Not Just About Food: Understanding Eating Disorders

Eating Disorders Awareness Week 2026 | Community, Connection, and the Role of Mental Health First Aid

23 February to 1 March 2026

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Eating Disorders Awareness Week 2026, running from 23 February to 1 March, carries a theme that cuts to the core of why so many people suffer for so long before getting help: Community. Beat Eating Disorders, the UK's leading eating disorder charity, chose this theme because eating disorders are profoundly isolating illnesses. ^[13] The person sitting across from you at work, the student in the classroom, the parent dropping children at the school gate: any one of them could be living with an eating disorder right now, and the overwhelming probability is that nobody around them knows.

In the UK, at least 1.25 million people have an eating disorder at any given time. ^[1] Anorexia nervosa carries the highest mortality rate of any psychiatric condition. ^[4] Despite this, the average wait between becoming unwell and starting treatment is three and a half years. ^[1] These are not statistics about a rare illness. They are statistics about an illness that hides in plain sight because the people closest to those affected lack the knowledge, the language, or the confidence to act.

This piece sets out what eating disorders actually are, where they come from historically, who they affect, and (critically) what the people around a sufferer can do. That last point matters most. Trained Mental Health First Aiders, workplace managers, teachers, and community members are often the first point of contact before any professional is involved. Getting that first contact right can change everything.

A Longer History Than Most People Realise

Eating disorders are frequently treated as a modern phenomenon, a product of social media and idealised body images. That framing is wrong in both directions: it overstates the role of contemporary culture and, by implication, suggests that eating disorders are somehow chosen or culturally fashionable. The historical record tells a different story.

Ancient Roots

Evidence of disordered relationships with food traces back to classical antiquity. Ancient Roman sources describe wealthy citizens purging during elaborate banquets to continue eating, behaviour documented by writers including Seneca and Suetonius. (The common claim that Romans used dedicated rooms called vomitoria for this purpose is a persistent historical myth: vomitoria were in fact the wide passageways in theatres and stadia through which crowds could exit quickly.) Egyptian papyri describe monthly purging practices. What we now recognise as binge eating behaviour appears in Persian and Chinese medical manuscripts. Medieval ascetics in Christian Europe practised extreme fasting, sometimes to the point of death, framed as spiritual discipline rather than illness.

The case of Saint Catherine of Siena (1347 to 1380) is often cited in the medical literature. Her refusal of food was understood by her contemporaries as holy devotion. Modern clinical analysis of her surviving accounts suggests severe restriction consistent with anorexia nervosa. Catherine is one of many historical figures (including Mary, Queen of Scots) whose behaviour, viewed through a 21st-century clinical lens, fits recognisable eating disorder patterns.

These historical cases do not mean eating disorders are simply a matter of willpower misapplied, as the religious framing of earlier centuries implied. They mean the underlying vulnerabilities (biological, psychological, social) have existed across human history, expressing themselves within whatever cultural context was available.

The First Medical Descriptions

The earliest medical description of what we now call anorexia nervosa is generally attributed to the English physician Richard Morton in 1689. ^[5] His ‘Phthisiologia’ described a condition he called ‘nervous consumption’: a wasting illness caused neither by fever nor infection, in which patients refused food and displayed profound physical deterioration. Morton was clear that the condition was distinct from tuberculosis, though he could not fully explain it.

The formal naming of anorexia nervosa came almost two centuries later in 1873, through two physicians working independently. London physician Sir William Gull, one of Queen Victoria’s personal doctors, presented detailed case studies to the Clinical Society of London and established the term ‘anorexia nervosa’ ^[5], meaning loss of appetite of nervous origin. He deliberately chose ‘nervosa’ rather than ‘hysterica’ (which his French contemporary Ernest-Charles Lasègue had used) because Gull noted the condition occurred in men as well as women. That distinction matters: it placed the illness in the mind rather than the female anatomy, and it acknowledged a reality still underappreciated today. Eating disorders are not exclusively female conditions.

