Duration of untreated illness in eating disorders: a comprehensive systematic review and meta-regression
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
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.
Source: Journal of Eating Disorders
Authors: Gyselle de Geus, Mike Trott, Alessio Maria Monteleone, Joseph Firth, Dan Siskind, Scott Teasdale, Urska Arnautovska, Ravi Iyer, Brendon Stubbs, Natasha Demidenko, David Martin, Ruxandra Antochi, Jess G. Fiedorowicz, Amelia Austin, Ulrike Schmidt, Tracey Wade, Fernando Fernandez-Aranda, Beate Herpertz-Dahlmann, Hans W. Hoek, Ulrich Voderholzer, David Kolar, Stephan Zipfel, Kathleen M. Pike, Andreas Karwautz, Stephen Wonderlich, Lee Smith, Marco Carfagno, Marco Solmi
Institutions: University of Ottawa, Ottawa Hospital Research Institute, The University of Queensland, Metro South Health, Queensland Centre for Mental Health Research, Addiction and Mental Health Services - MSH, University of Campania "Luigi Vanvitelli", University of Manchester, UNSW Sydney, Swinburne University of Technology, University of Vienna, King's College London, Ottawa Hospital, Royal Ottawa Mental Health Centre, University of Calgary, South London and Maudsley NHS Foundation Trust, Flinders University, Instituto de Salud Carlos III, Spanish Biomedical Research Centre in Physiopathology of Obesity and Nutrition, Bellvitge University Hospital, Institut d'Investigació Biomédica de Bellvitge, Universitat de Barcelona, University Hospital Cologne, RWTH Aachen University, University Medical Center Groningen, Parnassia Groep, Columbia University, Schön Klinik Roseneck, Ludwig-Maximilians-Universität München, University of Regensburg, Deutsches Zentrum für Psychische Gesundheit, University of Tübingen, Columbia University Irving Medical Center, Medical University of Vienna, University of North Dakota, Biruni University, Anglia Ruskin University, Charité – Universitätsmedizin Berlin
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: gold
Estimated APC paid: $2,190
Award: G852547454
OpenAlex ID: W7203757184