An over-reliance on Body Mass Index (BMI) to measure recovery from eating disorders has sparked calls for better assessment methods.
University of Queensland researchers reviewed 60 studies from 5 databases across 16 countries between 1990-2025 to understand more about how nutrition fits in to eating disorder treatment.
PhD candidate Lauren Pearson , from UQ’s School of Human Movement and Nutrition Sciences , said existing assessments of nutrition recovery in people with eating disorders was inadequate and focused inappropriately on the use of BMI or weight.
“We found international guidelines lack tools that effectively reflect the complexity of nutrition-focused interventions or dietary changes in eating disorder treatment,” Ms Pearson said.
“The method of measuring nutrition varied greatly across studies, even when diagnosis or setting was consistent.
“This is concerning because when treatment involves a clinician lacking nutritional training – weight and BMI are often used as a proxy for recovery.
“Anyone who has sought support knows changes to food, eating and nutrition extend far beyond this and are frustrated when their efforts are reduced to weight or BMI.
“We need better ways to measure and communicate nutrition-related change so treatment can be tailored to the individual.”
Eating disorders are serious, complex and potentially life-threatening mental health conditions that have risen significantly over the past 2 decades.
They are characterised by the National Eating Disorder Collaboration as disturbances in behaviours, thoughts and feelings towards body weight and shape, and/or food and eating.
“Our work is part of broader research on assessing eating disorders and to our knowledge, is the first review to examine how food and nutrition outcomes are measured in this field,” Ms Pearson said.
In addition to BMI, treatment outcomes are typically evaluated using psychometric measures including questionnaires.
“Given documented harms linked with weight stigma and bias, and the origins of BMI, we are concerned arbitrary weight targets may reinforce disordered behaviours,” Ms Pearson said.
“Our hope is the research will lead to a re-examination of ‘gold-standard’ treatments by better understanding what effective treatment looks like through individualised measures.
“I’m not saying BMI and weight isn’t important, but it’s not the only piece of the puzzle we need to pay attention to.
“For some people it shouldn’t even be in the puzzle.”
Ms Pearson said progress might be being able to eat socially again, going out for a meal or snack, celebrating a birthday, improved concentration or bowel movements or blood tests, better athletic performance or the ability to choose, prepare and consume an adequate meal.
“Eating disorders can affect anyone – regardless of size, age, race or background – and we encourage anyone who is concerned for themselves or others to seek help early.”
Read the research in The Journal of Treatment & Prevention
Meta-analysis
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