National Eating Disorders Association

Why Early Intervention for Eating Disorders is Essential

Megan Jones, PsyD, and Tess Brown

Treatment works best when delivered early. 

Research on treatments for eating disorders, as well as most mental health problems in general, indicates that early identification and treatment improves the speed of recovery, reduces symptoms to a greater extent and improves the likelihood of staying free of the illness. For example, when adolescents with anorexia nervosa are given family-based treatment within the first three years of the illness onset they have a much greater likelihood of recovery (Lock, Agras, Bryson, & Kraemer, 2005; Loeb et al., 2007; Russell, George, Dare, & Eisler, 1987; Treasure & Russell, 2011).

Early intervention helps prevent serious psychological and health consequences.

Eating disorders have the highest mortality rate of any mental health illness. Eating disorders are unique among mental health disorders in that they manifest in physical health complications, which can lead to serious and life-threatening illnesses such as diabetes, cancer, organ failure and even death if not treated. Anorexia nervosa is the third most common chronic illness among adolescents. Young women who suffer from this illness have a mortality rate that is 12 times higher than average, making it the mental health illness with the highest premature mortality rate. If left untreated, eating disorders tend to become more severe and less receptive to treatment (Becker, Franko, Nussbaum, & Herzog, 2004; Fichter, Quadflieg, & Hedlund, 2006). 

It is important to acknowledge that developing an eating disorder is not a conscious choice. People suffering from eating disorders often do not understand the severity of their illness and are thus reluctant to seek help. It is critical to pursue early intervention strategies, such as education and screening, to prevent chronic malnutrition, long-term health complications and death. In other words, detecting and treating eating disorders as soon as possible has the potential to save lives.

In many cases, eating disorders can be prevented.

One of the biggest sparks of hope in eating disorders research is that some eating disorders can be prevented through in-person and online programs. Two examples of programs that have been shown to prevent eating disorder onset in at-risk groups are The Body Project and Healthy Body Image Program (StudentBodies). 

Widespread screening improves access to early intervention. 

Early interventions should start with education and screening . Screening is not intended to be diagnostic, but rather, to help identify individuals who are at-risk for or may be experiencing eating disorders and to provide information about appropriate resources. Diagnosis of an eating disorder should be done by a mental health professional, and ideally, an eating disorders specialist. This is important because treatment for eating disorders should involve a medical professional (e.g., primary care physician, family medicine, adolescent medicine specialist or pediatrician)—and ideally also one who specializes in eating disorders. 

Eating disorders screening is important across multiple settings: middle and high schools, colleges and universities, pediatrics and primary care and within employee wellness programs (just to name a few). 

The majority of eating disorders develop during adolescence and young adulthood, making screening during this period particularly critical for early intervention. Much research has focused on college students; college campuses are an ideal avenue to maximize prevention and test treatment approaches, as they are an environment conducive to spreading information quickly through a surplus of channels. The typical onset period for eating disorders coincides with early college ages, and studies have identified a wide treatment gap on college campuses: 80% of students with clinically significant symptoms do not receive care (Eisenberg et al., 2011). Students with subclinical symptoms are even less likely to seek help, which evolves into more serious disordered eating, a poorer prognosis and an increased chance of relapse (Yager et al., 2006). Tactics to encourage people to seek help have typically focused on minimizing stigma, improving knowledge and access and addressing other barriers emphasized by traditional theories of health behavior (Biddle, Donovan, Sharp, & Gunnell, 2007). However, the majority of students with ED symptoms report not seeking help for other reasons such as a lack of time, lack of recognition and a desire to deal with the issue “on my own” (Lipson et al. in press). Therefore, research suggests that early intervention strategies should focus on initiatives that educate and engage students about the severity of EDs by providing convenient, relevant and action-oriented options. (Check out more information on NEDA’s college campus initiative, Proud2Bme On Campus .)

Online, campus-wide screenings upon college enrollment is one strategy to reach students who are unaware of the severity of the illness and/or those who wish to handle the disease independently. These screenings serve as a gateway for students to learn more about eating disorders, and also as a means to get the best treatment associated with their level of risk. Connecting eating disorder screening to specific resources tailored to the individual’s needs improves access to care and facilitates early intervention.

Eliminating stigma and raising awareness are important measures to initiate conversations, encourage further research development and influence prevention policies. However, early detection and screening may have the most significant life-saving impact. We should collectively focus our efforts to promote online screening tools that touch as many potentially at-risk people as possible to build a road to recovery.