Lasègue, working in Paris, published 'De l'Anorexie Hystérique' in the same year. ^[6] His analysis differed from Gull's in one important respect: he focused extensively on family dynamics and interpersonal relationships as both contributing factors and maintaining mechanisms. He described scenes in which relatives pleaded with patients to eat, inadvertently intensifying the illness rather than alleviating it. This insight into the relational dimension of eating disorders anticipated by more than a century the family therapy approaches now central to evidence-based treatment.

The Twentieth Century: From Misunderstanding to Recognition

The early 20th century did not build constructively on the work of Gull and Lasègue. Bitter divisions between neurology, Freudian psychotherapy, and biological psychiatry meant that eating disorders fell between disciplines, interpreted variously as endocrine deficiency (Simmonds' disease, a pituitary condition, was fashionable for decades), sexual repression, or adolescent rebellion. Treatments, including ‘parentectomy’ (the deliberate removal of patients from their families), were often harmful.

The modern era of eating disorder understanding began in the 1960s and 1970s. Psychiatrist Hilde Bruch published influential work identifying distorted body image and difficulties recognising internal states (hunger, satiety, emotion) as core features of anorexia. Her 1973 book 'Eating Disorders: Obesity, Anorexia Nervosa and the Person Within' shifted clinical thinking ^[8] decisively toward a psychological rather than purely physical model.

Bulimia nervosa was not formally named until 1979, when British psychiatrist Gerald Russell published 'Bulimia Nervosa: An Ominous Variant of Anorexia Nervosa'. ^[7] Although binge-purge behaviour had been described in medical literature since the early 1900s (Pierre Janet described a patient, 'Nadia', in 1903), Russell's paper gave it diagnostic status. Binge eating disorder was not formally recognised until the 1990s, introduced at the International Eating Disorders Conference in 1992 and incorporated into the DSM-5 in 2013. ^[7]

The cultural resonance of eating disorders in the late 20th century partly reflects genuine increase in prevalence and partly reflects increased recognition. The death of Karen Carpenter in 1983 from heart failure caused by anorexia nervosa brought the condition into public consciousness in a way that clinical literature had not managed. It also, unfortunately, entrenched the stereotype of the young, white, female, middle-class sufferer, a stereotype that continues to delay diagnosis in everyone who does not fit it.

What Eating Disorders Actually Are

The World Health Organisation's ICD-11 defines eating disorders as psychiatric conditions involving abnormal eating behaviour and preoccupation with food, accompanied in most instances by body weight or shape concerns. This definition is accurate but incomplete as a guide for those trying to recognise them in practice. The reality is more complex, more varied, and far less visible than common stereotypes suggest.

Anorexia Nervosa

Anorexia nervosa involves persistent restriction of energy intake, an intense fear of weight gain or becoming fat (or persistent behaviour that interferes with weight gain, even in someone already at a dangerously low weight), and a distorted perception of body weight or shape. The word 'anorexia' means loss of appetite, but it is misleading: most people with anorexia experience hunger acutely. The illness is characterised by overriding that hunger through an act of will driven by profound psychological distress.

There are two subtypes. The restricting type involves primarily food restriction, fasting, and often excessive exercise. The binge-purge type involves periods of restriction punctuated by binge eating followed by compensatory behaviours including vomiting, laxative misuse, or fasting. The distinction matters clinically because the medical complications differ.

Anorexia nervosa carries the highest mortality rate of any psychiatric disorder. A 2024 meta-analysis by Solmi and colleagues found that people with anorexia nervosa have approximately five times higher mortality than the general population. ^[4] Mortality estimates vary across studies, but figures consistently indicate that around 5% of patients die within four years of diagnosis ^[4], with rates rising significantly over longer follow-up periods in untreated cases. Death occurs through cardiac arrhythmia (the heart depends on electrolyte balance, which starvation destroys), multi-organ failure, and suicide. This is not a condition that resolves on its own.

