Dr Benjamin Geers (left) and Dr Tamsin Newlove-Delgado (right) discuss how the Mental Health of Children and Young People in England surveys help researchers move beyond medical diagnoses to support adolescents experiencing eating problems.
Why eating problems in young people matter
Eating disorders and eating-related difficulties in adolescence are important public health issues. They can be associated with distress, impairment, physical-health consequences and mortality.
Earlier intervention and treatment for eating disorders are associated with improved outcomes, which aligns with the NHS 10-Year Plan’s broader shift from treating illness to preventing it.
In particular, NHS guidance for children and young people’s community eating disorder services specifically emphasises early support before eating disorders or disordered eating become more serious.
However, early identification is not straightforward.
Published findings from the 2023 Mental Health of Children and Young People in England (MHCYP) survey show why: possible eating problems (as identified by screening questions from the Eating Disorders module of the Development and Wellbeing Assessment) were common, particularly in older adolescents.
In 2023, 59.4% of young people aged 17 to 19 screened positive for a possible eating problem, including 77.5% of young women and 42.3% of young men.
These figures indicate that these young people had an increased likelihood of broader difficulties with eating, and do not mean that these young people had a clinically impairing eating disorder; in fact, research using the earlier 2017 MHCYP survey found that only a small proportion of those ‘screening positive’ in the survey met diagnostic criteria for an eating disorder.
However, they do show the scale of eating-related concerns in adolescents.
For some young people, eating-related difficulties may be transient or may not require specialist eating-disorder treatment. For others, they may be early signs of more persistent distress, later clinical need, other mental health difficulties, or an emerging eating disorder.
This creates an important question for researchers, clinicians and services: how can we better understand which young people may need support, where they are currently seeking help, and which groups may be less visible to services?
Why population data is needed
As highlighted by the charity Beat, there can be a long delay between eating-disorder symptoms developing and becoming visible to services, particularly when symptoms are hidden, normalised or not recognised as eating-related. Even when concerns are recognised, clinically significant symptoms may not meet criteria for a formal eating-disorder diagnosis.
Routine electronic healthcare records are valuable for studying eating disorders and service contact because they can show when an eating disorder has been recorded in a healthcare system.
This is done through diagnostic or clinical codes, such as those defined in the International Classification of Diseases (ICD), Read codes and Systematised Nomenclature of Medicine Clinical Terms (SNOMED CT).
However, relying on these codes to identify cases may miss young people not in contact with services, those whose eating difficulties are not recognised clinically, and those whose difficulties are recognised but not coded.
This is a challenge for early-identification research, because diagnostic codes can bias studies towards more severe or clinically visible presentations. Population data is therefore essential for studying possible eating problems before they become visible in routine healthcare records.
The value of the Mental Health of Children and Young People surveys
The NHS England MHCYP 2017 survey, available through the UK Data Service, provides a valuable way to study these questions.
Because it is based on a population-representative sample rather than a clinical sample, it allows researchers to examine possible eating problems among young people regardless of whether they have sought help, received a diagnosis, or had their difficulties recorded in healthcare data.
The 2017 survey also included the full Development and Wellbeing Assessment (DAWBA), a standardised diagnostic assessment which uses clinical rating to determine whether the children and young people in the survey met criteria for a psychiatric disorder.
This means it is also possible to study eating difficulties in the context of other conditions such as anxiety and depression.
The survey combines information on possible eating problems with rich mental-health, sociodemographic and service-contact data.
This allows researchers to examine the wider context of eating-related concerns, including young people’s and parents’ self-reported contact with a range of mental-health support sources, including schools, primary care, child health and specialist mental-health services.
These routes are not always visible in routine healthcare data but may offer opportunities for recognition and support.
The follow-up surveys in 2021 and 2023 also include valuable information on possible eating problems and on eating disorders.
MHCYP 2021 included the screening questions on possible eating problems, and MHCYP 2023 included the full Eating Disorders Module of the DAWBA, which provided data on the prevalence of eating disorders to ICD-10 criteria.
MHCYP 2017 and the follow-up surveys in 2020, 2021, 2022 and 2023 are fully described in this cohort profile resource, and the individual survey datasets are available to researchers through the UK Data Service Data Catalogue, where they can be found by searching for “Mental Health of Children and Young People in England“.
Looking beyond diagnostic codes
Population survey data therefore complements, rather than replaces, electronic health records.
Clinical records are invaluable for studying diagnosed eating disorders, healthcare use and treatment pathways, but population data can capture eating-related concerns before they become visible, formally recognised or coded in clinical settings.
MHCYP 2017 is especially valuable because it combines possible eating-problem measures, sociodemographic data and self-reported service-contact information within a population-representative sample.
This allows researchers to examine whether eating-related concerns and patterns of support differ by age, sex, ethnicity and household circumstances, including among underserved or marginalised groups who may be less visible in routine healthcare data.
This is also the rationale for our ongoing linked-data work with the Avon Longitudinal Study of Parents and Children, which examines how questionnaire-reported eating-related difficulties and routine coded records capture different aspects of clinical visibility.
Why access through the UK Data Service matters
The UK Data Service makes this work possible by providing safe, trusted and timely access to high-quality, population-representative national survey datasets that can answer questions not easily addressed using clinical records alone.
In eating disorder research, this allows us to develop earlier, more equitable and better-informed responses to eating problems in adolescence.
About the authors
Dr Benjamin Geers is an NIHR Academic Clinical Fellow in Child and Adolescent Psychiatry at the University of Exeter.
His research focuses on adolescent eating problems, clinical visibility, service contact, and the use of population and linked healthcare data to understand where young people with eating-related difficulties may be recognised or missed.
Dr Tamsin Newlove-Delgado is an Associate Professor in Child Public Mental Health at the University of Exeter and Director of CHYME, the Children and Young People’s Mental Health Research Collaboration.
She was an academic consultant on the NHS England Mental Health of Children and Young People in England survey series and co-led the academic input to the survey consortium. Her research focuses on child and adolescent mental-health epidemiology, population mental-health trends, service contact and the use of survey data to inform policy and service planning.
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