Eating disorders and psychiatry: past, present, and future

Eating disorders (EDs) are complex conditions at the interface of mental and physical health, associated with high morbidity, mortality, and chronic disability. Historically, ED psychiatry has shifted from early medical observation to psychiatric formulation and, more recently, to psychology- and nursing-led service models. Despite advances in evidence-based psychological therapies and community expansion, outcomes remain modest and access to treatment is limited. Recent workforce growth centred on allied health professionals has not been paralleled by investment in psychiatric training, academic capacity, or consultant posts, resulting in limited specialist expertise. This imbalance has produced fragmented care and a two-tier system in which child and adolescent services have advanced while adult provision remains critically underfunded. Future progress will depend on revitalising eating-disorder psychiatry through sustained investment in training, workforce, and translational research. Integrating metabolic psychiatry, neurobiology, behavioural science, and digital health offers a path toward comprehensive, equitable, and improved treatments.