Exercise is increasingly utilised as a complementary therapy within eating disorder treatment because of the emerging evidence for the psychological and physical benefits of exercise in eating disorders. Despite this, there is currently limited guidance on assessment within exercise therapy and eating disorders.

This review aimed to (a) outline outcome assessments used in the exercise and eating disorder literature, including interventional and cross-sectional studies; and (b) provide an overview of the general impacts of exercise intervention trials in eating disorders.

A scoping review was employed with searches on databases PsycINFO, Medline and EMBASE, with terms related to eating disorders, exercise and health outcomes. Data extraction included study and intervention characteristics, assessments and outcome change.

Twenty-six intervention and cross-sectional studies were included, consisting of anorexia nervosa (n = 27%), binge eating disorder (n = 19%), bulimia nervosa (n = 4%) and mixed diagnostic populations (n = 50%). Body composition assessment was conducted with the greatest frequency of included studies (n = 26), followed by eating disorder psychopathology (n = 21), subjective physical activity level (n = 13) and exercise assessment (n = 11), including strength assessment (n = 6) and cardiorespiratory fitness testing (n = 6). No adverse events were reported in the included studies.

The results of this review outline that comprehensive assessment within exercise interventions and eating disorders, including strength and cardiorespiratory fitness exercise tests, are safe when conducted in appropriate contexts and may offer additional insight into patient health and function beyond current standard practice. The results of this review may guide future exercise professionals in eating disorder services on relevant assessment as part of exercise therapy.

Reinforcement motivation, particularly heightened punishment sensitivity and its imbalance relative to reward sensitivity (“motivational bias”), can predict outcomes in anorexia nervosa (AN). However, previous studies did not account for affective symptoms, which are intertwined with reinforcement processes and illness trajectory. This study examined whether affective symptoms explain outcomes beyond reinforcement motivation.

Adolescent girls and young women with AN (n = 192; Mage = 16.33 years, SD = 2.61) completed self-report measures of punishment/reward sensitivity, depressive symptoms, and trait anxiety at treatment admission and at 1-year follow-up. Outcomes included ED symptoms, body mass index, and multidimensional recovery (Morgan–Russell outcome assessment schedule). Cross-sectional comparisons included long-term recovered individuals (n = 154) and healthy controls (n = 440); longitudinal associations were tested using nested linear regression.

Patients with AN and recovered individuals showed elevated punishment sensitivity (η2ₚ = 0.19) and stronger motivational bias (punishment>reward; η2ₚ = 0.17). At baseline, reinforcement motivation and affective symptoms showed limited predictive utility. Longitudinally, shifts in motivational bias were associated with ED symptoms and multidimensional outcomes (|β| > 0.248, pFDR < .002), whereas changes in affective symptoms were the most robust and consistently associated predictors (|β| > 0.173, pFDR < .017).

Depressive symptom improvement emerged as the key predictor of outcome, showing stronger associations with follow-up ED symptoms and psychosocial functioning than reinforcement motivation. While changes in reinforcement motivation accompanied ED outcomes, affective symptom change was more predictive across outcomes. These findings emphasize the importance of prioritizing affective processes within developmentally tailored AN treatment frameworks.

The Health of the Nation Outcome Scales (HoNOS) are the most widely used psychiatric clinical outcomes tool in the UK. Nonetheless, HoNOS scores and their change during treatment for people with anorexia nervosa have not been investigated. We retrieved clinical data from the Clinical Records Interactive Search register from 234 with an anorexia nervosa or an eating disorder diagnosis, a body mass index (BMI) <18.5 kg/m2 and with available HoNOS, BMI and C-reactive protein (CRP) data at admission.

From admission to discharge, patients showed a significant moderate improvement in HoNOS total score (mean±s.d.) from 14.30±6.23 to 10.11±4.81, and a significant moderate-to-large increase in BMI from 14.15±1.45 kg/m2 to 16.22±2.56 kg/m2. CRP levels >2 mg/L on admission were significantly associated with age, a personality disorder diagnosis, agitation and hallucinations in the HoNOS.

