In 1993, The Lancet, a prestigious medical journal, published an article titled “The future of eating disorders,” which critically examined the state of clinical research into eating disorders. The article highlighted the challenges faced in this field, including small, unreplicated clinical studies, a lack of large-scale population-based studies, and a general lack of interest in these disorders despite their clinical significance. Â
Fast forward to the present, and while there have been some advancements in the field, eating disorders remain relatively neglected within mental health research. Funding for research into eating disorders still trails significantly behind other mental disorders. This lack of attention and resources has led to a significant underestimation of eating disorders globally, masking their true burden.
Additionally, there is a noted lack of clinical efficacy for psychological treatments of anorexia nervosa, one of the most severe eating disorders. In a recent issue of The Lancet Psychiatry, Amelia Austin and colleagues suggest a novel approach to address these challenges. They propose using a standard set of measures to track treatments and outcomes for eating disorders.
This initiative, developed in coordination with the International Consortium for Health Outcomes Measurement, involved a panel of experts in clinical care and research, as well as those with lived experience of eating disorders. The recommended set includes a range of age-dependent measures focusing on eating disorder behaviors and cognitions, co-occurring mental disorders (like depression and anxiety), as well as functioning and well-being.
These measures were chosen with considerations for accessibility, cost, language translations, burden on users, and feasibility in low-resource settings. One notable point of contention in the development of these measures was the inclusion of Body Mass Index (BMI). BMI is widely used in inpatient clinical settings for tracking response to eating disorder treatment and diagnosing the severity of certain eating disorders.
However, it was ultimately removed from the recommended set due to a lack of consensus, highlighting the controversial nature of physical health measures like BMI in eating disorder care and research. Critics argue that the traditional emphasis on weight classification can overshadow the underlying behavioral and cognitive issues driving disordered eating. Â
Caroline da Cunha Lewin, a survivor of an eating disorder, emphasizes that recovery should not be solely defined by meeting a clinician-defined weight classification. She points out that the subjective experience and conceptualization of an eating disorder often stem from a lost sense of self and feeling wrong in one’s own body. Â
Reaching a consensus on outcome measures in mental health research is inherently challenging. Without comparable metrics between studies and treatments, monitoring progress in the field is difficult. The Lancet Psychiatry commends the efforts of Austin and colleagues in developing a standard set of measures in eating disorders research.
This initiative not only helps harmonize datasets and improve comparisons between studies and treatments but also integrates various stakeholders, including those with lived experience, into the process. Looking back at the state of eating disorders research since 1993, significant changes have occurred.
The Lancet continues its commitment to eating disorder research, with the hope of further advancements and improvements in the lives of those living with these disorders over the next thirty years. The integration of diverse perspectives and the development of standardized measures mark a significant step towards understanding and effectively treating eating disorders. Â
Journal Reference Â
(N.d.). Retrieved from https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(23)00372-3/fulltextÂ
