A substantial majority of individuals suffering from eating disorders face critical delays in receiving specialized treatment because general practitioners (GPs) fail to refer them, according to a major study published in The Lancet. The research found that three-quarters of patients were not referred to specialist services following an initial GP appointment.
Patients who are a healthy weight are four times more likely to be dismissed by a doctor compared to those who are underweight, the study highlights. This is particularly concerning as research indicates only six percent of individuals with eating disorders have a low Body Mass Index (BMI).
The findings suggest that medical professionals may be failing to recognize eating disorders that do not present with significant underweight symptoms, such as binge eating disorder, bulimia, and avoidant/restrictive food intake disorder (ARFID), which are more common than anorexia nervosa. Men, patients over 30, and those living in the North East of England were also found to be more likely to miss out on necessary referrals.
Researchers from King's College London and the University of British Columbia analyzed a decade of health records for 35,000 patients aged 18-80 in England and Northern Ireland. They examined referrals to eating disorder services after initial GP consultations, considering factors like gender, age, ethnicity, and location. Out of the total patient group diagnosed with an eating disorder, 76 percent did not receive a GP referral to specialized care.
Anorexia patients who were underweight (BMI below 18) were four times more likely to be referred to specialist care than those who were not underweight. The study authors emphasized that patients do not need to be abnormally thin to meet the diagnostic criteria for an eating disorder, noting that many present with so-called 'atypical' forms.
Current guidelines from the National Institute for Health and Care Excellence (NICE) state that patients should be immediately referred to appropriate services if an eating disorder is suspected. The study raises questions about the consistent identification and management of eating disorders other than anorexia by GPs.
"There's need for better GP education and improved screening tools across all diagnoses," the authors noted. "Especially because eating disorders can be equally serious regardless of a person's weight."
The researchers also suggested that enabling direct self-referrals to eating disorder services, bypassing the need for a GP referral, could help reduce treatment access delays. An estimated 3.5 million people in the UK are affected by eating disorders, with ARFID and binge eating disorder being the most prevalent.
Full recovery rates vary significantly, with approximately half of anorexia sufferers and roughly a third of bulimia and binge eating patients never fully recovering, according to NICE. Recent NHS data indicates a five-fold increase in the prevalence of eating disorders among 11 to 16-year-olds between 2017 and 2023. Experts attribute this rise to various factors, including increased social media use, academic pressures, and the lingering effects of pandemic lockdowns. Free support is available through the eating disorder charity Beat.