Researchers describe the early warning signs of eating disorders

The early warning signs of eating disorders have been clearly defined in a large study from the Swansea University researchers. The team has published their study results in the latest issue of the British Journal of Psychiatry by the Royal College of Psychiatrists.

The researchers noted that those with eating disorders had a higher rate of misdiagnosis (being diagnosed with other conditions) before being diagnosed with an eating disorder. The experts believe that this study could help general practitioners identify the disorders much earlier than their clear manifestation.

Woman stood on weighing scale.Tero Vesalainen | Shutterstock

Most patients ‘are not known to specialist eating disorder services’

Experts on the study team explained that eating disorders include anorexia nervosa, bulimia nervosa and binge eating disorders that affect around 1.6 million people in the UK. These figures, they add may be the tip of the proverbial iceberg with a large number of cases being missed out because many do not seek professional help until too late.

It is hoped that the current study will help GPs diagnose the disorder earlier for earlier interventions early. The team explains that earlier the diagnosis, better are the chances of the patient for a complete recovery.

The team from the Swansea University Medical School looked at electronic health records from GPs and hospital admissions in Wales between 1990 and 2017 and found that 15,558 people in Wales were diagnosed with some or the other form of eating disorders.

The team explored the records that were anonymous to see the health parameters a couple of years before the individual was diagnosed. They noted that patients with eating disorders also had higher levels of mental disorders such as personality or alcohol disorders and depression within two years of being diagnosed with eating disorders.

Patients with eating disorders also suffered more incidences of accidents, injuries, and self-harm. Many of them had been diagnosed earlier with conditions that necessitated the use of antipsychotics and antidepressants.

Not surprisingly, patients were also commonly diagnosed with gastrointestinal problems and had been prescribed drugs for upset stomach, constipation etc. these patients had been diagnosed earlier with malnutrition and vitamin and mineral deficiencies as well, write the researchers.

The team of researchers thus warn that one or more combination of these factors could mean that the individual could be at a greater risk of eating disorders. These factors thus could help the GPs to look out for the disorders in their patients.

Lead researcher’s Dr Jacinta Tan, associate professor of psychiatry at Swansea University and the Welsh representative of the Eating Disorder Faculty in the Royal College of Psychiatrists, commented on the research:

I cannot emphasise enough the importance of detection and early intervention for eating disorders. Delays in receiving diagnosis and treatment are sadly common and also associated with poorer outcomes and great suffering.

This research contributes to the evidence about prevalence of eating disorders and begins to quantify the scale of the problem in the entire country of Wales. The majority of these patients we identified are not known to specialist eating disorder services.

The increased prescriptions by GPs both before and after diagnosis indicates that these patients, even if not known to specialist services, have significantly more difficulties or are struggling. This underlines the clinical need for earlier intervention for these patients and the need to support GPs in their important role in this.”

Dr. Joanne Demmler, a senior data analyst in the National Centre for Population Health and Wellbeing Research in her statement said, “This has been an absolutely fascinating project to work on. We used anonymized clinical data on the whole population of Wales and unraveled it, with codes and statistics, to tell a story about eating disorders."

"This 'story-telling' has really been an intricate part of our understanding of this extremely complex data and was only possible through a very close collaboration between data analysts and an extremely dedicated and enthusiastic clinician.”

Professor Keith Lloyd, chair of the Royal College of Psychiatrists Wales added, “Eating disorders can have a devastating impact on individuals and their families so this study is very timely. We're committed to making the case for adequate services and support for people with eating disorders in Wales delivered close to where they live.”

UK Government’s stance

The UK House of Commons picked up this study and released a statement called, “Ignoring the Alarms: too many avoidable deaths from eating disorders.” The report adds that there has been a gross lack in information regarding the epidemiological picture of eating disorders across the nation.

The report says that in 2017 (December), the Parliamentary and Health Service Ombudsman (PHSO) had spoken about the eating disorders and presented a report titled, “Ignoring the Alarms: How NHS eating disorder services are failing patients.” The report came after the death of 19-year-old Averil Hart and two other girls due to complications related to eating disorders.

That report had recommended five steps to deal with the situation. These included –

  • Training of doctors and other medical professionals regarding the management of eating disorders
  • Quality and availability of adult services and easy transition from child to adult services
  • Improving coordination when more than one service is involved
  • Using training to address gaps in the provision of eating disorder specialists
  • Improving investigation and learning, in particular from serious incident investigations

The latest report from the House of Commons wanted to assess the progress made on each of these five recommendations made in 2017.

The report describes a serious lack of training for doctors and inadequate reporting on  the prevalence of eating disorders. The report says, “As a matter of urgency NHS England should commission a national population-based study to properly assess how many people have an eating disorder.”

The authors suggest that there should be greater awareness and uptake of “Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN) guidelines”. The report says that there has been increased funding for mental health but they add that specific amounts spent on adult eating disorders need to be allocated.

The report concludes:

NHS England established an Adult Eating Disorder Expert Reference Group, chaired by Professor Tim Kendall and Jess Griffiths, an expert by experience, to help review the data and modelling for the NHS Long Term Plan. Welcome steps are being made in response to the PHSO’s report, but sufficient progress has not yet been made in response to the PHSO’s report.”

Journal references:
Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.

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