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Peer-reviewedCC BYJournal of eating disorders

Duration of untreated illness in eating disorders: a comprehensive systematic review and meta-regression.

  • Gyselle de Geus1,2
  • Mike Trott3,4,5
  • Alessio Maria Monteleone6
  • Joseph Firth7
  • Dan Siskind3,4,6
  • Scott Teasdale8
  • Urska Arnautovska3,4,5
  • Ravi Iyer9
  • Brendon Stubbs10,11
  • Natasha Demidenko1,12
  • David Martin1,12
  • Ruxandra Antochi13
16 more authors
  • Jess G Fiedorowicz1,12,14
  • Amelia Austin15
  • Ulrike Schmidt16,17
  • Tracey Wade18
  • Fernando Fernandez-Aranda19,20,21,22
  • Beate Herpertz-Dahlmann23,24
  • Hans W Hoek25,26,27
  • Ulrich Voderholzer28,29
  • David Kolar30
  • Stephan Zipfel31,32
  • Kathleen M Pike33
  • Andreas Karwautz34
  • Stephen Wonderlich35
  • Lee Smith36,37
  • Marco Carfagno6
  • Marco Solmi38,39,40
40 affiliations
  1. 1Ottawa Hospital Research Institute, Ottawa, ON, Canada.
  2. 2SCIENCES Lab, Department of Psychiatry, University of Ottawa, 501 Smyth Road, Ottawa, ON, Canada.
  3. 3Queensland Centre for Mental Health Research, Brisbane, QLD, Australia.
  4. 4Faculty of Health, Medicine and Behavioural Sciences, The University of Queensland, Brisbane, QLD, Australia.
  5. 5Addiction and Mental Health Service, Metro South Health, Brisbane, QLD, Australia.
  6. 6Department of Psychiatry, University of Campania Luigi Vanvitelli, Naples, Italy.
  7. 7Division of Psychology and Mental Health, University of Manchester, Manchester, UK.
  8. 8School of Clinical Medicine, Nutrition, Exercise and Social Equity Research Group, University of New South Wales, Sydney, NSW, Australia.
  9. 9Swinburne University of Technology, Centre for Mental Health and Brain Sciences, Melbourne, VIC, Australia.
  10. 10Department of Psychological Medicine, King's College London, London, UK.
  11. 11Center for Sport Science and University Sports, University of Vienna, Vienna, Austria.
  12. 12The Ottawa Hospital, Mental Health Department, Ottawa, ON, Canada.
  13. 13Royal Ottawa Mental Health Centre, Ottawa, ON, Canada.
  14. 14Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada.
  15. 15Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada.
  16. 16Centre for Research in Eating and Weight Disorders (CREW), King's College London, London, UK.
  17. 17South London and Maudsley NHS Foundation Trust, London, UK.
  18. 18Blackbird Initiative, Flinders University, Adelaide, SA, Australia.
  19. 19Ciber Fisiopatología Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, Spain.
  20. 20Psychoneurobiology of Eating and Addictive Behaviors Group, IDIBELL, Barcelona, Spain.
  21. 21Department of Clinical Psychology, Bellvitge University Hospital, IDIBELL, Barcelona, Spain.
  22. 22Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
  23. 23Department of Child and Adolescent Psychiatry, RWTH Aachen University, Aachen, Germany.
  24. 24West German Center for Child and Adolescent Health, University Hospital Cologne, Cologne, Germany.
  25. 25Parnassia Psychiatric Institute, The Hague, The Netherlands.
  26. 26Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands.
  27. 27Department of Epidemiology, Columbia University, New York, NY, USA.
  28. 28Schoen Clinic Roseneck, Prien am Chiemsee, Germany.
  29. 29Department of Psychiatry and Psychotherapy, LMU Munich, Munich, Germany.
  30. 30Department of Psychology, University of Regensburg, Regensburg, Germany.
  31. 31Department of Psychosomatic Medicine and Psychotherapy, University of Tuebingen, Tübingen, Germany.
  32. 32German Centre for Mental Health (DZPG), Tübingen, Germany.
  33. 33Departments of Psychiatry and Epidemiology, Columbia University Irving Medical Center, New York, NY, USA.
  34. 34Department of Child and Adolescent Psychiatry, Medical University Vienna, Vienna, Austria.
  35. 35Department of Psychiatry and Behavioral Science, University of North Dakota, Fargo, ND, USA.
  36. 36Centre for Health Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK.
  37. 37Department of Public Health, Faculty of Medicine, Biruni University, Istanbul, Turkey.
  38. 38Ottawa Hospital Research Institute, Ottawa, ON, Canada. [email protected].
  39. 39SCIENCES Lab, Department of Psychiatry, University of Ottawa, 501 Smyth Road, Ottawa, ON, Canada. [email protected].
  40. 40The Ottawa Hospital, Mental Health Department, Ottawa, ON, Canada. [email protected].
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Abstract

Introduction

Eating disorders (EDs) substantially impair physical health, psychological well-being, and social functioning. Shorter untreated illness duration has been proposed to be associated with better outcomes, though evidence for this relationship remains mixed. Nonetheless, delays in accessing treatment remain common and contribute to prolonged suffering and risk of lasting harm. This study aimed to estimate the duration of untreated eating disorder (DUED) and examine potential moderators.Methods

