Bould, H

Lewis, G

Lloyd, EC

Solmi, F

English

UCL Discovery

1 Word count: 760 1 On the limited visibility of eating disorders research 2  3 Eating disorders affect up to 5% of the population at any point in time, and place an enormous 4 physical, psychological, and financial burden on both individuals who are affected and their 5 families. On average, only 50% of people with an eating disorder make a full recovery1, and 6 anorexia nervosa has one of the highest mortality rates of all psychiatric disorders.2  It is 7 estimated that eating disorders cost between £3.9 and £4.6 billion per year to the National 8 Health Service (NHS) and result in losses of between £6.8 and £8 billion to the economy.3  If 9 we are to address this major public health problem, we need to understand the aetiology of 10 eating disorders and gather evidence for effective treatments.  However, eating disorders 11 research is remarkably scant. The most recent National Institute for Care Excellence (NICE) 12 guidelines on the recognition and treatment of eating disorders4 find that the evidence-base 13 for both psychological and pharmacological therapies currently used to treat eating disorders 14 relies on a few small studies, and that many areas remain under-researched.  15  16 To quantify the magnitude of the disparity between research on eating disorders and other 17 mental illnesses, we searched Web of Science for papers mentioning eating disorders in their 18 title (“anorexia nervosa” OR “bulimia nervosa” OR “binge eating disorder” OR “binge eating” 19 OR “eating disorders” OR “disordered eating”) and found that, in 2018, only 1,390 studies 20 were published. This figure stands in stark contrast to 9,064 studies on mood disorders 21 (“depression” OR “depressive symptoms”); 6,121 on psychosis (“schizophrenia” OR 22 “psychosis” OR “psychotic symptoms” OR “psychotic experiences” OR “negative symptoms”); 23 4,596 on neurodevelopmental disorders (“ADHD” OR “attention deficit hyperactive disorder” 24 OR“ASD” OR “autism spectrum disorders” OR “autism” OR “autistic traits”), and 1,610 on 25 bipolar disorder (“bipolar disorder” OR “mania” OR “hypomania”).  26  27 An additional factor hindering progress in understanding and treating eating disorders is that 28 the available research base lacks visibility. To quantify this, we explored how often eating 29 disorder research is featured in the highest impact factor psychiatry journals. We found that 30 compared to other psychiatric conditions, the latter publish fewer papers researching eating 31 disorders, both in absolute and relative terms, despite having featured several letters and 32 2 articles calling for the need of more research in this field.5,6 We (FS, ECL) hand-searched all 33 2018 issues of the top five psychiatry journals (by impact factor)a yielding a total of 443 new 34 research articles. Of these, only 3 (0.7%) featured research focused solely on eating disorders, 35 as opposed to 89 (20.1%) on schizophrenia, 79 (17.8%) on depression, 26 (5.9%) on bipolar 36 disorder, and 36 (8.1%) on neurodevelopmental disorders. Of all the papers on eating 37 disorders published in 2018, only 0.2% were published in the top psychiatry journals, 38 compared to 0.9% of those on depression, 1.5% of those on schizophrenia, 1.6% of those on 39 bipolar disorder, and 0.8% of those on neurodevelopmental disorders.  40  41 The lower number of eating disorder research papers published annually compared to other 42 conditions might reflect the low levels of funding they receive, documented in the recent MQ 43 reports on research funding in mental health.7 However, it is unlikely that this alone would 44 explain the lower relative number of eating disorder studies published in major journals. We 45 believe that this disparity is indicative of the marginalization of eating disorders amongst 46 mental health researchers and professionals. Eating disorders are more common in women 47 and are characterised by the presence of intense body image concerns and disordered eating 48 behaviours often, but not always, aimed at weight loss. A number of studies have shown that, 49 because of these characteristics, they are stigmatised, by the general population,8 but also  50 by professionals.9 In the UK, medical students receive minimal training on eating disorders10 51 and questions on eating disorders are often omitted from large population studies. The failure 52 to include questions on eating disorders in the 2014 UK Adult Psychiatry Morbidity Survey not 53 only represents a missed opportunity to obtain up to date prevalence figures on these 54 conditions, but also sent an erroneous message to the research community that eating 55 disorders are not as important as other psychiatric disorders.  