.tandfonline.com/doi/abs/10.1080/10926771.2020.1832168