The term ‘under-served’ groups was developed by the NIHR (National Institute of Health Research - UK) - Include project to highlight that some groups of people are included in health research less often than one would expect based on their population prevalence or health care needs/burden. As a result, there is much less information on the treatment and service needs of these individuals. There is no single definition of what is 'under-served', rather this is highly context-specific.
Here, based on consensus between eating disorders clinicians and researchers we have chosen to include the following groups: people from ethnically and culturally diverse communities, men, members of the LGBTQ+ community, people with poverty/food insecurity, older adults, people with eating disorders and diabetes and those with ARFID. We have presented these here as separate groups, but are aware that there is significant overlap or intersectionality between several of these.
Under-served groups in context (epidemiology; help-seeking, identification)
- Bryant E, Spielman K, Le A, Marks P; National Eating Disorder Research Consortium; Touyz S, Maguire S. Screening, assessment and diagnosis in the eating disorders: findings from a rapid review. J Eat Disord. 2022 Jun 7;10(1):78. doi: 10.1186/s40337-022-00597-8. PMID: 35672777; PMCID: PMC9175461
- Eating Disorders and Marginalised Voices, The National Eating Disorders Association (NEDA)
- Hay P, Aouad P, Le A, Marks P, Maloney D; National Eating Disorder Research Consortium; Touyz S, Maguire S. Epidemiology of eating disorders: population, prevalence, disease burden and quality of life informing public policy in Australia-a rapid review. J Eat Disord. 2023 Feb 15;11(1):23. doi: 10.1186/s40337-023-00738-7. PMID: 36793104; PMCID: PMC9933292.
Eating disorders in ethnically and culturally diverse communities
Overviews and intersectionality
- Acle A, Cook BJ, Beasley T (2021). Cultural Considerations in the Treatment of Eating Disorders among Racial/Ethnic Minorities: A Systematic Review. Journal of Cross-Cultural Psychology, 52, 468-488.
- Becker, A., Franko, D., Speck, A. and Herzog, D., 2003. Ethnicity and differential access to care for eating disorder symptoms. International Journal of Eating Disorders, 33(2), pp.205-212
- Burke NL et al. (2022). Socioeconomic status and eating disorder prevalence: at the intersections of gender identity, sexual orientation, and race/ethnicity. Psychological Medicine, online ahead of print
- Goeree, M., Ham, J. and Iorio, D., 2011. Race, Social Class, and Bulimia Nervosa. IZA Discussion Paper, 5823
- Goode RW, Webster CK, Gwira RE. A Review of Binge-Eating Disorder in Black Women: Treatment Recommendations and Implications for Healthcare Providers. Curr Psychiatry Rep. 2022 Dec;24(12):757-766. doi: 10.1007/s11920-022-01383-8. Epub 2022 Nov 12. PMID: 36370263; PMCID: PMC9789195.
- Islam and Eating Disorders
- Marisol Perez, Ana L. Ramirez & Eva Trujillo-ChiVacuán (2019) An introduction to the special issue on the state of the art research on treatment and prevention of eating disorders on ethnic minorities, Eating Disorders, 27:2, 101-109, DOI: 10.1080/10640266.2019.1583966
- Small, Charlynn, and Mazella Fuller. Treating Black Women with Eating Disorders : a Clinician’s Guide / Edited by Charlynn Small and Mazella Fuller. New York: Routledge, Taylor & Francis Group, 2020. DOI: 10.4324/9781003011743
- Sun V, Soh N, Touyz S, Maguire S, Aouad P. Asian students in the anglosphere - unravelling the unique familial pressures contributing to eating pathology: a systematic review. J Eat Disord. 2023 Jan 10;11(1):4. doi: 10.1186/s40337-023-00733-y. PMID: 36627676; PMCID: PMC9832817.
- Abbas, S., Damani, S., Malik, I., Button, E., Aldridge, S. and Palmer, R.L. (2010), A comparative study of South Asian and non-Asian referrals to an eating disorders service in Leicester, UK European Eating Disorders Review, Vol. 18 No. 5, pp. 404-9.
- Channa, S., Lavis, A., Connor, C. et al. Overlaps and Disjunctures: A Cultural Case Study of a British Indian Young Woman’s Experiences of Bulimia Nervosa. Cult Med Psychiatry 43, 361–386 (2019).
