Financial Burden of Bulimia Nervosa: Cost of Food, Laxatives, Diuretics, and Diet Pills Adds Up

The financial burden of bulimia nervosa can be substantial, and yet little is known about the monetary costs associated with bulimic symptoms. At least little is known in academic circles – there is definitely a lot of anecdotal evidence floating around the internet. I found just one paper from 2009 by Scott J. Crow and colleagues. I stumbled upon it accidentally, actually. I was searching for articles on the economic burden of eating disorders (treatment cost, productivity loss, etc..) for a post I’m planning, but I thought I’d write about this in the mean time.

It is a short paper but I think it is important because it highlights an often overlooked issue.

The method Crow et al used to evaluate how much money individuals with bulimia nervosa spend on food, laxatives, diuretics and diet pills is simple (keep in mind, this hasn’t really been done before). Essentially, they asked 10 participants (with a clinical diagnosis of BN) to keep a food diary for a week. They then extrapolated these costs to determine the financial burden associated with bulimic symptoms over a year.

The average age of the participants was 26.6 (although the standard deviation was 6.2, meaning that there were people quite  a bit younger and quite a bit older, too). The mean duration of the illness was almost 13 years (standard deviation = 7.3). Importantly (because this may bias the results), these participants were seeking treatment, and were recruited to partake in this study during the time they were completing a clinical evaluation.

Besides recording their food intake and incidents of purging, participants also kept track of laxative, diet pull and diuretic use. They also classified binge eating episodes into “objective” and “subjective” categories, according to EDE (Eating Disorder Examination) guidelines.

In terms of calculating costs, the prices were based on food costs in a local grocery store ( Minneapolis/St. Paul region) or from restaurants and drug stores where the items were bought.

The results are shown in Table 1 below:

Crow - 2009 - Table 1 Adapted

Over the one week period, the mean number of binge episodes was almost 5 (4.9), equally split between objective and subjective binges. The mean number of purges was less, at 3.6. Given that the sample size is only 10, the range of these values is also really interesting and important. With regard to binge eating, the range was 1 to 15, and for purging, the range was 0-9.

Commenting on whether those numbers are representative, high or low is irrelevant. They are just important in providing context for the monetary costs associated with bulimic symptoms in this study.

On average, cost for binge and purge food was around $30.5 a week (33% of total food cost), which adds up to almost $1,600 a year. While some individuals only spent roughly 7% of their total food costs on binge/purge food, others spent almost 10 times that amount: 68%. This equals to anywhere from $370 to $3,500 spent on binge/purge food, in this group.

Three out of ten participants reported the use of diet pills, diuretics or laxatives. Overall, the group average per week was $4.5, though the range was anywhere from $0 to $28 (or roughly $1,468 a year).

Of course, this is a tiny sample over a tiny period of time, but it does provide a hint of just how substantial the financials costs of bulimic symptoms can be. I think this arouses a lot of guilt on the part of the bulimic population. It does for me.

Particularly if you consider the accumulated cost over the duration of bulimia or bulimic symptoms:

The magnitude of these costs should be considered in the context of income levels. Median weekly earnings for women aged 25–34 in the United States in 2006 were $583; this yields annual earnings of $30,316. Mean annualized binge costs for participants in this study would thus represent 5.3% of pre-tax income. While these annual cost figures by themselves are substantial, they must be considered in relationship to the previously average duration from symptom onset to presentation for treatment. Previous reports suggest that this period is in the range of 4–7.5 years. If BN symptoms were of consistent severity from onset, this would correspond to an average accumulated cost of roughly $7,000–13,000 at the time of presentation.

Although the authors didn’t evaluate binge-purge type anorexics in this study, I don’t know if there’s reason to believe the numbers (especially if you sample a large enough population) would be any different.

Of course, these are just estimates: the sample is small, the duration of monitoring is short, the sample was treatment-seeking (and could possibly bias the findings), the very fact that their food intake was monitored could have led to reductions in binge eating/purging frequency, these estimates don’t take into account the short and long-term variation in BN symptoms within one individual and between individuals.

Additionally, the mean frequencies of binge eating and purging per week are somewhat less than those reported in some recent treatment trials. For example, three recent BN trials have reported mean baseline binge eating frequencies of 23 and 25 binge episodes per 28 days. By comparison in this sample, weekly binge eating rates were equivalent to 19.6 binge episodes per week.

All this suggests that if anything, the numbers reported in this study are an underestimate.

So, what do you do with this information besides, if you are like me, feel really really guilty about all the money “wasted” on food?

(I’m usually a very, very thrifty person, but during periods of pretty symptomatic bulimia, this was thrown out of the window – though, if I would go shopping the next day for food that I didn’t think would be for bingeing/purging, I’d back to my super thrifty self, browsing through different flyers to find the cheapest tomatoes and lettuce around me. Point is: bulimic symptoms, the urgency of the act, the impulsiveness, the almost addictive features of bingeing and purging… well, they shouldn’t be underestimated, even for normally rational and money-conscious individuals.)