In-patient treatment for anorexia nervosa improves health and social functioning.

Anorexia nervosa is a debilitating eating disorder with high mortality and chronicity rates owing to the paucity of effective existing treatments. Several clinical trials using psilocybin therapy have demonstrated therapeutic efficacy and safety in psychiatric conditions, including anorexia nervosa.

This study aimed to further assess the safety, feasibility and potential efficacy of psilocybin therapy in anorexia nervosa.

This single-blind, within-individual pilot study recruited 21 females with anorexia nervosa, who underwent three dosing sessions with oral psilocybin (COMP360) over 6 weeks in a fixed order (1 mg, 25 mg, 25 mg), alongside talk therapy and adjunctive to treatment as usual. Adverse events were monitored throughout the study. Primary clinical outcome measures were global Eating Disorder Examination Interview (EDE) and Readiness and Motivation Questionnaire (RMQ) precontemplation scores. Primary time points for the EDE were the 6-week final visit, 3-month follow-up and 6-month follow-up; and for the RMQ, they were the 6-week final visit and comparison between dosing days. Global EDE Questionnaire scores were a key secondary outcome. Key time points were the 6-week final visit and comparison between dosing days. There was a 12-month remote follow-up.

Psilocybin was well tolerated by all participants. The most common adverse events were headache, nausea and dizziness. Two serious adverse events (suicide attempts) were reported for one participant within the 6–12-month period. Relative to baseline, participants displayed significant improvements in their eating disorder symptoms (EDE scores: p < 0.0001, d = 0.98, 6 months) and motivation to change (RMQ scores: p = 0.0017, d = 0.65, 12 months). However, there was a large variation in improvement and maintenance during the follow-up.

This study further provides preliminary support for the feasibility, safety and potential efficacy of this intervention to treat adult females with anorexia nervosa, and warrants further investigation in larger and more rigorously designed studies.

The experience of hearing an ‘anorexic voice’ is common amongst those diagnosed with anorexia nervosa and can act as a barrier to recovery. The relationship with the anorexic voice can become coercive and hostile. Relating Therapy promotes assertive responding to the anorexic voice and was previously evaluated over 16 sessions. Consultation with people with lived experience suggested that Relating Therapy should be offered over an extended duration to facilitate the guided application of learning to eating behaviours.

The primary aim of this study was to inform the design of a future trial by exploring the feasibility of evaluating an extended course of Relating Therapy over 24 sessions. A secondary aim focused on the preliminary exploration of signals of change.

A mixed-methods feasibility study used a case series with repeated within-person measures to explore signals of change.

Seven of nine participants completed a course of Relating Therapy. Feasibility outcomes were positively confirmed. Signals of change were evident in relation to a greater ability to engage with important and meaningful aspects of life, a re-defined relationship with the anorexic voice, and reduced distress around eating and body image.

The study generated evidence of the feasibility of evaluating an extended version of Relating Therapy for those who are distressed by an anorexic voice. Qualitative and quantitative data were suggestive of positive changes for some participants. A larger trial is warranted to evaluate the efficacy of Relating Therapy for the anorexic voice.

Although there may be common challenges and opportunities for early career researchers (ECRs), those working in the field of eating disorders may face unique barriers and require tailored support.

The current study sought to explore consensus on career concerns and opportunities in eating disorder ECRs.

A three-stage Delphi model was conducted. Round 1 involved participants rating career concern and opportunity statements, with free-text responses. Researchers then generated a list of Delphi statements, which were shared in round 2, and participants were asked to indicate their level of agreement. A final round was shared, with median ratings from round 2 and the option to change or further expand on responses. Final consensus was calculated as percentage agreement.