- Eating Disorders within BAME (Black, Asian and Minority Ethnic) Communities’ Year: 2020
- Sinha, Sarmila, and Nasir Warfa. (2013) "Treatment of eating disorders among ethnic minorities in western settings: A systematic review." Psychiatr Danub 25.Suppl 2: 295-299.
- Solmi, F., Hatch, S.L., Hotopf, M., Treasure, J. and Micali, N. (2014), Prevalence and correlates of disordered eating in a general population sample: the South East London community (SELCoH) study”, Social Psychiatry and Psychiatric Epidemiology, Vol. 49 No. 8, pp. 1335-46.
- Wales J, Brewin N, Raghavan R and Arcelus J (2017) Exploring Barriers to South Asian Help-Seeking for Eating Disorders, Mental Health Review Journal, 22 (1), pp. 40-50
- Waller, G., Schmidt, U., Treasure, J., Emanuelli, F., Alenya, J., Crockett, J., Murray, K. (2009). Ethnic origins of patients attending specialist eating disorders services in a multi-ethnic urban catchment area in the United Kingdom. International Journal of Eating Disorders, 42(5), 459-463.
- Young Minds – 'Eating Disorders are Black women’s issues too’
- Cheng, H. L., Tran, A. G., Miyake, E. R., & Kim, H. Y. (2017). Disordered eating among Asian American college women: A racially expanded model of objectification theory. Journal of counseling psychology, 64(2), 179.
- Cheng, H. L. (2014). Disordered Eating Among Asian/Asian American Women Racial and Cultural Factors as Correlates. The Counseling Psychologist, 42(6), 821-851
- Cheng ZH, Perko VL, Fuller-Marashi L, Gau JM, Stice E. Ethnic differences in eating disorder prevalence, risk factors, and predictive effects of risk factors among young women. Eat Behav. 2019 Jan;32:23-30. doi: 10.1016/j.eatbeh.2018.11.004. Epub 2018 Nov 23. PMID: 30529736; PMCID: PMC6382562.
- Goode, Rachel & Cowell, Mariah & Mazzeo, Suzanne & Cooper‐Lewter, Courtney & Forte, Alexandria & Olayia, Oona‐Ifé & Bulik, Cynthia. (2020). Binge eating and binge‐eating disorder in Black women: A systematic review. International Journal of Eating Disorders. 53. 10.1002/eat.23217.
- Gordon KH, Brattole MM, Wingate LR, Joiner TE Jr. The impact of client race on clinician detection of eating disorders. Behav Ther. 2006 Dec;37(4):319-25. doi: 10.1016/j.beth.2005.12.002. Epub 2006 Jul 21. PMID: 17071210.
- Kanakam, N. Therapists’ Experiences of Working with Ethnic Minority Females with Eating Disorders: A Qualitative Study. Cult Med Psychiatry 46, 414–434 (2022). https://doi.org/10.1007/s11013-021-09721-w
- Doris, E., Shekriladze, I., Javakhishvili, N., Johnes, R., Treasure, J., & Tchanturia, K. (2015). Is cultural change associated with eating disorders? A systematic review of the literature. Eating and Weight Disorders, 20(2), 149–160.
- Shekriladze, I & Tchanturia, Kate. (2017). Acculturation to Western Culture in the Context of Eating Disorders. 10.1007/978-981-287-104-6_204.
- Burke, N.L., Schaefer, L.M., Hazzard, V.M. and Rodgers, R.F., 2020. Where identities converge: The importance of intersectionality in eating disorders research. International Journal of Eating Disorders, 53(10), pp.1605-1609.
- Burnette CB, Luzier JL, Weisenmuller CM, Boutté RL.(2022) A systematic review of sociodemographic reporting and representation in eating disorder psychotherapy treatment trials in the United States. Int J Eat Disord. 55(4):423-454. doi: 10.1002/eat.23699. Epub 2022 Mar 14. PMID: 35288967; PMCID: PMC8988395.
Eat Well guides for different populations
Further under-served groups
Men with eating disorders
- Beat 'Do Men Get Eating Disorders?'
- Brown TA, Keel PK. Eating Disorders in Boys and Men. Annu Rev Clin Psychol. 2022 Feb 3. doi: 10.1146/annurev-clinpsy-080921-074125. Epub ahead of print. PMID: 36737595.
