Eating disorder services review: summary recommendations

Clinical Aspects of Eating Disorders

Eating disorders include anorexia nervosa (AN), bulimia nervosa (BN), avoidant restrictive food intake disorder (ARFID) and binge eating disorders (BED), and variants which are classified under other specified feeding or eating disorders OSFED), and feeding or eating disorders, unspecified (ICD-11 classification) (5). They are mental disorders with serious medical consequences as well as risks of suicide. Eating disorders have the highest mortality of all mental disorders.

There have been recent advances in treatments as well as changes and expansions of diagnostic categories for eating disorders. There is a trend towards inclusive services for treatment of all people with eating disorders, regardless of age and severity, with the development of all age services and early intervention approaches.

Eating disorders typically develop in early to mid-adolescence but can emerge at any age (6). There can be long periods of time before people seek or receive help and half of all first presentations are to adult (18 years and over) services. The prevalence of anorexia nervosa in the general population is approximately 1% among women and 0.5% among men. There has been a significant increase in the annual incidence in 10 to 14 year olds in the last 7 years. It is reported that half of those who meet diagnostic criteria in the community do not access treatment. Bulimia nervosa is reported to have prevalence of about 2%, and binge eating disorders up to 4%. The population prevalence of ARFID is not known, largely because it is a relatively new diagnosis and still not well known. The overall lifetime prevalence of eating disorders is estimated to be 8.6% for females and 4.07% for males. Changes in diagnostic categories and criteria affect estimates of prevalence rates but prevalence has been increasing over time. The overall one-year prevalence is estimated to be 1.66% (2.62% for females and 0.67% for males) (7–10).

Data from the 2019 NHS-England health survey reported that 16% of people over the age of 16 screened positive for a possible eating disorder (11). This is up by 277% over the preceding 12 years. This included 4% of people who reported that their feelings about food interfered with their ability to work, meet personal responsibilities or enjoy a social life. Eating disorders have significant impacts on functioning. These figures are likely to be an underestimate due to stigma and the fact that eating disorders can be seen by the person as part of themselves and not an illness so go unrecognised even by people themselves who have them. We do not have equivalent data from Scotland but there is no reason to believe that the data would be any different.