Bulimia Nervosa

Bulimia nervosa is characterised by recurrent episodes of binge eating followed by compensatory behaviours designed to prevent weight gain. These behaviours include self-induced vomiting, misuse of laxatives or diuretics, fasting, and excessive exercise. The binge-purge cycle is accompanied by a sense of loss of control during binges and intense shame, guilt, and self-criticism afterward.

People with bulimia nervosa are often within a medically normal weight range, which makes identification much harder. Physical signs develop over time and can include dental erosion from repeated exposure to stomach acid, calluses on the back of the hand (Russell's sign, from inducing vomiting), swollen salivary glands, and electrolyte imbalances that carry serious cardiac risk. The illness is significantly underdiagnosed, partly because it is less visible and partly because the intense shame drives concealment.

Binge Eating Disorder

Binge eating disorder (BED) is now the most common eating disorder in the UK, affecting approximately 1 in 50 people. ^[1] It involves recurrent episodes of eating unusually large quantities of food in a discrete period of time, with a sense of loss of control. Unlike bulimia nervosa, BED does not involve regular compensatory behaviours. Episodes are typically characterised by eating more rapidly than normal, eating beyond comfortable fullness, eating when not physically hungry, eating alone due to embarrassment, and feeling disgusted, depressed, or guilty afterward.

BED is often dismissed as 'comfort eating' or confused with obesity, which delays appropriate support. Approximately 40% of people with BED are male ^[1], giving it the most even gender distribution of the major eating disorders. The condition causes significant psychological distress regardless of whether it results in weight gain, and it is associated with high rates of anxiety, depression, and other mental health conditions.

ARFID: Avoidant/Restrictive Food Intake Disorder

ARFID involves persistent avoidance or restriction of food intake, but not primarily driven by fear of weight gain or body image distortion as seen in anorexia. The restriction is driven by other factors: sensory characteristics of food (texture, smell, appearance), fear of choking or vomiting, or a simple lack of interest in food. ARFID affects children disproportionately but also adults, and it is more common in people with autism spectrum conditions and ADHD.

Because ARFID does not involve the weight and shape preoccupations associated with the other disorders, it is frequently misunderstood as 'fussy eating' in children and dismissed in adults. The health consequences of significant nutritional restriction are identical regardless of the reason for that restriction.

OSFED and Other Presentations

Other Specified Feeding or Eating Disorder (OSFED) accounts for the largest proportion of all eating disorder diagnoses, approximately 47% in UK data. ^[14] OSFED covers presentations that cause significant distress and impairment but do not meet the full diagnostic criteria of the disorders above. This includes atypical anorexia nervosa (where all the features of anorexia are present but weight remains in a 'normal' range), purging disorder (purging without binge eating), and night eating syndrome.

OSFED is not a 'mild' or 'subclinical' category. The medical and psychological consequences can be just as severe as any other eating disorder, and the lack of a 'clean' diagnosis frequently delays access to treatment.

Who Eating Disorders Affect: Demolishing the Stereotype

The EDAW 2025 theme was 'Eating Disorders Can Affect Anyone'. ^[13] It needed saying. Despite decades of evidence to the contrary, the public image of a person with an eating disorder remains remarkably fixed: young, female, white, thin, and middle class. That image is demonstrably wrong on almost every count, and it has caused real harm by delaying diagnosis in everyone who does not recognise themselves in it. 

Men and Boys

Men make up roughly a quarter of all eating disorder diagnoses, yet remain dramatically underserved. Stigma operates differently for men: where seeking help for mental health is already challenging, seeking help for a condition culturally coded as female is doubly so. Male sufferers are more likely to pursue muscularity rather than thinness. Muscle dysmorphia, characterised by an obsessive belief that one’s body is insufficiently muscular, may affect up to 2.5% of men ^[14] and is closely related to eating disorder presentations, but it sits in a clinical grey area that often escapes formal diagnosis.

GPs and mental health professionals are less likely to suspect an eating disorder in a male patient presenting with weight loss or dietary restriction. This is a training and awareness gap, not a gap in prevalence.

