Unmet need for treatment in the eating disorders: A systematic review of eating disorder specific treatment seeking among community cases

To systematically review the literature on the proportion of community cases with a diagnosable eating disorder who seek eating disorder specific treatment. CSA PsycInfo, Medline/PubMed and Scopus databases were searched for relevant articles that were written in English, published between January 1989 and January 2010, and satisfied three selection criteria: 1) recruited a representative sample of community cases; 2) used a standardized eating disorder screening instrument; 3) reported percentage of cases with eating disorders that sought appropriate (mental health or medical) treatment specifically for their eating disorder. Reference lists were also scanned for relevant articles. Of 200 articles identified, 14 met inclusion criteria, comprising 1581 participants with a diagnosable eating disorder. The pooled proportion seeking treatment was 23.2% (95% CI = 16.6, 31.4), however this estimate was associated with significant variability. The proportion seeking treatment for weight loss ranged from 30% to 73%, indicating that individuals with eating disorders are much more likely to receive treatment for a perceived problem with weight. The literature provides a complex picture, as a minority receive appropriate mental health care, yet many receive treatment for weight loss. Significant gaps in the literature currently exist and future research needs to focus on treatment seeking in the young and elderly, males, and in countries outside of Australia and the United States. There is a need for interventions that assist community members, health professionals and treatment services to recognize eating disorders and understand their associated burden and the benefit of providing appropriate and timely treatment. ► A systematic review returned 200 articles, of which 14 met the inclusion criteria. ► Pooled prevalence of treatment seeking: 23.2% (95% CI=16.6, 31.4). ► Cases more likely to receive treatment for weight loss than for eating problem. ► Findings indicate a very large unmet need for treatment for eating disorders. ► Significant gaps in the literature exist.