Background: Health-related quality of life (HRQOL) estimates are important for accurately estimating the individual and community burden from eating disorders and cost-utility of treatments. Aims: The aim was to conduct a systematic review in order to evaluate and compare attempts to estimate HRQOL in eating disorders (EDs). Method: A MEDLINE database and Quality of Life Research Journal search was conducted for relevant English-language papers that used validated measures of HRQOL and ED diagnostic symptoms. Results: Fifteen papers were identified which all supported EDs having a substantial impact on individual's HRQOL, in the mental health domain, that in some studies remained when controlling for body weight. Some studies indicated that presence of psychiatric co-morbidity increases the impact of the ED. In one study, when accounting for prevalence, community burden estimates were for EDs low relative to mood disorders. Findings were mixed for participants with AN, possibly reflecting its ego-syntonic nature. Conclusions: An important gap identified was the paucity of large scale community-based studies. In order to better estimate the “true” costs of EDs there is an urgent need for such research, and studies that include psychiatric control groups as well as medically ill and well groups.