The evolving profile of eating disorders and their treatment in a changing and globalised world

Yet eating disorders may be even more common in people who are financially disadvantaged,3,4 are overweight or experience food insecurity,4 and in communities with multiple marginalised identities, including those relating to gender, ethnicity, and sexuality.3 Substantial efforts have been made to reflect this diversity and to listen to the voices of patients, families, activists, clinicians, and service providers within the eating disorders community.5 Body ideals vary depending on the country of residence and people's sociocultural status. [...]the Eating Attitudes Test-2612 was originally developed with North American females, but a later evaluation of this measurement tool found that its factor structure across ethnic subgroups in Israel differed considerably both across the subgroups and from the typical three-factor structure found in Europe and North America.13 Indeed, there is considerable intercountry and intracontinental variation in eating behaviours, participation in research, discourse around mental health, and access to nutritious food, education, and health-care information.13 Accordingly, established barriers to research participation include limited access to or awareness of recruitment efforts,14 worries about misrepresentation, and distrust in medical research resulting from its history of discrimination.15,16 Strategies to improve recruitment from under-represented groups include setting clear recruitment targets from the start; promoting education and awareness about research projects;17 providing financial incentives to collect data from underserved communities;18 and engagement of people from marginalised populations and those with lived experience of eating disorders. Notably, several cohorts that contributed to genetic studies of anorexia nervosa were funded by charities that included families with lived experience (eg, the Charlotte's Helix project, the Klarman Family Foundation, and the Price Foundation).24 Such genetic research advanced the understanding of eating disorders as metabo-psychiatric disorders.24 Research indicates that a higher genetic risk of anorexia nervosa is correlated with a lower genetic risk of a number of metabolic traits, some of which have a role in metabolic syndrome such as insulin resistance.25 Additional evidence from genetic studies points to a differing underlying biology in anorexia nervosa compared with binge-type eating disorders.26 However, as with other areas of research on eating disorders, ge