Research focus

How to treat eating disorders in primary care

Three studies highlight the growing incidence of eating disorders in primary care

Eating disorders have long-term consequences for all aspects of health and are associated with the highest mortality rate among all mental disorders. Three recent studies highlight the growing incidence of eating disorders in general practice, discuss how orthorexia nervosa is a distinct diagnosis and describe nurses’ training needs

Young woman with eating disorder
Picture: iStock

Learning points

  • Primary care professionals could diagnose and treat people with eating disorders earlier if they had better training and resources
  • Online training of healthcare professionals working with people with eating disorders is cost-effective and increased knowledge and confidence
  • Orthorexia nervosa involves highly restrictive eating behaviours and is closely associated with eating disorders

Shining the light on eating disorders, incidence, prognosis and profiling of patients in primary and secondary care: national data linkage study

Better training and resources for primary care professionals could help ensure people with eating disorders are diagnosed and treated earlier, and have better outcomes, according to research into the incidence of eating disorders, co-morbidities, and survival rates in Wales in 1990-2017.  

Researchers found a low incidence of eating disorders, with between one and three newly diagnosed patients being seen at each general practice a year. Those diagnosed had previously presented with mental distress and weight loss.

Electronic patient records of patients newly diagnosed with eating disorders covering the two years before diagnosis and three years afterwards were reviewed. The results were compared with those for a control group and a survival analysis was undertaken.

The research found 14,304 people had been diagnosed with eating disorders. They were aged 10-65 years, peaking at 15-19 years across genders, but with men tending to be older at diagnosis. 

The number of prescriptions for central nervous system, gastrointestinal and dietetic medications were greater than those for the control population before and after diagnosis. 

There was a higher prevalence of other mental health issues and self-harm among those with eating disorders, and the majority of eating disorders were found in primary care. 

People with anorexia nervosa were significantly more likely to die – 6% within 15 years of diagnosis – with women at greatest risk.   

Demmler J, Brophy S, Marchant A et al (2019) The British Journal of Psychiatry. doi: 10.1192/bjp.2019.153


Orthorexia nervosa: a review of psychosocial risk factors

Orthorexia nervosa (ON), defined as a pathological obsession with healthy eating, cannot be predicted by age or gender, a study of the psychosocial risk factors of ON in relation to other mental disorders indicates.

A systematic literature review of 54 studies found no relationship between gender or self-esteem and an ON diagnosis. 

There were, however, associations with obsessive compulsive thinking and ritualistic behaviours, and a higher prevalence of ON among those with a current or historical mental health diagnosis, including other eating disorders.   

ON involves highly restrictive eating behaviours and is closely associated with other disordered eating habits, such as meticulous food sourcing and preparation. 

This study found people with ON experience ‘distress or impairment likely to be driven by psychological factors’ and intrusive thoughts about eating. 

Although many features of ON are similar to those of other eating disorders, it is an independent diagnosis and is not prevalent among younger women. 

Another distinction is that people with ON are typically ‘proud’ of their lifestyle and want to share, rather than hide, their eating habits.

McComb S, Mills J (2019) Appetite 140, 50-75

Evaluating the effectiveness of an evidence-based online training program for health professionals in eating disorders

An online training programme significantly increased the skills, knowledge and confidence of health professionals working with people with eating disorders, and was found to be cost-effective.

The course was undertaken by psychologists, nurses (21.7%), dietitians and social workers from a range of practice areas, including general practice.

Pre and post training self-evaluations for 1160 participants were carried out, with 480 completing both of the questionnaires used. 

The findings indicate that the willingness of participants to work with people with eating disorders did not increase, but there was a statistically significant rise in participants’ confidence and skills in treating and managing them.

Meanwhile, stigmatised perceptions and associated negative attitudes towards people with eating disorders decreased. 

The reasons for not treating people with eating disorders altered post-training from a lack of knowledge and it being too time consuming, to a lack of resources.

Maguire S, Li A, Cunich M et al (2019) Journal of Eating Disorders. 7, 14

Compiled by Pam Hodge, lecturer in practice learning, Middlesex University, London

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