56  57 Over the past few years, funding bodies such as the Medical Research Council/Medical 58 Research Foundation have introduced funding calls targeted at eating disorder research. 59 Increased investment in research into eating disorders is welcome and much needed, and will 60 eventually lead to improvements in services and treatment effectiveness. However, these 61 initiatives alone are unlikely to close the current large gap in eating disorder research outputs 62                                                  a JAMA Psychiatry, Molecular Psychiatry, World Psychiatry, The American Journal of Psychiatry, The Lancet Psychiatry.  3 and visibility, until we stop viewing eating disorders as a ‘niche specialty’ within psychiatry 63 and grant them ‘parity of esteem’ with other psychiatric disorders.  64  65  66 Authors 67 Francesca Solmi PhD1, Helen Bould PhD2,3, E. Caitlin Lloyd PhD4,5,6, Glyn Lewis PhD1 68  69 1 Division of Psychiatry, University College London, London, UK 70 2 Centre for Academic Mental Health, Population Health Science, University of Bristol, Bristol, 71 UK  72 3 Gloucestershire Health and Care NHS Foundation Trust  73 4 Centre for Exercise, Nutrition and Health Sciences, School of Policy Studies, University of 74 Bristol, Bristol, United Kingdom 75 5 Department of Psychiatry, Columbia University Irving Medical Center, New York, New York 76 6 Department of Psychiatry, New York State Psychiatric Institute, New York, New York 77  78  79 Corresponding author:  80 Francesca Solmi, PhD 81 UCL Division of Psychiatry 82 Wing B, 6th Floor, Maple House, 83 149 Tottenham Court Road,  84 London, W1T 7NF 85 Email: francesca.solmi@ucl.ac.uk  86 Phone: +44(0)2076799643 87  88 Declaration of interest:  89 The authors have no conflicts of interest to declare.  90  91   92 4 References 93 1 Mairs R, Nicholls D. Assessment and treatment of eating disorders in children and 94 adolescents. Arch. Dis. Child. 2016. DOI:10.1136/archdischild-2015-309481. 95 2 Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia 96 nervosa and other eating disorders: A meta-analysis of 36 studies. Arch Gen 97 Psychiatry 2011; 68: 724–31. 98 3 BEAT. 34% of adults unable to name any signs or symptoms of eating disorders. 2018. 99 https://www.beateatingdisorders.org.uk/news/adults-unable-name-signs-symptoms. 100 4 NICE. Eating Disorders: recognition and treatment Appendix P: Health economic 101 evidence – evidence tables. 2017. 102 5 Schmidt U, Adan R, Böhm I, et al. Eating disorders: the big issue. The Lancet 103 Psychiatry 2016; 3: 313–5. 104 6 Murray SB, Pila E, Griffiths S, Le Grange D. When illness severity and research dollars 105 do not align: are we overlooking eating disorders? World Psychiatry. 2017; 16: 321. 106 7 MQ. UK Mental Health Research Funding 2014-2017. 2019. 107 8 Mond JM, Robertson-Smith G, Vetere A. Stigma and eating disorders: Is there 108 evidence of negative attitudes towards anorexia nervosa among women in the 109 community? J Ment Heal 2006; 15: 519–32. 110 9 McNicholas F, O’Connor C, O’Hara L, McNamara N. Stigma and treatment of eating 111 disorders in Ireland: healthcare professionals’ knowledge and attitudes. Ir J Psychol 112 Med 2016; 33: 21–31. 113 10 Ayton A, Ibrahim A. Does UK medical education provide doctors with sufficient skills 114 and knowledge to manage patients with eating disorders safely? Postgrad Med J 115 2018; 94: 374–80. 116  117 

The shrouded visibility of eating disorders research

https://discovery.ucl.ac.uk/id/eprint/10119426/1/Solmi_The%20shrouded%20visibility%20of%20eating%20disorders%20research_AAM.pdf

The shrouded visibility of eating disorders research

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