A new UK study reveals a connection between eating disorders and insomnia, shedding light on the health risks faced by people with these conditions.

The research, published in Eating and Weight Disorders and led by Anglia Ruskin University in collaboration with the University of Cambridge’s Biomedical Research Centre, explored the complex relationship between eating disorders, physical health, and other issues that can influence it. 

Researchers analyzed data from 7,403 UK adults. Respondents were asked about 20 physical conditions including cancer, diabetes, eye issues, migraines, digestive problems, and heart issues. Influential factors, or mediators, considered included alcohol dependence, insomnia, smoking, perceived stress, obesity, and being underweight.

The study found that people with possible eating disorders made up 6.4% of respondents, and individuals within this cohort were 2.11 times more likely to report physical multimorbidity, defined as having two or more physical health conditions concurrently. 

An eating disorder is defined as a pathological relationship with food that leads to significant disruptions in a person’s day-to-day life. It is estimated that as many as 3.4 million people in the UK have an eating disorder. 

The factors which were most important in the association between possible eating disorder and physical multimorbidity were insomnia and anxiety disorder, which explained more than 20% of the association. Factors such as perceived stress, depression, obesity, and alcohol dependence also explained this association but to a lesser extent.

In terms of insomnia, eating disorders may increase the risk for insomnia due to malnutrition and orexin—a neuropeptide released from the hypothalamus that’s involved in the regulation of both sleep–wake and appetite, according to the study. Increased orexin signaling promotes greater wakefulness and feeding. “It has been posited that levels of orexin are increased during the hunger state to promote wakefulness and incite the body to search for food. In turn, insomnia may increase risk for multimorbidity through dysfunction of the inflammatory system,” the researchers write.

Previous research has shown that multimorbidity is associated with a significant burden on healthcare services including care transition costs and primary care, dental care, and hospitalizations. Multimorbidity affects around 42.4% of the world’s population.

“We believe this is the first study to investigate the association between eating disorder symptoms, or possible eating disorder, and physical multimorbidity and also the first to quantify how this association may be explained by a variety of influencing factors,” says lead author Lee Smith, PhD, professor of public health at Anglia Ruskin University, in a release. “This research underscores the complex interplay between mental and physical health. It is essential to recognize that eating disorders can have far-reaching consequences, affecting not only emotional well-being but also physical health. Understanding the role of potential mediators in this relationship is crucial for developing effective interventions.”

The findings highlight the need for further investigation into the causality and underlying mechanisms of the link between eating disorders and physical multimorbidity. In the long term, this research could guide the development of strategies to reduce multimorbidity in people with eating disorders by addressing influencing factors.

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