NHD PAEDIATRIC HUB FACT FILE
Tackling anorexia: medical insights and public health strategies
An estimated 1.25 million people in the UK are currently living with an eating disorder, with approximately 10% of those affected being diagnosed with anorexia nervosa (AN).
Research shows that 10–25% of individuals with AN are male, and referrals for adolescents have risen sharply since the COVID-19 pandemic.
This highlights both a growing prevalence and a pressing need for an improved early intervention and tailored support (BEAT eating disorders).
AN is a serious mental health disorder characterised by:
Intentional restriction of food intake, leading to significantly low body weight.
Intense fear of gaining weight or becoming fat.
Distorted body image — the person sees themselves as overweight even when dangerously underweight.[1]
It is one of the most common eating disorders and has one of the highest mortality rates among psychiatric disorders due to both medical complications and suicide.[2]
Types of anorexia nervosa:
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), AN is classified into two main subtypes:
1. Restricting type:
Weight loss is primarily achieved through dieting, fasting, or excessive exercise. [1] There are no regular episodes of binge eating or purging, but rigid control over food intake. It is common in early stages or in younger adolescents.
Binge eating/purging type:
The individual engages in recurrent episodes of binge eating or purging behaviours (such as self-induced vomiting, misuse of laxatives, diuretics or enemas). It could be harder to detect due to secrecy and shame.
*Additionally, Avoidant/Restrictive Food Intake Disorder (ARFID) is often confused with AN in children. While not technically anorexia nervosa, ARFID involves restricted eating that leads to nutritional deficiency, though it's not driven by body image concerns. This distinction is crucial for appropriate treatment.
Signs and symptoms:
Although commonly associated with adolescence, the average age of onset is dropping, and UK clinicians report seeing children as young as eight presenting with symptoms.[3]
Not every child who diets has an eating disorder, but early vigilance can save lives. if in doubt, trust your instincts and seek help early. GPs can make referrals to CAMHS or specialist services.[4]
Causes:
AN is rarely caused by a single factor. Instead, it usually results from a combination of influences which can be broadly categorised as:
1. Biological factors
Genetics:
A family history of eating disorders, depression or anxiety.5
Brain chemistry:
Imbalances in neurotransmitters such as serotonin may affect mood, impulse control, and appetite.6
Puberty:
Hormonal changes during adolescence.
2. Psychological factors
Perfectionism:
Many children with anorexia have high-achieving, perfectionist personalities.[7]
Low self-esteem:
A negative self-image can be a powerful trigger.[8]
Control Issues
For some children, controlling food becomes a way to cope with anxiety or chaos in their lives.
3. Environmental and social factors
Peer pressure:
Bullying or comments about weight can significantly impact a child's self-perception.[8]
Media influence:
Exposure to unrealistic body standards through social media and advertising.[9]
Family dynamics:
High parental expectations, criticism, or dysfunctional family relationships.[10]
Trauma or abuse:
A history of physical, emotional, or sexual abuse.[11]
Major life changes:
Events like divorce, moving, or academic transitions can act as stressors.
4. Environmental and Social Factors
Early dieting:
Bullying or comments about weight can significantly impact a child's self-perception.[8]
Sports and activities:
Participation in activities that emphasise weight (eg, ballet, gymnastics, athletes).[12]
Treatment and Support in the UK:
In the UK, treatment for AN in children is primarily provided through the NHS, via Child and Adolescent Mental Health Services (CAMHS) and specialist community eating disorder services (CEDS-CYP). Early intervention is key and can significantly improve outcomes.
The gold standard: Family-Based Treatment (FBT):
Also known as the Maudsley Approach, FBT involves parents taking an active role in helping their child eat and regain weight, gradually transitioning eating responsibility back to the child.[13]
Hospitalisation:
Children may be hospitalised in severe cases (eg, very low BMI, medical instability) either in paediatric wards or specialist inpatient eating disorder units (such as the South London and Maudsley Trust).
Other therapies may include:
Cognitive behavioural therapy – Enhanced (CBT-E): Targets disordered thinking patterns. Especially helpful for teens.
Nutritional rehabilitation and dietetic support.
Monitoring of physical health to prevent complications like heart arrhythmias or osteoporosis.
Medication, such as SSRIs, is only used to treat co-existing conditions like anxiety or depression, not AN itself.[14]
Prevention
Government action plans:
1. Major Research Funding & Initiatives
In June 2023, UK funders — including the AHRC, ESRC, MRC, NIHR, and the Medical Research Foundation — jointly committed £4.25 million to new interdisciplinary research on eating disorders across the UK.[15]
The NIHR Maudsley Biomedical Research Centre has led a systematic programme since 2022, generating evidence-based interventions, like MANTRA and ECHO, now incorporated into NHS and NICE treatment guidelines.[16]
Other ongoing research includes the Eating Disorders Genetics Initiative (EDGI-UK) — a UK-wide genetic study involving participants via online surveys and saliva samples to explore genetic risk factors, prognosis, and treatment response risk markers for ANand other eating disorders.[17]
2. National Policy Framework & NHS Strategy
Since 2014, the UK Government allocated initial funds (~£30 million/year) to establish dedicated community eating disorder services for CYP, expanded by an additional £22 million over 2019–2021.[18]
The Eating Disorders Access and Waiting Time Standard mandates that by 2020–21, 95% of CYP urgent cases should begin treatment within one week, and routine cases within four weeks. As of the latest data, ~80% of young people meet these targets.[19]
In March 2025, NHS England began refreshing guidance to promote early recognition in schools, colleges, primary care and mental health settings, training of doctors in eating disorders, as well as expanding early support hubs backed by £7 million. [20,21]
Annual government spending on CYP eating disorder services has grown steadily — from £46.7 million (2017/18) to a planned £101 million in 2024/25. [22]
Health Education England (HEE) is scaling training on CBT-ED, MANTRA, and ARFID therapies for professionals working in CAMHS and ED services.[23]
Conclusion:
AN in children is a multifaceted and severe condition with profound physical and psychological implications. Given the unique developmental needs of children, early detection, evidence-based treatment, and comprehensive family involvement are vital.