A PRISMA 2020-compliant systematic review and meta-analysis was conducted. Searches were performed from inception to March 2026 in PubMed, Embase, PsycINFO, and CINAHL. Random-effects models were used to estimate pooled DUED of available studies, with subgroup and meta-regression analyses to explore moderators. Study quality and risk of bias were assessed using National Institutes of Health (NIH) tools.Results

Of 2,776 records identified, 29 studies (n = 17,433) were included. The pooled DUED of available studies was 21.9 months (95% CI 18.0-25.8), with substantial heterogeneity (I² = 99.7%). In subgroup analyses, DUED was longer in bulimia nervosa than anorexia nervosa (41.5 vs. 19.9 months). Meta-regression identified mean age as a significant moderator (β = 1.91, 95% CI 1.1 to 2.7, p < 0.001), indicating longer delays in older individuals. DUED also differed across country, continent, age group, and study design, while decade subgroup estimates were lower in studies from the 2020s than the 2010s.Conclusion

Individuals with EDs experience substantial delays before accessing treatment, with untreated illness exceeding 20 months on average. Older age was associated with longer DUED, suggesting potential gaps in detection and help-seeking among adults. DUED varies across demographic, geographic and methodological factors. While decreasing DUED over time is encouraging, these findings highlight the need for earlier identification and streamlined care pathways to reduce delays and improve outcomes in people with ED.

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Cite

BibTeXRIS
BibTeX
@article{geus2026duration,
  title = {{Duration of untreated illness in eating disorders: a comprehensive systematic review and meta-regression.}},
  author = {Gyselle de Geus and Mike Trott and Alessio Maria Monteleone and Joseph Firth and Dan Siskind and Scott Teasdale and Urska Arnautovska and Ravi Iyer and Brendon Stubbs and Natasha Demidenko and David Martin and Ruxandra Antochi and Jess G Fiedorowicz and Amelia Austin and Ulrike Schmidt and Tracey Wade and Fernando Fernandez-Aranda and Beate Herpertz-Dahlmann and Hans W Hoek and Ulrich Voderholzer and David Kolar and Stephan Zipfel and Kathleen M Pike and Andreas Karwautz and Stephen Wonderlich and Lee Smith and Marco Carfagno and Marco Solmi},
  journal = {Journal of eating disorders},
  year = {2026},
  month = aug,
  doi = {10.1186/s40337-026-01731-6},
  url = {https://europepmc.org/article/MED/42897606},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - Duration of untreated illness in eating disorders: a comprehensive systematic review and meta-regression.
AU  - Gyselle de Geus
AU  - Mike Trott
AU  - Alessio Maria Monteleone
AU  - Joseph Firth
AU  - Dan Siskind
AU  - Scott Teasdale
AU  - Urska Arnautovska
AU  - Ravi Iyer
AU  - Brendon Stubbs
AU  - Natasha Demidenko
AU  - David Martin
AU  - Ruxandra Antochi
AU  - Jess G Fiedorowicz
AU  - Amelia Austin
AU  - Ulrike Schmidt
AU  - Tracey Wade
AU  - Fernando Fernandez-Aranda
AU  - Beate Herpertz-Dahlmann
AU  - Hans W Hoek
AU  - Ulrich Voderholzer
AU  - David Kolar
AU  - Stephan Zipfel
AU  - Kathleen M Pike
AU  - Andreas Karwautz
AU  - Stephen Wonderlich
AU  - Lee Smith
AU  - Marco Carfagno
AU  - Marco Solmi
PY  - 2026
DA  - 2026/08/01
JO  - Journal of eating disorders
DO  - 10.1186/s40337-026-01731-6
UR  - https://europepmc.org/article/MED/42897606
AB  - Introduction  Eating disorders (EDs) substantially impair physical health, psychological well-being, and social functioning. Shorter untreated illness duration has been proposed to be associated with better outcomes, though evidence for this relationship remains mixed. Nonetheless, delays in accessing treatment remain common and contribute to prolonged suffering and risk of lasting harm. This study aimed to estimate the duration of untreated eating disorder (DUED) and examine potential moderators.Methods  A PRISMA 2020-compliant systematic review and meta-analysis was conducted. Searches were performed from inception to March 2026 in PubMed, Embase, PsycINFO, and CINAHL. Random-effects models were used to estimate pooled DUED of available studies, with subgroup and meta-regression analyses to explore moderators. Study quality and risk of bias were assessed using National Institutes of Health (NIH) tools.Results  Of 2,776 records identified, 29 studies (n = 17,433) were included. The pooled DUED of available studies was 21.9 months (95% CI 18.0-25.8), with substantial heterogeneity (I² = 99.7%). In subgroup analyses, DUED was longer in bulimia nervosa than anorexia nervosa (41.5 vs. 19.9 months). Meta-regression identified mean age as a significant moderator (β = 1.91, 95% CI 1.1 to 2.7, p < 0.001), indicating longer delays in older individuals. DUED also differed across country, continent, age group, and study design, while decade subgroup estimates were lower in studies from the 2020s than the 2010s.Conclusion  Individuals with EDs experience substantial delays before accessing treatment, with untreated illness exceeding 20 months on average. Older age was associated with longer DUED, suggesting potential gaps in detection and help-seeking among adults. DUED varies across demographic, geographic and methodological factors. While decreasing DUED over time is encouraging, these findings highlight the need for earlier identification and streamlined care pathways to reduce delays and improve outcomes in people with ED.
SN  - 2050-2974
ER  -