Older Adults

Eating disorders are persistently framed as adolescent conditions. They are not. Adults over 40 can develop eating disorders for the first time, and many people live with an eating disorder for decades without ever receiving treatment. Life transitions such as retirement, bereavement, or relationship breakdown can precipitate onset or relapse at any age. Older adults face additional barriers to diagnosis because clinicians are less likely to consider an eating disorder when the patient presents primarily with weight loss or gastrointestinal symptoms.

Ethnic Minority Communities

Research consistently shows that eating disorders in Black, Asian, and other minority ethnic communities are underdiagnosed and undertreated. Multiple factors drive this: racial bias in clinical assessment, cultural differences in how distress is expressed, lower rates of self-referral due to stigma within specific communities, and a persistent assumption in both the public and some clinical settings that eating disorders are a 'white' condition. They are not.

Social Media and the Post-COVID Context

The relationship between social media and eating disorders is real but more complex than the standard narrative. Social media platforms can expose vulnerable individuals to harmful content (the Online Safety Act 2023 places obligations on platforms regarding this ^[3]), but social media did not create eating disorders. The underlying biological and psychological vulnerabilities predate the internet.

What is unambiguous is the COVID-19 impact. NHS child and adolescent eating disorder services reported that urgent and routine referrals almost doubled during the pandemic. ^[11] A 2023 systematic review confirmed a post-COVID surge in diagnoses, particularly in teenage girls. ^[11] Social isolation, disrupted routines, increased family conflict, and the removal of protective social structures all appear to have accelerated presentations in people who were already vulnerable.

Why Eating Disorders Develop: The Biopsychosocial Picture

Eating disorders do not have a single cause. That point needs emphasising because it directly influences how we talk about them and how we respond to someone who has one. Telling someone to 'just eat' is equivalent to telling someone with clinical depression to 'just cheer up'. It misunderstands the nature of the illness.

Genetic and Biological Factors

The most reliable research suggests that at least 50% of the risk of developing an eating disorder is attributable to genetic factors. ^[14] People with a positive family history have a 7 to 12 times higher risk of developing an eating disorder ^[14] than those without. Twin studies consistently show higher concordance rates in identical twins than non-identical twins for all major eating disorder categories.

Neurobiological research has identified alterations in serotonin and dopamine pathways in people with anorexia and bulimia, affecting regulation of mood, impulse control, and the experience of reward. There is also emerging evidence linking eating disorder risk to metabolic factors, suggesting that what presents as a purely psychological illness has significant biological underpinning that persists even in recovery.

Psychological Factors

Certain psychological traits appear with high frequency across eating disorder presentations: perfectionism, harm avoidance, obsessive-compulsive tendencies, difficulties with emotional regulation, and low self-esteem. These are not character flaws; they are psychological profiles that create vulnerability when exposed to specific environmental pressures.

The experience of trauma, including childhood abuse, sexual assault, and chronic invalidation, is strongly associated with eating disorder development. For many sufferers, the eating disorder functions (initially, at least) as a coping mechanism: a way of managing overwhelming emotion, creating a sense of control in uncontrollable circumstances, or suppressing feelings that cannot otherwise be processed.

58% of people with an eating disorder carry at least one additional psychiatric diagnosis. ^[14] Anxiety disorders, depression, and obsessive-compulsive disorder are particularly common. This is not coincidental: shared neurobiological pathways and shared psychological vulnerabilities mean these conditions frequently co-occur.

Social and Environmental Factors

Cultural pressure around food, body image, and weight creates the environment within which biological and psychological vulnerabilities become eating disorders. This includes both the pervasive thin ideal in Western culture and, increasingly, the muscular ideal promoted in fitness culture. High-pressure environments, competitive sport (particularly gymnastics, rowing, endurance sports, and ballet), and industries where appearance is professionally evaluated all carry elevated risk.

