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Eating disorders affect at least 1.25 million people across the UK, impacting individuals, families and communities. For many, difficulties begin in subtle or less visible ways and can go unnoticed or unsupported until they escalate. 

Eating Disorders Awareness Week draws national attention to the experiences of people affected by eating disorders. This year’s theme, community, highlights the importance of early and effective support in the community – helping people access the right care sooner, closer to home, and before their mental health reaches crisis point.

Why early support matters 

In recent years, services across the country have seen a sharp rise in people seeking help for eating disorders. Between 2022-23, adult referrals increased by 56% in London. Several factors have contributed to this rise, including the impact of the COVID-19 pandemic, the growing influence of social media, and the persistence of a pervasive diet culture, with trends such as ‘cutting’ and ‘bulking’ normalising extreme dieting behaviours.  

When support is delayed, symptoms can worsen, recovery can take longer, and people may need more intensive treatment later on.  

In response to this growing demand, North London NHS Foundation Trust has developed a new community-based eating disorder (ED) pathway for people with mild-to-moderate needs. The pathway is designed to provide timely, accessible support earlier in the course of illness, helping individuals receive appropriate care before difficulties escalate to crisis and more intensive intervention is required. 

Alongside this development, the specialist team at St Ann’s Eating Disorder Service (SAEDS) has published a treatment pathway audit, undertaken in the context of rising service pressures. 

Offering effective treatment, sooner: 

Our specialist eating disorder service, SAEDS, provides care for people aged 18 and above with moderate-to-severe eating disorders. Based in Haringey, the service is comprised of Iris Ward, which is a national provider of specialist eating disorder inpatient treatment, along with a community service and a day programme.  

Since COVID-19, demand for this service has risen significantly leading to longer waiting times and pressure on existing treatment pathways. In 2021, an internal audit found that referrals had increased by 150% (in comparison to referral numbers in the years prior), prompting the team to review the support offer.  

One example of this is outlined below. Traditionally in our service, the primary treatment for people with Bulimia Nervosa has been a 16-session Cognitive Behavioural Therapy-ED (CBT-ED) group programme, led by two facilitators. With 70% of referrals for this pathway waiting over a year for treatment post COVID-19, it became clear that this approach was unsustainable. To respond to this, the team explored alternative, evidence-based ways of offering effective treatment more quickly, without compromising on quality.  

Having seen positive preliminary research, the service decided to pilot Cognitive Behavioural Therapy-10 (CBT-T) between 2022-current. CBT-T is a new, short-term, structured therapy which is delivered one-to-one in the community. Over the course of 10 sessions, the treatment focuses on helping people understand and change patterns of thoughts and behaviours linked to their eating difficulties through practical tools, while also supporting their wider mental health. 

Evaluating the impact of CBT-T  

The service evaluated whether the pathway was a ‘realistic, feasible and acceptable’ way of meeting increased service demand whilst delivering effective care through an audit. The audit analysed a combination of qualitative and quantitative data. This included analysing changes in the standard outcome measures routinely used within the service:

• Eating Disorder Examination Questionnaire (EDE-Q) - a 28-item self-reported questionnaire designed to assess the range, frequency and severity of behaviours associated with a diagnosis of an eating disorder 
• Clinical Impairment Assessment (CIA) - a 16-item self-reported questionnaire focusing on the impact an eating disorder has on general wellbeing
• Patient Health Questionnaire, Depression (PHQ9) - a 9-item, self-reported tool used to screen for, diagnose, and measure the severity of depression
• Generalised Anxiety Disorder Assessment) (GAD-7) - a 7-item, self-reported questionnaire used to measure the severity of  Generalized Anxiety Disorder over the past 2 weeks 

 

A total of 106 patients completed pre and post treatment outcome measures. 

While primarily this pathway was delivered for patients with Bulimia Nervosa, there were also a few patients who were diagnosed with Binge Eating Disorder and Anorexia Nervosa included in this sample as well. 

The evaluation also included end of treatment patient feedback, attendance and dropout review and a staff focus group involving 12 clinicians delivering CBT-T.

The audit suggested that CBT-T led to reduced ED symptoms and positive outcomes on an individual’s broader mental health difficulties. Through the audit, CBT-T demonstrated promising results as a feasible, acceptable and realistic intervention for managing rising ED referrals and delivery of care. It is, however, important to remain mindful that the sample size was limited, and that the team did not have the capacity to conduct short or long term follow up with patients to ascertain if symptom reduction was maintained.  

