Three quarters of eating disorder patients face critical delays to treatment because GPs fail to refer them to specialists, according to a major study published in The Lancet.
The study found that patients who are a healthy weight are four times more likely to be dismissed by a doctor compared with someone who is underweight. This is despite studies showing that just six per cent of people with eating disorders have an unhealthily low BMI.
Men, patients aged over 30 and those living in the North East of the country are also more likely to miss out on a referral, according to the study. The researchers, from Canada and the UK, said the findings suggest medics are failing to recognise eating disorders other than anorexia, such as binge eating disorder, bulimia and avoidant/restrictive food intake disorder, or ARFID.
A recent audit by the Healthcare Quality Improvement Partnership found some eating disorder patients in England are waiting nearly two years for specialist care, with an average wait of 42 days. Studies show that patients who access treatment within three years of the onset of illness have the best chance of a full recovery.
How the study was carried out
Researchers from King's College London and the University of British Columbia in Canada analysed a decade of health records covering 35,000 patients in England and Northern Ireland aged 18 to 80. All the patients had received a diagnosis of an eating disorder at some point over the 10-year period.
The scientists looked for referrals to eating disorder services following an initial GP appointment, and recorded characteristics such as gender, age, ethnicity and area of residence. They found that 76 per cent of patients did not receive a GP referral to specialist services.
Anorexia patients who were underweight, defined as having a BMI below 18, were four times more likely to be referred to specialist care compared with those who were not underweight, even though patients do not have to be abnormally thin to meet the criteria for diagnosis. Guidelines for GPs from the National Institute for Health and Care Excellence, known as NICE, state that patients must be referred immediately to appropriate services if an eating disorder is suspected.
Calls for better GP training
The findings raise questions about how consistently eating disorders other than anorexia are identified and acted upon by GPs, the study authors said. They said there is a need for better GP education and improved screening tools across all diagnoses, especially because eating disorders can be equally serious regardless of a person's weight.
The authors also suggested that allowing patients to refer themselves directly to eating disorder services, rather than requiring a GP referral, could help reduce delays in accessing treatment.
Scale of eating disorders in the UK
An estimated 3.5 million people in the UK suffer from an eating disorder, with the most common being atypical types such as ARFID, followed by binge eating disorder. According to NICE, around half of anorexia sufferers will never make a full recovery, and the same is true for roughly a third of bulimia and binge eating patients.
Recent NHS data show the prevalence of eating disorders in 11 to 16 year-olds increased five-fold between 2017 and 2023. A poll published in April found that almost half of primary school teachers in England see pupils with eating disorders. Experts have blamed multiple factors for the rise, including time spent on social media apps like Instagram, educational pressure and the residual effect of lockdowns.
Free support is available from the UK charity Beat on 0808 801 0677, with lines open Monday to Friday, 3pm to 8pm.