Family environment matters, but not in the simplistic way sometimes implied. Families do not cause eating disorders. Certain family dynamics, including high levels of conflict, poor emotional communication, and excessive focus on weight and appearance, can increase risk in biologically or psychologically vulnerable individuals. But blaming families, or allowing families to blame themselves, is neither accurate nor helpful.

Recognising the Signs: What to Watch For

One of the most important skills a trained Mental Health First Aider develops is learning to recognise the signs that a colleague, friend, or family member may be struggling with an eating disorder. This matters for two reasons. First, because the average gap between onset and treatment is 3.5 years, and early intervention substantially improves outcomes. Second, because eating disorders are expertly concealed: the shame, secrecy, and ambivalence about recovery that characterise these illnesses mean sufferers rarely disclose voluntarily.

Mental Health First Aid training teaches individuals to recognise suspected mental health conditions, not to diagnose them. That distinction is essential. What follows is a guide to the kinds of indicators that warrant concern, not a diagnostic checklist.

Behavioural Signs

Changes in eating behaviour are often the most visible early indicators, though they are also frequently rationalised or minimised:

• Preoccupation with food, calories, diet, or weight that dominates conversation and thinking
• Strict dietary rules, often with escalating restriction over time
• Avoidance of eating in social settings, or making excuses to avoid meals with others
• Disappearing to the bathroom immediately after meals
• Evidence of food hoarding, hiding, or disposal
• Excessive or compulsive exercise that continues despite injury, illness, or weather
• Changes in food rituals: cutting food into very small pieces, rearranging food, eating in a fixed order
• Wearing loose or baggy clothing to conceal body shape
• Frequent checking of the body in mirrors, or conversely, avoidance of mirrors entirely

Emotional and Psychological Signs

• Intense fear of weight gain that appears disproportionate to actual weight
• Distorted perception of body size, such as expressing the belief of being fat when objectively underweight
• Mood that is strongly linked to perceived eating behaviour ('good' days when restriction is maintained, 'bad' days when it is not)
• Heightened anxiety or irritability around mealtimes
• Social withdrawal, especially from situations involving food
• Expressions of worthlessness, self-disgust, or shame, often anchored to eating or body image
• Denial of hunger or fatigue that appears genuine rather than performative

Physical Signs

Physical signs are often late indicators in conditions like anorexia, and in conditions like bulimia they may not be externally visible at all. However, the following warrant attention:

• Significant or unexplained weight loss
• Fine downy hair on the body (lanugo), the body’s response to severe cold from inadequate insulation
• Hair thinning or loss
• Dental erosion, particularly of the back surfaces of front teeth (from stomach acid in repeated vomiting)
• Swollen cheeks or jaw area (swollen parotid glands from repeated vomiting)
• Calluses or scarring on the knuckles of the dominant hand (Russell's sign, from inducing vomiting)
• Fainting, dizziness, or persistent fatigue
• Feeling constantly cold regardless of ambient temperature
• Oedema (swelling, particularly in the lower legs) in severe cases
• In women, cessation of menstrual periods

Important: What These Signs Do Not Tell You

You cannot tell whether someone has an eating disorder by looking at their weight. A person with anorexia nervosa may be at a medically 'normal' weight while experiencing severe psychological and physical harm. A person with binge eating disorder may not be overweight at all. A person with OSFED may show no single obvious sign while experiencing serious distress.

Weight is not a proxy for illness severity. Concern should be triggered by behaviour, mood, and relationship with food, not appearance alone.

The Mental Health First Aider’s Role: Recognition, Response, and Boundaries

Eating disorders are covered in Mental Health First Aid qualifications at intermediate and advanced levels, with greater depth in supervisory training. The First Aid for Mental Health framework is clear about what a Mental Health First Aider can and cannot do, and understanding those boundaries is not a limitation. It is the foundation of effective support.

What a Mental Health First Aider Is Not

A Mental Health First Aider is not a therapist, counsellor, or clinician. They cannot and must not attempt to diagnose an eating disorder. They are not equipped to provide treatment or to manage a clinical condition. That is not the role, and overstepping it causes harm.