The UK has made commendable progress in the treatment and prevention of eating disorders in youth. However, persistent challenges, including delayed diagnoses, service disparities and the pervasive influence of digital media, underscore the need for ongoing vigilance, research and resource allocation. A collaborative and compassionate approach that includes families, schools, healthcare providers and policymakers is essential to safeguarding the health and well-being of children at risk of or affected by anorexia.
Salma is a Clinical Nutritionist and a freelance writer for nutrition and dietetics. Her special areas of interest are the management of emotional eating and weight management for women.
Fact file references
NHS England. [Online] 2026. https://www.nhs.uk/mental-health/conditions/anorexia/overview/.
2. Predictors of Suicide Attempts in Individuals with Eating Disorders . Jaeun Ahn, Jung-Hyun Lee, Young-Chul Jung. 3, s.l. : suicide life threat behav, 2019, Vol. 49. 789-797.
beateatingdisorders. [Online] 2025. https://www.beateatingdisorders.org.uk/media-centre/eating-disorder-statistics/.
Anorexia nervosa in adolescents . Josephine Neale, Lee D Hudson. 6, s.l. : british journal of hospital medicine, 2020, Vol. 81.
What next for eating disorder genetics? Replacing myths with facts to sharpen our understanding . Laura M. Huckins, Rebecca Signer,Jessica Johnson, Ya ke wu,Karen S MitchellCynthia M Bulik. s.l. : Molecular Psychiatry, 2022, Vol. 27. 3923-3938.
Genetics and neurobiology of eating disorders . Cynthia M. Bulik, Jonathan R. I. Coleman, J. Andrew Hardaway, Lauren Breithaupt, Hunna J. Watson, Camron D. Bryant ,Gerome Breen. s.l. : Nature Neuroscience, 2022, Vol. 25. 543-554.
Perfectionism and eating disorders in children and adolescents:A systematic review and meta-analysis. Elizabeth Bills, Danyelle Greene, Rose Stackpole, Sarah J Egan. 187, s.l. : Apetite, 2023, Vol. 1.
Self-esteem, self-image, and school bullying in eating disorders . Pedro Manuel Ruiz Lázaro, Carlos Imaz Roncero , Jesús Pérez Hornero. 39, s.l. : Nutr Hosp, 2022, Vol. 26. 41-48.
Mitigating Harms of Social Media for Adolescent Body Image and Eating Disorders: A Review . Suzanne E Mazzeo, Madison Weinstock, Taylor Nadine Vashro, Taryn Henning, Karly Derrigo. 17, s.l. : psychol Res Behav manag, 2024, Vol. 4. 2587-2601.
A systematic review of eating disorders and family functioning . Renee D Rienecke, Xanthe Trotter, Paul E Jenkins. s.l. : clin Psychol Review, 2024.
Past-Year Abuse and Eating Disorder Symptoms Among U.S. College Students . Vivienne M Hazzard, Hannah N Ziobrowski, Skylar L Borg, Lauren M Schaefer, Ani C Mangold, Nicola A Herting, Sarah K Lipson,Ross D Crosby, Stephen A Wonderlich. s.l. : J interpers Voilence, 2022, Vol. 37. 15-16.
Adena Neglia . Nutrition, Eating Disorders, and Behavior in Athletes. 3, s.l. : psychiatr clin North Am, 2021, Vol. 44. 431-441.
Family therapy approaches for anorexia nervosa . Caroline A Fisher, Sonja Skocic, Kathleen A Rutherford, Sarah E Hetrick. 5, s.l. : cochrane database syst rev, 2019, Vol. 1.
Role of antidepressants in the treatment of adults with anorexia nervosa . Marketa Marvanova, Kirstin Gramith. 3, s.l. : mental Health Clin, 2018, Vol. 8. 127-137.
UKRI. [Online] https://www.ukri.org/news/uk-funders-invest-4-25m-into-new-eating-disorders-research/.
NIHR. [Online] 2022. https://www.nihr.ac.uk/story/saving-lives-new-treatments-anorexia-nervosa.
EDGI-UK. [Online] https://edgiuk.org/about.
NHS England. [Online] https://www.england.nhs.uk/mental-health/cyp/eating-disorders.
RCPSYCH. [Online] feb 2024. https://www.rcpsych.ac.uk/news-and-features/latest-news/detail/2024/02/29/rcpsych-calls-for-an-end-to-children-s-eating-disorders-crisis.
Kinnoc, Stephen. Parliment UK. [Online] 2025. https://hansard.parliament.uk/commons/2025-03-04/debates/25030452000009/EarlySupportHubs .
NHS England. [Online] 2023. https://webarchive.nationalarchives.gov.uk/ukgwa/20230418155402/https:/www.longtermplan.nhs.uk/publication/nhs-long-term-plan/.
House of commons library. Parliment UK. [Online] 2025. https://commonslibrary.parliament.uk/research-briefings/cdp-2025-0069.
GOV UK. [Online] 2023. https://www.gov.uk/government/publications/the-impact-of-body-image-on-mental-and-physical-health-government-response.