Career concerns reaching consensus included timeline pressures, personal sacrifices for roles, unclear career trajectories, job insecurity, funding concerns, fears of being pushed out of the field and pressures to publish. There was no consensus on a range of other concerns (work/life balance, isolation, mental health and well-being and power imbalances), suggestive of context-dependent experiences. Participants agreed that almost all the presented career opportunities were of importance to eating disorder ECRs.

Findings suggest that eating disorder ECRs face significant barriers toward remaining in the field. Although many concerns reflect broader ECR experience (limited research funding, associated job insecurity), some appear to be particularly exacerbated for ECRs working in the eating disorder field. Further research is needed to inform directions for tailored support strategies, such as peer support, mentoring schemes and increased funding from governing bodies.

Studies have consistently found that up to 20% of people with anorexia nervosa experience a persistent illness, resulting in considerable psychosocial impairment, morbidity and mortality. This has been variously termed severe and enduring anorexia nervosa or longstanding anorexia nervosa (L-AN). Conflicting findings have hindered progress in distinguishing the nosological features of individuals with persistent illness.

This study aims to investigate the putative defining features of individuals reporting symptoms of L-AN, including consideration of their treatment trajectory.

This cross-sectional study, drawing from a mixed-methods design, utilised a sample of symptomatic individuals who reported experiencing eating disorder treatment (n = 208). Several qualitative and quantitative data strands (a–c) were embedded within a single, self-report questionnaire measuring eating disorder severity and treatment experiences. Between-group comparisons were used to compare those of shorter (<3 years) and longer (>7 years) duration of illness.

No between-group differences were found in measures of severity, including body mass index (kg/m2), eating disorder symptom scores, psychological distress or perceived health-related quality of life. However, those with L-AN had a significantly higher number of mental and physical health comorbidities, longer treatment delay, greater number of episodes of treatment and poorer subjective ratings of their treatment experiences.

Delineating L-AN by severity may be inappropriate; anorexia nervosa of any duration is a severe illness. This study suggests that treatments, or lack thereof, may have an inadvertent impact on duration of illness. Future focus needs to be on reconceptualising L-AN and its treatments. Treatment refinements informed by lived experience are proposed.

Anorexia nervosa (AN) often persists for years, resulting in high morbidity and mortality. Hypoglycaemia, typically assessed from a single morning blood sample, is a critical severity indicator. Continuous glucose monitoring (CGM) provides more comprehensive information on glycaemic patterns. This study aimed to characterize glycaemia in patients with AN and identify its potential drivers among metabolic severity (current BMI), clinical severity (Eating Disorder Inventory-2 [EDI-2] score), and illness duration, in a real-world outpatient setting.

This cross-sectional study included female outpatients with restricting subtype AN. Participants underwent CGM for five days in their usual environment. Collected data comprised age, BMI, illness duration, EDI-2 score, and continuous glycaemic measurements. Glycaemic biomarkers (hypoglycaemic area under the curve [AUC], mean and minimum glycaemia, and coefficient of variation) were computed over 24-hour periods.

Three hundred and four female patients were monitored for a mean of 4.8 days. No significant correlations were observed between glycaemic biomarkers and BMI. Illness duration was significantly associated with mean and minimum glycaemia (r = 0.26 and 0.23, respectively, p < 0.001) and with hypoglycaemia AUC (r = −0.25, p < 0.001).

In female patients with restricting subtype AN, illness duration, rather than BMI, appears to significantly influence glycaemic profiles. This may reflect glycaemic adaptations, a hypothesis that warrants further investigation using CGM, a practical tool for exploring metabolic changes and their potential clinical significance in AN.

Anorexia nervosa is associated with high personal and financial costs for sufferers, carers and society in general, but little is known about the long-term health economic burden.

To examine healthcare utilisation, social assistance, sick leave and disability pension in individuals with anorexia nervosa over a period of 30 years.

Fifty-one individuals with adolescent-onset anorexia nervosa and 51 matched comparison cases (COMP) were recruited in the community and followed prospectively from 1985. All individuals were examined on five occasions. At the 30-year follow-up, mean age 44, data on in- and out-patient care, prescribed medications, social assistance, sick leave and disability pension were collected from Swedish national registers.

