Doctors need more education to tackle the rising tide of eating disorders

Eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating disorder affect at least 1% to 4% of people in high income countries, although this is likely under-reported. Increasing numbers of cases are being diagnosed in men, older adults, and people from ethnic, sexual, and gender minority groups.12 There has been a call from the all party parliamentary group on eating disorders for a national strategy to tackle the increasing prevalence of eating disorders, including delivery of mandatory training on eating disorders to GPs, dentists, teachers, and nurses.3 Medical education is central to improving care for these common and serious conditions and every doctor has a responsibility to improve their knowledge.

As a psychiatry trainee in the UK with lived experience of anorexia nervosa, I was taken aback by the lack of time dedicated to eating disorders during my undergraduate education. I assumed that all doctors would have a reasonable understanding of common eating disorders. Even before medical school, I knew how widespread and harmful eating disorders could be. There was a 90% rise in young people with eating disorders between 2015/6 and 2020/1, and an 84% rise in hospital admissions due to eating disorders during the same period.4 Anorexia nervosa is reported to have the highest mortality rate of any mental disorder, which includes the complications of malnutrition and suicide. However, doctors in the UK regularly graduate from medical school with little exposure to patients with eating disorders and limited formal teaching on these conditions.5

Clinicians in all settings must do better for patients, not just in psychiatry, given what is known about the harm caused by eating disorders to the physical and psychological health and wellbeing.67 No singular test or treatment for eating disorders exists and therefore the patient perspective is an essential part of our understanding.

Firstly, we must listen to patients with an open mind and avoid making assumptions about their experience or goals. For example, some patients find it triggering to be told their weight in a clinical setting or that their weight is too high to access certain services. The way that doctors ask questions or make assumptions can also have a huge effect on patient receptiveness.8 When I was a patient, I found that the way doctors asked questions would influence my willingness to share my symptoms. If a question was asked with negative phrasing, I would tend to agree. Similarly, closed questions did not encourage elaboration and discouraged me from sharing my concerns.

Secondly, healthcare professionals should be aware of the role of the charity sector, because much of the patient experience is in the community rather than in acute or psychiatric hospitals. The all party parliamentary group report highlights that a disproportionate amount of the care burden falls to charities and formal or informal carers.3 By failing to involve charities in medical education, we are missing a large part of the patient experience. In the UK, organisations such as Beat and Mind have a variety of support groups and services that might be suitable for our patients. We should be signposting services, particularly if the patient is ineligible or unable to access mainstream healthcare (eg, long waiting lists or strict inclusion criteria).

If there is no capacity for traditional experience or training about eating disorders for medical students in healthcare settings, there could be scope to create placements or shadowing experience in charities. A wealth of creative options for improving undergraduate education exists, including using lived experience volunteers, using problem based learning cases, and discussing ethical scenarios.

Finally, it is vital that healthcare professionals are aware of current research on eating disorders and recognise gaps in their knowledge. For example, there is emerging evidence about the relation between specific eating disorders and other mental illnesses or neurodevelopmental conditions (eg, autism).9All specialties, not only psychiatry, should consider the routes for ongoing training, such as journal clubs or discussion of cases in departmental teaching.

We also need clinicians to be confident in treating patients from diverse backgrounds, including a culturally sensitive approach to eating disorders, which is currently lacking in education.5 Teaching on eating disorders often lacks insight from different cultures, which is important because hospital admissions for eating disorders are rising faster in certain groups such as black and minority ethnic patients.10 When we produce educational resources, we must seek input from a range of patients, clinicians, and researchers.

Eating disorders continue to pose a substantial risk to life and health. Healthcare professionals in all settings must be familiar with recognising these conditions. Improvements in medical education are a key component in ensuring that patients receive the care that they deserve, but every professional also has a responsibility to expand their own understanding. The voices of patients with eating disorders and their carers must remain central to the development of new resources and placement opportunities and help guide our future practice.