A new study published in The BMJ suggests that many adults with diagnosed eating disorders in England and Northern Ireland are not being referred by their GP for specialist care, and that patients are less likely to be referred if they are not underweight.
The research, published on 5 August 2026, analysed health records from 2010 to 2023 covering 35,404 adults with at least one recorded eating disorder diagnosis. It found that 26,822 people, or 76%, did not receive an eating disorder referral. The study’s authors, from King’s College London, said GPs need more education about eating disorder presentations and should not rely on body mass index alone when deciding about referrals.
Underweight patients were more likely to get specialist support
According to the study, adults with anorexia nervosa who were clinically underweight — defined as a BMI below 18.5 — were four times as likely to be referred to specialist care as those who were not below that threshold. The findings also indicated that referral patterns varied across different eating disorder diagnoses, raising concerns that some patients may be overlooked before their condition becomes more severe.
The study comes at a time when eating disorder services continue to face pressure, and it adds to the debate over how primary care identifies people who need help. The authors argued that referral decisions should not depend on weight alone, because eating disorders can present in different ways and affect people across a wide range of body sizes.
What the findings could mean for primary care
For clinicians, the research highlights the need to consider symptoms, behaviour and risk, rather than using BMI as the main trigger for referral. For patients and families, it underlines the importance of seeking help early if warning signs are present, even when weight loss is not obvious.
The study does not by itself explain why referrals are being missed, but its message is clear: specialist assessment may be harder to access for people who do not fit a narrow picture of eating disorder risk. That, the researchers say, is a gap the NHS should address through better training and clearer pathways.
As eating disorder awareness grows, the findings suggest that referral practice in primary care may need to change if more patients are to receive timely support.
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