They are also not an enforcement mechanism. A First Aider cannot compel someone to seek help, cannot report a person's eating to their employer (outside the limits of confidentiality relating to immediate risk), and should not surveil or monitor someone's eating under the guise of support. The role is to provide a first contact, a compassionate and informed response, and a bridge to professional services.

What a Mental Health First Aider Can Do

A Mental Health First Aider can recognise suspected eating disorder presentations, approach the person with care, provide a non-judgemental listening presence, and signpost toward appropriate professional support. These are not trivial skills. Done well, a good first-contact conversation can be the difference between a person seeking help and a person shutting down entirely.

Before Approaching

Before speaking to someone you are concerned about, Mental Health First Aid training encourages preparation:

• Find a private, quiet space where the conversation cannot be overheard
• Choose a time when neither of you is rushed or distracted
• Consider your relationship with the person: are you the right person to have this conversation, or would another colleague, family member, or professional be better placed?
• Be clear in your own mind that you are not going to deliver a diagnosis or ultimatum, but to express care and open a door

Starting the Conversation

The first words matter. An approach grounded in observation of behaviour rather than appearance is both more accurate and less likely to trigger a defensive or shame-driven response. Commenting on what you have noticed ('I've noticed you seem stressed at lunch lately, are you alright?') is more constructive than commenting on appearance ('You look very thin, I'm worried about you').

The First Aid for Mental Health Action Plan guides First Aiders toward an approach of calm, non-judgemental inquiry. You are not confronting the person or demanding they change. You are signalling that you have noticed, that you care, and that help exists. This initial signal of safety (that the person will not be judged, punished, or exposed) is often the precondition for any further conversation to happen at all.

During the Conversation: Key Principles

• Listen actively and without interruption. Resist the urge to fix, advise, or contradict.
• Do not comment on the person's weight, body size, or appearance. Focus on how they are feeling.
• Do not offer reassurance about their weight ('You look perfectly healthy to me'). This dismisses their experience and may reinforce disordered cognitions.
• Do not express shock, disgust, or distress at what they tell you, even if you feel it. Emotional reactions from others are a significant reason why people with eating disorders do not disclose.
• Avoid asking about specific eating behaviours unless the person volunteers them. The conversation is not an assessment.
• Acknowledge what the person has shared, however much or little that is: 'Thank you for telling me that. It sounds really hard.'
• Do not promise to keep everything secret if you are concerned about immediate risk to life. Be honest about confidentiality from the start.

Signposting to Professional Help

The end goal of a first-contact conversation is to support the person to take a step toward professional help. This might mean offering to help them contact their GP, sharing information about Beat's helpline, or (in a workplace context) pointing them toward an Employee Assistance Programme. It is not to resolve the problem yourself.

Mental Health First Aiders should not attempt to provide ongoing support as a substitute for professional care. Checking in is appropriate; becoming someone’s primary emotional support for an eating disorder is not. Signposting must be genuine, specific, and followed up.

When the Risk Is Immediate

Eating disorders carry a real risk of medical emergency. If someone discloses that they have not eaten or drunk fluids for a clinically dangerous period, if they report symptoms of severe electrolyte imbalance (irregular heartbeat, muscle cramps, fainting, confusion), or if there is any disclosure of intent to harm themselves, this moves into emergency response territory. In the workplace context, this means contacting emergency services (999) and not leaving the person alone.

In any situation involving danger to life, emergency services take priority over all other considerations.

The EDAW 2026 Theme: Why Community Matters in Eating Disorder Recovery

Beat's choice of 'Community' as the 2026 theme reflects something that the clinical evidence supports: eating disorder recovery does not happen in isolation. Supportive communities, whether family, workplace, peer group, or treatment community, are a consistent predictor of positive outcomes. The quality of relationships a person has access to shapes both the likelihood that they will seek help and the resilience available to them through recovery.

A Mental Health First Aider who responds well to a disclosure becomes part of that community. They are not treating the eating disorder. They are contributing to the human network that makes treatment possible and recovery sustainable.