Crow suggests that this data can be useful for clinicians in “helping build a rationale for change when working with individuals presenting for treatment”, and while that’s certainly true, I do wonder what impact that would actually make.

This is a touchy topic –  I know many bulimics are blamed by their families and friends for wasting food, wasting money, and generally just being very inconsiderate. I recall people having to face those reactions when I used to go to group. That’s incredibly unfortunate, because it shifts the focus from the real issue here: you can be money-conscious, thrifty, non-materialistic individual but caught-up in the bulimic cycle, spend a significant proportion of your income on food.

This isn’t a weakness. It has nothing to do with being inconsiderate. Instead, it illustrates the intensity and power of bulimia. And I don’t mean that in any kind of external-force-that-can’t-be-conquered way. People can and do recover – a lot of people, actually. But, the difficulty of recovery shouldn’t be underestimated – it is rare that people can just stop “cold-turkey”.


Crow, S.J., Frisch, M.J., Peterson, C.B., Croll, J., Raatz, S.K., & Nyman, J.A. (2009). Monetary Costs Associated with Bulimia. The International Journal of Eating Disorders, 42 (1), 81-3 PMID: 18704919

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Tetyana is the creator and manager of the blog. She has an Honours BSc in Neuroscience and an MSc in Medical Science. She can be reached at tetyana[at]scienceofeds[dot]org.


  1. Eh…to be honest as someone with AN b/p I’d say the cost of food is much, much higher. At least for me. Even with being EXTREMELY “thrifty” with cheap, crap food. It is embarrassing but as a small example I recently spent $900 in two weeks on binge food when I got a reimbursement for something. The average was 5 binges a week, right? This isn’t looking at people who average that or more in a DAY. And i guess maybe that’s less common than I think but the cost of it has been financially devastating for me.

  2. I agree, I would guess that if this same study was done with a larger sample size, they would find that the average amount spent is a lot more. I remember talking with a therapist about it once and coming up with a figure of about 500 bucks a month. At my worst, it was probably a bit more, and now that I’m working towards recovery, it’s significantly less.

    I think that another good point, aside from using this study just to show how much of a financial burden bulimia is, is that treatment costs a lot of money, too. If you are spending all of your money on binge food and are in the depths of your disorder, how are you supposed to find motivation to get into some sort of treatment program and spend MORE money on recovering?

    • I agree that treatment is utterly unaffordable…I’d argue though that if it were actually effective it could completely change a person’s quality of life, not to mention treatment is temporary and (again, if effective) could eliminate the financial burden of active bulimia (and while the financial piece is HUGE and incredibly stressful I’d say that even outside of that compulsive, very out of control binging and purging has sort of killed my ability to be happy almost any of the time.)

      • Sb & Anonymous, I agree with both of you – this is just a small preliminary study. It would be interesting to see results of a large-scale study. I am planning a post on the health economics perspective – the cost of treatment being a part of that – but there are very few studies! (And I’m also not well versed in that area, so it is hard to evaluate the quality and validity of the methods.)

        Sb, I’m really sorry and I hope you are doing better. Compulsive bingeing and purging is ridiculously awful and the sense of being completely out of control – almost outside of your body or mind, in a sense – is terrifying. Let me know if there’s anything I can do to help? I think long-term bingeing and purging becomes a thing and in and of itself, a habit that just continues and stopping it is like learning to stop brushing your teeth in the morning, or looking before crossing the street. It needs no trigger, no emotional state – it just becomes the state of things, in a way? I hope I’m making sense.

        • God you are sweet, thanks. It really is fucking terrible – you’d think I’d get used to it after all of these years but I just can’t escape the yearning to live differently and I can’t seem to stop regardless of what measures I attempt to put in place. Obviously my therapist has brought up residential treatment but I’m really not keen on that idea at the moment…I have done that over and over and over again and if I ever decide to do it again I need to be certain I’m willing to commit to doing absolutely everything in my power to benefit from it, and if I’m honest I’m not at the moment.

          I am making some changes though…I started seeing a doctor I like a lot this week, finally admitted to myself that the therapist I’m seeing isn’t the right fit…and obviously this is a bad thing but I didn’t realize how bad things have gotten medically, but the weird possible blessing in that is that if my doctor suggests that I need to be in the (medical) hospital, I’ll go,and maybe just a few days of that could really help me get this a little more under control. So we’ll see. I’ve been really lucky too in the last few months in making a couple of good friends from the job I was at who don’t have EDs themselves, and in them both turning out to be extra,extremely supportive when I had to leave and told them the truth about why.

          Oh long winded! Anyway, thank you.

