Patients with eating disorders less likely to be referred if they are not underweight, study suggests

People with eating disorders are less likely to be referred for specialist treatment if they are not underweight, according to new research, raising concerns that some patients may face delays in receiving appropriate care.

The study, published in BMJ Open, analysed electronic health records from primary care in England and found that body mass index (BMI) influenced referral decisions, despite eating disorders affecting people across the full range of body weights. Compared with people of a healthy weight, those who were underweight were significantly more likely to be referred to specialist eating disorder services, while people who were overweight or living with obesity were less likely to receive a referral.

Researchers said the findings suggest that some patients may not be accessing specialist support because eating disorders are still being associated with being visibly underweight. They stressed that serious eating disorders can occur regardless of a person’s weight and that early intervention is critical to improving outcomes.

The study also identified disparities in referrals between ethnic groups, with people from Black and Asian backgrounds less likely to be referred for specialist treatment than White patients, even after accounting for diagnosis and BMI. The authors say these inequalities warrant further investigation to ensure equitable access to care.

The findings reinforce existing NHS guidance, which advises clinicians not to rely on BMI alone when assessing eating disorders. Earlier guidance from NHS England emphasised that weight should not be a barrier to referral and encouraged healthcare professionals to consider behavioural changes, psychological symptoms and concerns raised by patients or their families when deciding whether specialist assessment is needed.

Around 1.25 million people in the UK are estimated to be living with an eating disorder. Experts say recognising symptoms early and ensuring timely access to specialist services remain key priorities for improving patient outcomes.

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