Eating Disorders in the Workplace

Two in three people with an eating disorder would not feel comfortable discussing it with their line manager. ^[13] Two in three would not tell a colleague. These figures come from Beat's own research and they expose a practical reality: the workplace is not a space where most people with eating disorders feel safe.

That is partly cultural: mental health stigma in the workplace is real, and eating disorders carry particular stigma. But it is also structural: most managers have no training in recognising or responding to eating disorders, and most organisations have no specific guidance.

What Employers Can Do

The role of the employer is not clinical. It is to create conditions in which people are not made worse, can access help, and will not face discrimination. Practically, that means:

• Ensuring there are trained Mental Health First Aiders who are accessible and visible, and who have received training that covers eating disorders specifically
• Having clear, well-communicated routes to an Employee Assistance Programme
• Training line managers in basic recognition (not diagnosis) and in how to refer concerns appropriately
• Reviewing whether any aspect of workplace culture actively increases eating disorder risk: weight-focused wellness initiatives, diet talk in team settings, performance criteria tied to physical appearance
• Making reasonable adjustments during treatment: flexible hours for clinical appointments, temporary redeployment if a role is incompatible with recovery, phased return to work

The Legal Position

An eating disorder that has a substantial and long-term adverse effect on ability to carry out day-to-day activities will meet the definition of disability under the Equality Act 2010. Where that threshold is met, the duty to make reasonable adjustments applies. Employers should be aware that dismissing or disadvantaging an employee because of an eating disorder may constitute unlawful discrimination.

The Health and Safety at Work etc. Act 1974 and associated regulations impose a duty on employers to address psychosocial risks in the workplace. While eating disorders are not directly referenced, an employer who creates or maintains conditions that exacerbate a mental health condition, for example through a culture of weight-focused commentary, may face exposure under health and safety law.

Treatment, Recovery, and Where to Find Help

Treatment for eating disorders is effective, but access is currently inadequate. The NHS has waiting time targets for children and young people: 95% of urgent referrals seen within one week and 95% of routine referrals within four weeks. ^[9] These targets apply to under-18s only. There are no equivalent national waiting time standards for adults, which is a significant part of why the overall average wait from onset to treatment remains so high. The Royal College of Psychiatrists has documented waiting times of up to 41 months for adult services. ^[9]

What Evidence-Based Treatment Looks Like

Treatment approaches differ by disorder and by severity. For anorexia nervosa, where restoring medical stability is the immediate priority, treatment typically involves a combination of nutritional rehabilitation, psychological therapy, and medical monitoring. Family-based therapy (the Maudsley approach) is strongly evidenced for younger patients. Cognitive behavioural therapy (CBT) has the strongest evidence base for bulimia nervosa. For binge eating disorder, both CBT and interpersonal therapy show good outcomes.

Recovery is rarely linear. The statistics tell a complicated story, and caution is needed when interpreting them because studies define ‘recovery’ inconsistently (physical weight restoration, psychological recovery, and functional recovery are measured differently across research). With that caveat noted, the longitudinal data broadly indicates that approximately 46% of people with anorexia make a full recovery, 33% improve substantially, and 20% remain chronically ill. ^[4] For bulimia, 45% make a full recovery and 27% improve considerably. ^[4] These figures reflect both the genuine treatability of eating disorders and the reality that successful treatment requires sustained access to specialised care that many people in the UK currently cannot get.

Key UK Support Resources

The Role of First Aid for Mental Health Training

The 3.5-year average wait between onset and treatment for eating disorders is not entirely, or even primarily, a failure of NHS services. It is a failure of early recognition. People do not seek help because they do not recognise what is happening as an illness. Or they recognise it and are too ashamed to disclose. Or they disclose to someone who does not know how to respond, and are met with silence, dismissal, or unhelpful advice.

This is precisely the gap that First Aid for Mental Health training addresses. A trained First Aider cannot close the gap between onset and clinical treatment by themselves. But they can reduce the gap between onset and first disclosure, which is the necessary precondition for everything else.