          Oh and you’re absolutely making sense. It’s bizarre what a habit it becomes. It’s weird because it’s not something I want to do (really at all anymore but especially as much as i do) but it feels like I actually *have* to. Which…makes no sense. If anything I really HAVE to figure out how to stop.

          (Tetyana edited: combined two comments)

          • “It’s weird because it’s not something I want to do (really at all anymore but especially as much as i do) but it feels like I actually *have* to. Which…makes no sense”

            Actually that does make sense. There are many addictive components to it that aren’t “positive”, they are just, addictive. I think people can underestimate the triggers inherent in just being in the same environment where one is used to bingeing/purging, for example.

            I would suggest trying to somehow limit the amount of cash you have on hand/can spend whenever you usually buy food, or in any way limiting places where you typically purge. It is not full-proof, but it can limit the frequency. (Giving keys/cash to your friends to hold onto for a day, or something.)

            I think breaking the symptoms can be really important, but the danger there is, of course, returning to those same triggering places (even if there’s nothing triggering except that you are used to being symptomatic there and have the chance to be).

            When I was really symptomatic with bulimia, I felt the same way (hating it and feeling compelled to do it).

  3. I’ve been browsing online more than 4 hours today, yet I never found any interesting article like yours. It is pretty worth enough for me. In my opinion, if all site owners and bloggers made good content as you did, the net will be a lot more useful than ever before.

  4. Once I started receiving disability living allowance (UK) my bulimia became much worse. I binge and purge twice daily (minimum) and spend roughly £7 a binge. Over a month, that is £392, £4702 a year… I hadn’t realized that till I sat and worked it out now. I feel so guilty, using the money I get to help myself while I’m sick only to further my illness. and I’m ashamed to admit, I have often resorted to shoplifting food.

    Sorry if this was an inappropriate place to write these things.

    • Hey Anon, thank you for your comment. No need to apologize–this is an appropriate place to write these things. If it is any consolation, your experiences (like using money that needs to go to essentials for bulimia, and stealing) are really common. It is the nature of the disorder, and if you can, try not to beat yourself up about it. It just speaks volumes about how difficult recovery from bulimia/bingeing and purging is. I hope you are able to get some help/support or treatment?


  5. Hi Tetyana,

    You have a wonderful, intelligent blog — thank you for all the work and time you put into it.

    I’m currently in active recovery from bulimia, and really appreciated your look into a facet of the disorder that many places overlook.

    On the money question, I’ve used (online personal finance tracker) since about 2008, and thus have month-by-month and category-by-category tracking for all my spending. I live in an expensive city, and saw my food spending go up 4X when I developed bulimia.

    Some months, my “Food” category spending would hit $2000. Part of it this was because I bought nice, high-quality food, and often from small shops, but a lot of it was the sheer volume and frequency of bingeing. This also doesn’t take into account the amount of money I was spending monthly on probiotics, digestive enzymes, herbal sleep aids, and other things to help me achieve basic human functioning in the midst of extreme bingeing and purging. It also doesn’t take into account all the other ‘externalities’ of the ED — how it affected my work, my relationships, and my pragmatism when it came to other consumption-related decisions (like clothes shopping). Bulimia is a nightmare!

    It was alarming to me, and yet my income at that time was high, so the cost (though insanely disturbing and excessive) still wasn’t enough to deter me in any significant way — as you say, addictive behavior patterns will almost always find a way to trump reason, financial, health or otherwise. I simply spent right up to where I could during the most severe months.

    I found that another difficult period was after starting recovery — and paying the costs of recovery (I have a coach, I purchase herbal supplements like rhodiola and herbal 5-HTP), while also still going through bingeing and purging. That’s the challenging ‘bridge’ period when things haven’t stabilized just yet so you’re sort of paying two bill collectors simultaneously, so to speak.

    Anyway, thanks so much again for your wonderful research and insights. You have a new regular reader in me!

    • Hi Susan,

      Thank you for your comment! I’m glad that you enjoy the blog!

      I agree — bulimia is a nightmare. An expensive nightmare, really. I think the length to which some individuals go to in order to binge and purge is scary, particularly in retrospect, and it is also scary how quickly those behaviours become normalized.

      Best of luck with recovery efforts and looking forward to reading more of your comments!


  6. Tetyana! Thank you for the wonderful and factos bases comenta and Study. It seems that it is extremely rate to fins commentary as scientific as this on a disease that affects hundreds of thousands of women.

    I was bulimic for 10 years, I calculate that over those 10 years I may have spent 150/week or 7200/yr – with those calculations bulimia for 10 years may have cost as much as 72000. Insane!!!! I too, am normally very thrifty.

    Today, I am 100% cured!!! I swear, there is light at the end of the tunnel. It took a lot of work and time. Cognitive behavior therapy, treatment for attention disorders, and help from growing older and wiser. Today I am 28. I wish anyone reading this the best. You will overcome this struggle!!!

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