- Bunnell, D. W., & Maine, M. (2014). Understanding and treating males with eating disorders. In L. Cohn & R. Lemberg (Eds.), Current findings on males with eating disorders (pp. 168–182). Routledge/Taylor & Francis Group.
- Coffino et al. (2019). Rates of help-seeking in US adults with lifetime DSM-5 eating disorders: Prevalence across diagnoses and differences by sex and ethnicity/race. Mayo Clinic Proceedings, 94, 1415-1426.
- 'Consider Eating Disorders in Men' - free online course (accredited by RCGP)
- EDIFY PaperMate: Dr Una Foye and Professor Heike Bartel on their new paper: ”It’s a touchy subject”: Service providers’ perspectives of eating disorders in men and boys’
- MacNeil, B.A., Hudson, C.C. & Leung, P. It’s raining men: descriptive results for engaging men with eating disorders in a specialized male assessment and treatment track (MATT). Eat Weight Disord 23, 817–824 (2018). https://doi.org/10.1007/s40519-018-0586-y
- MGEDT website
- Morgan JF (2008) The Invisible Man. A self-help guide for men with eating disorders, compulsive exercise and bigorexia. London: Routledge.
- Pope HG, Phillips KA & Olivardia R (2000) The Adonis Complex: How to identify, treat and prevent body obsession in men and boys. New York: Touchstone.
- Storther E, Lemberg R, Stanford SC, Turberville, D. Eating Disorders in Men: Underdiagnosed, Undertreated, and Misunderstood. Eat Disord. 2012 Oct; 20(5): 346–355.
- University of Nottingham 'Hungry for Words: Creative approaches to start the conversation about eating disorders in men'
People with food insecurity and eating disorders
- Becker, C., Middlemass, K., Gomez, F. and Martinez-Abrego, A., 2019. Eating Disorder Pathology Among Individuals Living With Food Insecurity: A Replication Study. Clinical Psychological Science, 7(5), pp.1144-1158.
- Hazzard, V. M., Loth, K. A., Hooper, L., & Becker, C. B. (2020). Food insecurity and eating disorders: A review of emerging evidence. Current Psychiatry Reports, 22, 1-9.
- Zickgraf, H. F., Hazzard, V. M., & O'Connor, S. M. (2022). Food insecurity is associated with eating disorders independent of depression and anxiety: Findings from the 2020–2021 Healthy Minds Study. International Journal of Eating Disorders, 55(3), 354-361.
Members of the LGBTQIA+ community with eating disorders
- Beat ‘Eating disorders in the LGBTQ+ community’
- Cao Z, Cini E, Pellegrini D, Fragkos KC. The association between sexual orientation and eating disorders-related eating behaviours in adolescents: A systematic review and meta-analysis. Eur Eat Disord Rev. 2023 Jan;31(1):46-64. doi: 10.1002/erv.2952. Epub 2022 Nov 11. PMID: 36367345.
- LBGT Action Plan: Improving The Lives of Lesbian, Gay, Bisexual and Transgender People. Government Equalities Office.
- Nagata JM et al. (2020). Emerging trends in eating disorders among sexual and gender minorities. Current Opinion Psychiatry, 33, 562-567.
- O'Flynn JL, Nowicki GP, Laveway K, Gordon AR, Rodgers RF. Toward inclusivity: A systematic review of the conceptualization of sexual minority status and associated eating disorder outcomes across two decades. Int J Eat Disord. 2023 Feb;56(2):350-365. doi: 10.1002/eat.23830. Epub 2022 Nov 2. PMID: 36321787.
- Parker, L.L., Harriger, J.A. Eating disorders and disordered eating behaviors in the LGBT population: a review of the literature. J Eat Disord 8, 51 (2020).
- RCPsych. Supporting transgender and gender-diverse people. Position statement. 2018.
- Riddle, M. C., Robertson, L., Blalock, D. V., Duffy, A., Le Grange, D., Mehler, P. S., Rienecke, R. D., & Joiner, T. (2022). Comparing eating disorder treatment outcomes of transgender and nonbinary individuals with cisgender individuals. International Journal of Eating Disorders, 55( 11), 1532– 1540.