The anorexia nervosa group had more days of in-patient care (p < 0.001) and out-patient visits to psychiatry (p < 0.001), more days of sick leave (p = 0.006), more days of disability pension (p = 0.002) and were prescribed more psychotropic medication (p = 0.045) compared with the COMP group. Of the anorexia nervosa group, 22% had ever received a disability pension compared with 2% in the COMP group (p = 0.004) and less than half the anorexia nervosa group worked full-time at the 30-year follow-up. In the anorexia nervosa group, 45% had received social assistance at some point, compared with 22% in the COMP group (p = 0.02). Age at onset of anorexia nervosa emerged as a predictor of healthcare utilisation with significant odds ratios for psychiatric in-patient (odds ratio 0.61, 95% CI: 0.39, 0.94; p = 0.027) and out-patient care (odds ratio 0.63, 95% CI: 0.40, 0.98; p = 0.042), i.e. individuals with a later onset of anorexia nervosa were less likely to require psychiatric care.

The long-term burden of adolescent-onset anorexia nervosa comprises increased utilisation of healthcare and dependence on society for a significant minority. A later onset of anorexia nervosa predicted a lower healthcare utilisation.

Eating disorders, particularly anorexia nervosa and bulimia nervosa, are significant global health challenges.

This study analyses historical trends and forecasts future patterns of eating disorders among young adults aged 15–29 years using machine learning techniques.

Global data on anorexia nervosa and bulimia nervosa from the Global Burden of Disease study 2021 spanning 1990 to 2021 were analysed, examining incidence, prevalence and disability-adjusted life years (DALYs) across age groups, sociodemographic index (SDI) levels and regions. Eight machine-learning models were employed to forecast trends from 2022 to 2050.

Bulimia nervosa showed more pronounced increases compared to anorexia nervosa across all metrics. The 15–19 age group had the highest incidence rates, while the 20–24 age group showed the highest prevalence and DALY rates. Low SDI regions experienced substantial increases, with bulimia nervosa prevalence rising by 179.05%. East Asia demonstrated the most significant rise in age-standardised rates. The Prophet model best forecast anorexia nervosa trends, while ARIMA performed best for bulimia nervosa. Projections indicate continued increases through 2050 for both disorders.

The global burden of eating disorders among young adults is projected to increase significantly by 2050, with bulimia nervosa showing more rapid growth than anorexia nervosa. Substantial variations exist across age groups, SDI levels and regions. These findings highlight the urgent need for enhanced prevention programmes targeting high-risk age groups, strengthened healthcare capacity in rapidly developing regions and evidence-based policy interventions to address the growing global burden of eating disorders.

Shared genetic risk has been shown across psychiatric disorders. In particular, anorexia nervosa (AN), obsessive-compulsive disorder (OCD), and schizophrenia (SCZ) show shared genetic risk that matches clinical evidence of shared illness and cognitive phenotypes. Given this evidence, we leveraged a large US-based population-based study to determine genetic associations of disorder-specific and shared psychiatric, cognitive, and brain markers and explore whether the latter might be state versus trait markers in eating disorders.

We used data from the population-based Philadelphia Neurodevelopmental Cohort (N = 4,729) and conducted sex-stratified analyses to test for associations between genetic risk for three disorders (AN, OCD, and SCZ) and mental health phenotypes, neurocognitive traits, and cortical features in a non-clinical population. Exploratory analyses on cortical features were run on a subset with neuroimaging data (N = 626).

Genetic risk for AN was significantly associated with body image distortion (pFDR = 0.02), and body image distortion was significantly related to a reduction in grey matter volume (pFDR = 0.05).

Genetic risk for AN associates with AN trait in a non-clinical sample of youth, particularly in females. Whilst genetic risk was not associated with cognitive or cortical markers, the AN phenotype was associated with cortical markers.