Beyond the Checklist: A large-scale analysis of under-recognised weight loss behaviours in individuals with eating disorders

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Abstract Objective This study aimed to identify and categorise under-recognised weight loss behaviours in individuals with eating disorders, addressing diagnostic gaps. Method We text mined free-text responses from 1,675 participants with anorexia nervosa, bulimia nervosa, or binge-eating disorder in the Genetic Links to Anxiety and Depression (GLAD) Study and the United Kingdom Eating Disorders Genetics Initiative (EDGI UK). In secondary analyses, we investigated differences by eating disorder and gender. Results Frequently endorsed behaviours included structured diets (341 endorsements) and calorie counting (321 endorsements) but also less commonly considered behaviours like compression garments (113 endorsements) and self-harm (63 endorsements). We identified four overarching themes: restriction-based approaches, medical intervention, body manipulation, and food avoidance. The most frequently reported weight loss behaviours and resultant themes did not differ among eating disorders or genders, closely resembling those in the broader sample. Discussion Our findings identify a crucial gap in current diagnostic criteria, which may hamper recognition and lead to underdiagnosis of eating disorders. By incorporating our insights, clinicians could capture a broader spectrum of behaviours, thus improving diagnostic accuracy. However, our sample homogeneity implicates the need for more diverse samples. Our study contributes essential insights for enhancing diagnostic criteria. Public Significance Statement Our study revealed under-recognised weight loss behaviours in people with eating disorders that current diagnostic tools miss, which may lead to underdiagnoses. By identifying these behaviours and taking a broader diagnostic approach, our research can help clinicians better understand eating disorders by improving diagnostic accuracy and opening up new avenues for personalised care.

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