Eating disorders are soaring in the UK – and so are wait times for vital support

Good morning. About 1.25 million people in the UK have an eating disorder, and that number, say psychologists and campaigners, is rising sharply.

The reasons why people experience conditions like anorexia and bulimia are complex and, despite their prevalence, still not well understood. Nor can experts fully explain why their numbers are increasing so quickly – including among children. Experts stress these conditions are treatable. People can and do make full recoveries, but the key can be getting early treatment – and that is often not happening.

New analysis this week by the children’s commissioner found that the number of children starting urgent treatment has soared, but the percentage of those being seen promptly has fallen, with large numbers waiting three months or more to get help.

I spoke to Dr Agnes Ayton, vice-chair of the eating disorder faculty at the Royal College of Physicians, about what is behind the rise and what needs to happen to address it, and with Tom Quinn of the eating disorder charity Beat about the help that is out there if you are concerned about yourself, a friend or family member.

That’s coming up after today’s headlines.

Five big stories

In depth: ‘A perfect storm’ of a pandemic and a stretched NHS

“I want to see more children and young people get the support they need, so they can lead healthy, happy lives,” the children’s commissioner, Rachel de Souza (pictured above), said this week, as she published an analysis of NHS England data on the number of children and young people needing sometimes life-saving help.

The numbers, once crunched, left her “extremely concerned” about young people experiencing illnesses that were “serious and potentially life-threatening”, De Souza said. “As we come out of the shadow of the pandemic, the extent of the crisis in children’s mental health is becoming more and more evident.”

The pandemic hasn’t helped – but it didn’t cause this crisis. So how can we explain the striking jump in children and young people – and others – suffering from eating disorders? And what needs to be done to ensure they all get the urgent help that can make such a critical difference?

The new analysis and what it found

There has been a “large and recent” increase in the number of children and young people being admitted to hospital due to eating disorders, the commissioner said. In 2015-16, 13,200 people were admitted to hospital in England; five years later that figure was 24,300. Of that later total, almost half were under the age of 25.

The large majority of that number are women and girls, but the number of boys and men doubled in that period.

Since 2020-21, NHS targets have required 95% of children and young people with eating disorders to begin treatment within a week for urgent cases, or four weeks for those judged less urgent. But as more and more young people are in need of treatment, services have increasingly fallen behind on that target.

At one point earlier this year, she found, almost half of urgent cases that were waiting for treatment had been stuck in a queue for more than 12 weeks. (The figures for 2022-3, the commissioner noted, are likely undercounts, thanks to data issues caused by a cyber-attack on NHS systems.)

“Knowing this,” the analysis found, “it is important that the NHS ensures that all children are able to swiftly access community care for eating disorders.”

What is causing this rise?

In February 2021, Dr Agnes Ayton told the Guardian that there had been a “tsunami” of patients needing support for eating disorders; today she prefers the word “surge”. Either way, it’s a huge increase, and Covid, for once, can’t be used as a catch-all reason.

“The bottom line is that there has been a year on year increase of hospital admissions since 2000 – so way before the pandemic,” she says. “We don’t have a very good understanding of why that surge has happened, but the chances are that it’s going to be multiple factors.”

That said, it is obvious the pandemic, and the isolation caused by lockdown, was hugely significant, Ayton says – not least because “there’s going to be uncertainty and anxiety within the population, and there is a link between anxiety and eating disorders”.

Also related, and a potential factor for some people, she says, was the “bombardment” of weight loss messages at a time when obesity was known to be a factor in worse outcomes from Covid. The reduced capacity in the NHS at the time also contributed, “so that created a perfect storm, really”.

“The NHS actually worked very hard to provide a mixture of online and in person treatment [during the pandemic], but as you can see from the children’s commissioner, that increased number of appointment hasn’t been sufficient to meet the demand.”

What needs to change?

There is no question services are doing what they can to meet demand, says Ayton, “but they will need more investment to make sure they meet the targets”. That doesn’t just mean funding treatment, but also prevention and – crucially – research into the causes and most effective interventions, much of which remains under explored.

There is some research to suggest school-based interventions can be helpful in preventing the disease, says Ayton, though she believes these lessons should be carefully tied in with messaging on obesity, which some warn can ironically be counterproductive. There are no easy answers here.

More funding for early interventions is clearly very important. Patients also need the correct treatment once they have been admitted to hospital, Ayton says; the RCP has prepared guidelines to help acute hospitals dealing with emergency admissions. And she also points out that while services for children are critically important, that should not be at the expense of those over 18, whose waiting times for treatment are not monitored, she says. “Unfortunately, eating disorders don’t go away at 18.”

Beat’s director of external affairs, Tom Quinn, agrees that research is critical. “Obviously, that won’t lead to immediate change. But in the long term, the more we know about what causes of eating disorders and the best ways to treat them, the quicker it will be to identify people who might be at risk and the sooner we can help people. That’s vital.”

What should I do if I’m worried?

“The message has to be the importance of asking for help quickly”, says Quinn. A key part of his organisation’s role, he says, is in helping people identify that they have an eating disorder, and understanding the best way to ask for help – which usually starts with talking to their GP.

However long sufferers may have to wait to be treated once they are in the system, he points out, the biggest delay to people actually getting help comes at the stage between the onset of the illness and their recognition that they need help. “So obviously, the shorter that time frame can be – where people recognise they might have a problem and seek help – the better.”

For more resources, Beat has this directory of eating disorder support services in the UK, and also runs helplines across the four UK nations. The RCP also has helpful resources for children and young people and their families.

In the US, more resources are available from the National Eating Disorders Association.

In Australia, contact Butterfly.

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