Read the published evaluation, 'Establishing CBT-T in a NHS moderate-severe adult eating disorder service' here. 

Eating Disorder Recovery Hubs: support for mild-to-moderate EDs 

Alongside this work, we have also developed Eating Disorder Recovery Hubs to support adults with mild-to-moderate eating disorders.  

Launched first in 2024, the hubs were created to address a clear gap in provision for people who do not require medical or dietetic intervention but still need specialist support. This pathway allows us to reach individuals whose have historically been categorised as “not sick enough”, challenging the narrative that to be diagnosed with an eating disorder you must be underweight or severe in presentation.

The ED recovery hubs break down this stigma by prioritising early intervention and moving away from severity-based classifications as well as providing treatment for conditions such as binge eating disorder, where support has previously been limited. 

The hubs are based within local adult mental health teams and currently support people across Barnet, Camden, Enfield, Haringey and Islington.  

By offering help at an earlier stage, the hubs prevent ED symptoms from becoming more severe, significantly improving long-term eating disorder recovery prospects.  

What evaluation is telling us 

In the first 18 months of the Eating Disorder Recovery Hubs, early outcomes are promising, showing:  

• reductions in eating disorder symptoms
• improvements in anxiety, depression and everyday functioning
• high levels of satisfaction with care
• strong engagement, with low dropout rates 

 

People using the service have told us how important it was to feel listened to and supported: 

“I made a lot of progress. It got me out of a dark and scary place. I felt very listened to and affirmed.” - Service User  

Hannah Hucklesby, Pathway Lead, shared:  

“As pathway lead it has been a privilege to be part of the pathway's development and to witness the fantastic progress our service users are seeing with the support of our dedicated team of therapists."

The feedback and early data findings in the hubs support the literature that early intervention is important for good clinical outcomes. 

Better outcomes for people and the NHS 

As well as improving people’s lives, early support also makes better use of NHS resources. Recent evidence shows that early treatment for eating disorders saves the NHS £10.9 million by preventing admissions and reducing dependence on intensive day programmes (McDaid et al., 2024). 

By investing in early, community‑based care, we can support recovery sooner, reduce pressure on hospital services and create a more sustainable mental health system. 

Looking Ahead

The combined findings from SAEDS and the ED Recovery Hubs underline the impact that short‑term, evidence‑based early interventions can have in transforming outcomes and improving system sustainability.  

Findings from the recent SAEDS audit highlight the potential effectiveness of structured, short‑term interventions – an important conclusion given the increase in service demand. It shows what is possible when a service recognises a challenge such as long waiting times and responds with research‑led innovation to deliver better, faster care. This reflects our Trust’s strategic commitment to embedding research and innovation in everything we do. 

At the same time, the promising evaluation of the ED Recovery Hubs 18 months on highlights the importance of prevention and early support in the community, supporting the wealth of early intervention literature and championing wider access to ED support across the UK. This also aligns with both national priorities outlined in the NHS 10 Year Plan, and the Trust’s focus on providing high‑quality care closer to home. Our experience shows that early, accessible intervention can significantly reduce deterioration, prevent crisis presentations and support quicker, more stable recovery trajectories. 

As demand for eating disorder treatment continues to rise across the country, sustained investment in early intervention will be essential, not only to manage pressure on specialist services, but to ensure people receive the right care at the right time.   

• Learn more about SAEDS, including how to refer.
• Learn more about our ED Recovery Hubs, including how to refer.
• Read our evaluation of CBT-T at SAEDS, ‘Establishing CBT-T in an NHS moderate-severe adult eating disorder service.'
• Learn more about Eating Disorder Awareness Week 2026.

 

Reference List  

McGill K, Behnam J, Plant T, Pope I, Chalmers R, Crabtree B, Ryan Tucker MJ, Khan FM, Dublin A, Tarapdar J, Evans J. Establishing CBT-T in an NHS moderate-severe adult eating disorder service. Eat Disord. 2025 Sep 2:1-19. doi: 10.1080/10640266.2025.2553012. Epub ahead of print. PMID: 40898422. 

 McDaid, D., Treasure, J., Fernández-Aranda, F., Herpertz-Dahlmann, B., Quoidbach, V., Dickson, S., & Gorwood, P. (2024). Quantifying the economic value of earlier and enhanced management of Anorexia Nervosa for adults in England, Germany and Spain: improving the care pathway. European Psychiatry, 67(1), e43.