Unmet need in adolescent eating disorder services: a comparative analysis

Abstract Background Recent evidence shows a significant rise in prevalence of eating disorders among young people, especially since COVID-19. Traditionally linked to teenage girls and affluent backgrounds, eating disorders now appear to affect broader demographics. We explored unequal access to eating disorder services among secondary school age adolescents. Methods We used data from the 2023 wave of the national OxWell survey of adolescent mental health, collected in secondary schools in Liverpool, UK (N = 11,000.) We compared these to all 41,000 adolescents registered with Liverpool doctors and born between 09/2004-08/2011 (UK secondary school ages.) We compared standardized counts of pupils who screened positive for possible eating disorders using the Development and Well-Being Assessment (Eating Disorders) tool in OxWell with those of adolescents either referred or in contact with NHS specialised eating disorders services. We modelled access relative to need using the ratio between counts of young people accessing services and those in the survey. To investigate disparities in access, we used a lagged Poisson regression model with predictors: sex, school-year, deprivation, and ethnicity. Results The ratio between access to NHS services and in the OxWell survey indicated marked disparities. Boys (OR = 0.23, 95% CI = (0.15-0.36)), younger school children (years 7-9) (OR = 0.32, 95% CI = (0.16-0.65)), and the most deprived 20% of the population (OR = 0.66, 95% CI = (0.49-0.89)), exhibited the highest unmet needs. Conclusions The findings reveal significant inequalities in access to eating disorder services. This study highlights substantial unmet needs among boys, younger children and more deprived groups. Services need to shift to earlier recognition and intervention and increased awareness of different presentations of eating disorders. Further research is needed to explore specific cultural barriers to access to develop appropriate interventions. Key messages • The findings reveal significant inequalities in access to eating disorder services. This study highlights substantial unmet needs among boys, younger children and more deprived populations. • Earlier intervention, increased recognition of different presentations and tailored, culturally-sensitive strategies are crucial to address these disparities and prevent escalation.