Older adults with eating disorders
- Disordered Eating in Older Adults in Care Homes, OHID and Yorkshire and the Humber Clinical Networks, April 2023
- Eating Disorders in Older Adults, OHID and Yorkshire and the Humber Clinical Networks, March 2022
- Mulchandani, M., Shetty, N., Conrad, A. et al. Treatment of eating disorders in older people: a systematic review. Syst Rev 10, 275 (2021).
- Older people have eating disorders too but they're a largely ignored group, The Conversation
Diabetes and eating disorders
- Diabulimia and Diabetes, Diabetes UK
- ‘Eating Disorders and the Patient with Diabetes’, National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
- Medical Emergencies in Eating Disorders (MEED): Guidance on Recognition & Management. Annexe 3: Type 1 diabetes and eating disorders (T1DE)
- NICE. Type 1 Diabetes in Adults: Diagnosis and Management. CG17. London: NICE; 2015.
- Peveler RC, Fairburn CG (1992) The treatment of bulimia nervosa in patients with diabetes mellitus. International Journal of Eating Disorders, 11(1): 45-53.
- Swimming with the T1DE, All Wales Diabetes Implementation Group (AWDIG), NHS Wales Health Collaborative, Cardiff and Vale UHB Psychology department, and funded by Public Health Wales NHS Trust
- Type 1 diabetes and eating disorders - JDRF, the type 1 diabetes charity
- ‘Type 1 Diabetes with Disordered Eating (T1DE)’, NHS King’s College Hospital NHS Foundation Trust
- ‘Type 1 Diabetes and Disordered Eating’, Beat
- Tan J, Johns G. The Welsh Eating Disorder Service Review 2018, Scottish Eating Disorder Service Review 2021 and recommendations of best practice in comorbid eating disorders and diabetes. Clin Child Psychol Psychiatry. 2021 Jul;26(3):595-605. doi: 10.1177/13591045211013855. Epub 2021 Jun 11. PMID: 34116593.
ARFID in adults
- Bourne L, Bryant-Waugh R, Cook J, Mandy W. Avoidant/restrictive food intake disorder: A systematic scoping review of the current literature. Psychiatry Res. 2020 Jun;288:112961. doi: 10.1016/j.psychres.2020.112961. Epub 2020 Apr 4. PMID: 32283448.
- Bryant-Waugh, R., & Higgins, C. (2020). Avoidant restrictive food intake disorder in childhood and adolescence: A clinical guide. Routledge.
- Cognitive Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder (CBT-AR): Patient and Family Workbook. Based on this book: Thomas, J.J. and Eddy, K.T. (2019). Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, Adolescents, & Adults. Cambridge: Cambridge University Press
- Kambanis PE, Thomas JJ. Assessment and Treatment of Avoidant/Restrictive Food Intake Disorder. Curr Psychiatry Rep. 2023 Feb;25(2):53-64. doi: 10.1007/s11920-022-01404-6. Epub 2023 Jan 14. PMID: 36640211.
- Thomas J et al. (2021). Cognitive-behavioral therapy for adults with avoidant/restrictive food intake disorder. Journal of Behavioral and Cognitive Therapy, 31, 47-55.
- Thomas JJ, Lawson EA, Micali N, Misra M, Deckersbach T, Eddy KT. Avoidant/Restrictive Food Intake Disorder: a Three-Dimensional Model of Neurobiology with Implications for Etiology and Treatment. Curr Psychiatry Rep. 2017 Aug;19(8):54. doi: 10.1007/s11920-017-0795-5. PMID: 28714048; PMCID: PMC6281436.
This content has been edited by Professor Ulrike Schmidt (MindEd Lead Editor and Professor SLAM/KCL) and Dr Raphael Kelvin MindEd Consortium Clinical Lead) with close support of:
- Elizabeth Dodge, MSc, Family Therapist
- Dr Karina Allen, Consultant Clinical Psychologist - Eating Disorders Outpatients Service | South London and Maudsley NHS Foundation Trust
- Dr Nikola Kern, SLAM ED Services/KCL
- Dr Sheryllin McNeil, Consultant Clinical Psychologist, Specialist Eating Disorder Service, Forward Thinking Birmingham
- Dr Suzanne Heywood Everett, Consultant Clinical Psychologist, Bradford District Care NHS Foundation Trust, Clinical Associate for Eating Disorders for Yorkshire and Humber Clinical Network, NHS England
- Dr William Rhys Jones, Consultant Psychiatrist - CONNECT: The West Yorkshire, Adult Eating Disorders Service
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