A substantial majority of individuals with eating disorders are experiencing critical delays in accessing treatment because general practitioners (GPs) are failing to refer them to specialist services, according to a major study published in The Lancet. The research found that three-quarters of patients with eating disorders did not receive a referral from their GP.
Patients who maintain a healthy weight are four times more likely to be dismissed by a doctor compared to those who are underweight, the study revealed. This disparity is particularly concerning given that studies show only six percent of individuals with eating disorders have a low body mass index (BMI). The findings suggest that medical professionals may be overlooking or misidentifying eating disorders beyond anorexia, which is often associated with being underweight.
Patient Demographics and Referral Rates
The analysis, conducted by researchers from King's College London and the University of British Columbia, examined the health records of 35,000 UK patients aged 18-80 over a decade. It identified that men, patients over 30, and those residing in the North East of England were also more likely to miss out on essential referrals.
Specifically, patients diagnosed with anorexia who were underweight (BMI below 18) were four times more likely to be referred to specialist care than those who were not underweight. However, the study authors noted that patients do not need to be abnormally thin to meet diagnostic criteria for eating disorders, and many are classified as 'atypical'.
The National Institute for Health and Care Excellence (NICE) guidelines stipulate that patients should be 'immediately' referred to appropriate services if an eating disorder is suspected. The study's authors stated that the findings raise questions about the consistent identification and action taken by GPs for eating disorders other than anorexia.
Broader Impact and Treatment Delays
Eating disorders, including binge eating disorder, bulimia, and avoidant/restrictive food intake disorder (ARFID), are far more common than anorexia. Despite this, the study suggests a systemic failure in recognizing and acting upon these less outwardly apparent conditions.
This lack of timely referral contributes to significant treatment delays. Recent reports indicate that some patients in England wait nearly two years for specialist care, while the average wait time, according to an audit by the Healthcare Quality Improvement Partnership, is 42 days. Experts emphasize that accessing treatment within three years of illness onset offers the best chance for a full recovery.
The study authors recommend improved GP education and enhanced screening tools for all types of eating disorders, stressing that the severity of these conditions is independent of a patient's weight. They also proposed that allowing direct self-referral to eating disorder services, bypassing the GP, could help mitigate delays.
Prevalence and Contributing Factors
An estimated 1.25 million people in the UK suffer from eating disorders, with ARFID and binge eating disorder being the most prevalent. According to NICE, approximately half of those with anorexia, and around a third with bulimia and binge eating disorder, may never fully recover.
Recent NHS data highlights a concerning five-fold increase in the prevalence of eating disorders among 11 to 16-year-olds between 2017 and 2023. Experts attribute this rise to a combination of factors, including increased social media use, academic pressures, and the lingering effects of pandemic-related lockdowns. A poll in April revealed that nearly half of primary school teachers in England reported seeing pupils with eating disorders.