Eating disorder outcomes: findings from a rapid review of over a decade of research
Authors: Miskovic-Wheatley Jane , Bryant Emma , Ong Shu Hwa , Vatter Sabina , Le Anvi ,   National Eating Disorder Research Consortium, Aouad Phillip , Barakat Sarah , Boakes Robert , Brennan Leah , Bryant Emma , Byrne Susan , Caldwell Belinda , Calvert Shannon , Carroll Bronny , Castle David , Caterson Ian , Chelius Belinda , Chiem Lyn , Clarke Simon , Conti Janet , Crouch Lexi , Dammery Genevieve , Dzajkovski Natasha , Fardouly Jasmine , Felicia Carmen , Feneley John , Firriolo Amber-Marie , Foroughi Nasim , Fuller-Tyszkiewicz Mathew , Fursland Anthea , Gonzalez-Arce Veronica , Gouldthorp Bethanie , Griffin Kelly , Griffiths Scott , Hambleton Ashlea , Hannigan Amy , Hart Mel , Hart Susan , Hay Phillipa , Hickie Ian , Kay-Lambkin Francis , King Ross , Kohn Michael , Koreshe Eyza , Krug Isabel , Linardon Jake , Long Randall , Long Amanda , Madden Sloane , Maguire Sarah , Maloney Danielle , Marks Peta , McLean Sian , Meddick Thy , Miskovic-Wheatley Jane , Mitchison Deborah , O’Kearney Richard , Ong Shu Hwa , Paterson Roger , Paxton Susan , Pehlivan Melissa , Pepin Genevieve , Phillipou Andrea , Piccone Judith , Pinkus Rebecca , Raykos Bronwyn , Rhodes Paul , Rieger Elizabeth , Rodan Sarah-Catherine , Rockett Karen , Russell Janice , Russell Haley , Salter Fiona , Sawyer Susan , Shelton Beth , Singh Urvashnee , Smith Sophie , Smith Evelyn , Spielman Karen , Squire Sarah , Thomson Juliette , Touyz Stephen , Utpala Ranjani , Vartanian Lenny , Vatter Sabina , Wallis Andrew , Ward Warren , Wells Sarah , Wertheim Eleanor , Wilksch Simon , Williams Michelle , Touyz Stephen , Maguire Sarah 
Published: May 2023

Background

Eating disorders (ED), especially Anorexia Nervosa (AN), are internationally reported to have amongst the highest mortality and suicide rates in mental health. With limited evidence for current pharmacological and/or psychological treatments, there is a grave responsibility within health research to better understand outcomes for people with a lived experience of ED, factors and interventions that may reduce the detrimental impact of illness and to optimise recovery. This paper aims to synthesise the literature on outcomes for people with ED, including rates of remission, recovery and relapse, diagnostic crossover, and mortality.

Methods

This paper forms part of a Rapid Review series scoping the evidence for the field of ED, conducted to inform the Australian National Eating Disorders Research and Translation Strategy 2021–2031, funded and released by the Australian Government. ScienceDirect, PubMed and Ovid/MEDLINE were searched for studies published between 2009 and 2022 in English. High-level evidence such as meta-analyses, large population studies and Randomised Controlled Trials were prioritised through purposive sampling. Data from selected studies relating to outcomes for people with ED were synthesised and are disseminated in the current review.

Results

Of the over 1320 studies included in the Rapid Review, the proportion of articles focused on outcomes in ED was relatively small, under 9%. Most evidence was focused on the diagnostic categories of AN, Bulimia Nervosa and Binge Eating Disorder, with limited outcome studies in other ED diagnostic groups. Factors such as age at presentation, gender, quality of life, the presence of co-occurring psychiatric and/or medical conditions, engagement in treatment and access to relapse prevention programs were associated with outcomes across diagnoses, including mortality rates.

Conclusion

Results are difficult to interpret due to inconsistent study definitions of remission, recovery and relapse, lack of longer-term follow-up and the potential for diagnostic crossover. Overall, there is evidence of low rates of remission and high risk of mortality, despite evidence-based treatments, especially for AN. It is strongly recommended that research in long-term outcomes, and the factors that influence better outcomes, using more consistent variables and methodologies, is prioritised for people with ED.