Constellation Training delivers Ofqual-regulated NUCO First Aid for Mental Health qualifications at three levels: Level 1 (Awareness), Level 2 (First Aid for Mental Health), and Level 3 (Supervising). Eating disorders feature across all three, with broader scope and greater confidence expected at each level. Level 1 focuses on recognising concerns and starting a conversation. Level 2 introduces the First Aid for Mental Health Action Plan and how to respond appropriately. Level 3 supports managers and supervisors to embed good practice, support teams, and understand a wider range of conditions and support pathways.

For organisations without trained Mental Health First Aiders, or where training is out of date, Eating Disorders Awareness Week 2026 (theme: Community) is a sensible moment to act. Investing in trained First Aiders is one practical way to build a workplace community where people feel safe enough to ask for help.

Conclusion

Eating disorders have been documented across three millennia. They affect over a million people in the UK right now, at enormous personal and economic cost. They are not a lifestyle choice, a phase, or a consequence of vanity. They are serious mental health conditions with biological roots, psychological complexity, and medical consequences that can be fatal.

The good news is that recovery is possible. The treatment evidence is solid, the specialist services exist, and the outcomes for people who receive early intervention are substantially better than for those who wait. The bad news is that the structures connecting people in distress to those services are still inadequate, and the average person struggling with an eating disorder will spend three and a half years without appropriate help.

That gap is not closed by clinical services alone. It is closed by the people around sufferers: the colleague who notices a change in behaviour and knows how to respond, the manager who creates space for a difficult conversation, the friend who has learned that 'you look fine' is the wrong thing to say, and the community that understands these illnesses well enough not to dismiss, minimise, or stigmatise them.

That is what Eating Disorders Awareness Week is for. And that is why First Aid for Mental Health training matters, not because trained individuals can treat eating disorders, but because they can be the first, decisive human link in the chain of support that makes treatment possible.

Not sure what you need? We’ll help you choose a practical, proportionate approach.

References and Sources

1. Beat Eating Disorders. 'Statistics for Journalists'. beateatingdisorders.org.uk

2. NHS Digital. 'Mental Health of Children and Young People in England 2023'. digital.nhs.uk

3. House of Commons Library. 'Eating Disorders Awareness Week 2026 Debate Pack'. commonslibrary.parliament.uk (February 2026)

4. Solmi, M. et al. (2024). Outcomes in people with eating disorders: a transdiagnostic and disorder-specific systematic review, meta-analysis and multivariable meta-regression analysis. World Psychiatry, 23(1): 124–138

5. Gull, W.W. (1874). 'Anorexia Nervosa'. Transactions of the Clinical Society of London, 7: 22-28

6. Lasègue, E.C. (1873). 'De l'Anorexie Hystérique'. Archives générales de Médecine

7. Russell, G.F.M. (1979). 'Bulimia Nervosa: An Ominous Variant of Anorexia Nervosa'. Psychological Medicine, 9(3): 429-448

8. Bruch, H. (1973). Eating Disorders: Obesity, Anorexia Nervosa and the Person Within. Basic Books

9. Royal College of Psychiatrists. 'The Right to Health: APPG on Eating Disorders Report Response' (January 2025). rcpsych.ac.uk

10. NHS England Digital. 'Adult Psychiatric Morbidity Survey: Eating Disorders Chapter' (2023/24). digital.nhs.uk

11. Devoe, D.J. et al. (2023). 'The impact of the COVID-19 pandemic on eating disorders'. International Journal of Eating Disorders, 56(1): 5-25

12. Nuco Training. 'First Aid for Mental Health Level 2 and Level 3 Qualification Framework'. nuco.co.uk

13. Beat Eating Disorders / Healthwatch Westminster. 'EDAW 2026: Community'. beateatingdisorders.org.uk

14. WeightMatters. 'UK Eating Disorder Statistics 2025'. weightmatters.co.uk