New research shows doctors’ lack of training on eating disorders puts lives at risk

Posted 05/06/2018

A new study reveals today that medical students receive less than two hours of training on eating disorders over four to six years of undergraduate study, which experts and the UK’s eating disorder charity Beat warn is putting patients’ lives at risk.

The research, published in the Postgraduate Medical Journal (a specialist journal published by the BMJ), is the first comprehensive analysis of the extent of training on eating disorders in the UK.

Surveying all medical schools in the country, it finds that the average teaching and assessment time on eating disorders in undergraduate courses amounts to just 1.8 hours, and one in five medical schools do not offer any training on eating disorders at all.

Of the 33 universities offering medical degrees, only six offered placements in specialist eating disorder units for children, and seven in units for adults, and even these placements were limited to six – twelve students. This means just 1% of doctors have the opportunity for clinical experience on eating disorders, and even see how the theory translates to clinical practice.

The research also highlights the severe lack of specialist training posts, with just 17 such posts dedicated to training clinicians to treat eating disorders. Sufferers of eating disorders should be referred to specialist services and should not be treated in general mental health units, but the lack of specialist training placements will only add to shortage of specialist clinicians.

This research comes in the wake of a 2017 Parliamentary and Health Service Ombudsman (PHSO) inquiry into the deaths of three people with eating disorders, which concluded that lack of training was one of the factors that contributed to the tragedies.

The lead author of the research, Dr Agnes Ayton, said: 

“Tragedies such as those outlined in the PHSO inquiry should not happen, people should not die from eating disorders and the lack of eating disorder training for our doctors is contributing to the risk to patient safety.
“Too often under-trained doctors only look at the physical symptoms like weight, or do not recognise that someone is ill at all. Patients end up not getting the treatment they need and suffer unnecessarily.
“Medical schools are treating eating disorders as a niche subject, despite the fact that they affect 1.25 million people in the UK and cost the NHS hundreds of millions of pounds. Improved training would save lives at a minimal cost to the NHS.”

People suffering with an eating disorder have told Beat how doctors’ knowledge of eating disorders, or lack of it, can be the difference between continuing to suffer and recovery. In a survey of 1,700 people in 2017, only 42% felt that their GP understood eating disorders and only 34% believed their GP knew how to help them with their illness.

One sufferer described her first visit to a GP who had clearly had little or no training on eating disorders:

“They told my mum that my not eating was a phase I would grow out of and sent us away with a meal plan cut from the back of a cereal box. […] Since then I've had staff in general psychiatric wards tell me that I don't look like I have an eating disorder, which has been very triggering and difficult.”

Others spoke of doctors whose understanding of eating disorders enabled them to make appropriate referrals. One patient described this as: 

“…a huge help to my recovery and a major factor in me not requiring inpatient treatment later on.”

Beat’s Director of External Affairs, Tom Quinn said: 

“We know that the best way of dealing with an eating disorder is early treatment. All doctors should leave medical school equipped to recognise eating disorders and stop them in their tracks by making appropriate referrals.
We are calling on the General Medical Council to review training of eating disorders for junior doctors as recommended by the PHSO. We need to see questions on eating disorders in all medical students’ exams. Only with adequate training covering the psychological and physical aspects of these serious mental illnesses can doctors protect patient safety.”

Notes to editors

  • Case studies of people who have suffered from an eating disorder, current medical students, and health professionals and clinical experts are available on request. These include testimonies of both positive and negative experience of encounters with health professionals and of training.
  • The full paper is available here.
  • Beat has launched a petition calling on the General Medical Council to review the training of eating disorders for all junior doctors and to ensure:
    • Increased training in medical schools with a curriculum that includes teaching on the physiological and psychiatric aspects of eating disorders.
    • Sufficient examination on eating disorders across all medical schools.
    • Increased opportunities for medical students to gain clinical experience with eating disorders.
    • Increased training and opportunities to gain experience with eating disorders, for all junior doctors.
  • The December 2017 report by the Parliamentary and Health Service Ombudsman, titled Ignoring the alarms: How NHS eating disorder services are failing patients, concluded that lack of understanding of eating disorders among NHS staff was amongst a number of failings which led to the death of Averil Hart and that the current level of eating disorder training is not enough. It also concluded, as one of its main recommendations: “The General Medical Council (GMC) should conduct a review of training for all junior doctors on eating disorders to improve understanding of these complex mental health conditions.”
  • Anorexia nervosa has a higher mortality rate than any other any mental health condition. Other eating disorders also have high mortality rates.
  • A report by Beat published in November showed that on average there is a delay of 176 weeks between the first signs of an eating disorder and someone beginning treatment. After seeing a GP, children have to wait an average of nearly 6 months (25 weeks) before treatment begins. For adults, the wait is nearly 9 months (36 weeks).
  • As the UK’s eating disorder charity, Beat offers support to sufferers and their families based on clinical expertise and also runs training for healthcare professionals. More information at beateatingdisorders.org.uk.
  • Health Education England control the provision of specialist training posts following doctors’ graduation from medical school.