Researchers' Zone:

We still don't understand all the pieces, when talking about eating disorders.

More people are seeking help for eating disorders - but we still don't understand the illnesses

New research center aims to shine light on how and why eating disorders develop

Why do some people develop eating disorders when others do not, even when faced with the same challenges? This is just one of the questions that scientists within the field of mental health are investigating today.

The importance of extensive, scientific research cannot be overstated. Without it, how would we for example have ever known that the bacteria in our gut may play a role in the development of anorexia nervosa?

This is a crucial realisation, both in terms of understanding what eating disorders are and in our future prospects of developing treatments that help more patients effectively.

However, there is still much that we do not know about eating disorders.

To put a stop to the destructive impact of eating disorders on lives around the world, we need more research to better understand what these illnesses are, why they develop, and how we can treat them.


A problem on the rise

Eating disorders are deadly illnesses, with catastrophic consequences for sufferers, their families, and wider society.

Between 2010 and 2018, the number of people reporting to a psychiatric hospital with an eating disorder in Denmark increased by an astounding 60 percent.

We do not know the exact reason for this increase, but it is most likely caused by both more people seeking help as well as an increase in the number of people experiencing eating disorders.

More recently, in 2023, ‘Foreningen Spiseforstyrrelser og Selvskade’ (the Eating Disorders and Self-Harm Association) received 17 percent more phone calls than they received in 2022.

Despite these alarming statistics, these illnesses remain overlooked, under-researched, and misunderstood, as many researchers have shown (see 1, 2, 3, 4 and 5).

Such a lack of recognition is not a new phenomena, and was in fact the catalyst for the establishment of ‘Eating Disorders Awareness Week’ (EDAW) in 1988. This year, EDAW took place between 28th February and 3rd March.

We at the Copenhagen-based Center for Eating and feeding Disorders Research (CEDaR) - a newly-established, growing team of 20+ researchers from around the world led by Professor Nadia Micali - want to take this opportunity to introduce you to our research.


What is the Center for Eating and feeding Disorders Research?

Nadia Micali set up CEDaR in 2022 thanks to a Laureate award from the Novo Nordisk Foundation and support from the Capital Region of Denmark and Psychiatric Center Ballerup. We are a team with expertise in epidemiology, psychotherapy, lived experience, and biology including the brain, genetics, and gut bacteria, working alongside colleagues in Copenhagen and beyond. We are fortunate enough to be based in Denmark - the location of one of the world’s oldest nationwide hospital registries

This means we have access to high-quality information on almost the whole population, instead of only a small number of volunteers, which makes our job that little bit easier. We are also passionate about keeping an open dialogue with the patient community, and have organised events such as our upcoming “Tema eftermiddag om spiseforstyrrelser” (theme-afternoon) in connection with EDAW. 

The event includes three talks from researchers, ranging from the genetics of eating disorders to new ways of approaching treatment for adults and adolescents, and will conclude with a discussion from people with lived experience of eating disorders and caregivers on recovering from an eating disorder.


All the things we don’t know

Scientists have barely scratched the surface in terms of our understanding of eating disorders.

For example, whilst we know that eating disorders usually begin between the ages of 16 to 20 years - a crucial time of brain, body, and social development - we don’t yet know how to identify those at high risk, before the eating disorder develops.

We also know that, at best, about half of people with an eating disorder get better after treatment (see 6, 7), but we don’t really know why this number isn’t higher.

Similarly, there persists uncertainty as to how clinicians, young people, and their families can best develop effective treatments together.

We know that whilst some people experience long-term eating disorders and struggle to find a treatment that works for them, others experience more mild symptoms and recover quickly, even without treatment. But why do some people develop more severe symptoms than others?

The role of the environment in developing an eating disorder has been widely studied by scientists, but what about other factors? For example, what is the role of our DNA?


How will we find answers?

At our new research center, we will consider these questions initially using our own individual expertise, before coming together to produce answers that take into account our multiple and diverse perspectives.

For example, with the help of powerful computers, some of us are sifting through a tonne of information from the Danish health registries to identify environmental risk factors and, in those who have generously donated their genetic data, genetic risk factors.

Others in our group are collecting stool samples from patients with eating disorders to better understand how the different types of bacteria in their gut might be linked to the behaviours associated with these disorders. Compared to people without eating disorders, we anticipate seeing a reduced range of bacteria as well as disturbances in the body's natural balance of processes.


Does the brain look different when someone is ill with anorexia nervosa?

Some members of our group are taking a close look at the brains of young women with anorexia nervosa using a modern and powerful ‘magnetic resonance imaging’ scanner. This scanner captures pictures of the entire brain, including tiny details that are less than one millimetre in size!

We’ll compare these pictures of the brain to those of young women without anorexia nervosa. In sufferers, we expect to find smaller brain volume and less of a substance called myelin, which helps the brain transmit signals at high speed.

After the women with anorexia nervosa recover, we'll do another scan to see if the differences we found during their illness can be reversed with treatment.

Regarding our research into treatment, we will soon be starting a large study to work out what treatment works and for whom in sufferers with binge-eating disorder. Binge-eating disorder is a relatively lesser known eating disorder as it has been defined as an illness only recently, but it affects many sufferers across all genders and ages. We are looking forward to comparing different types of talking therapy to see what might work best in a Danish public healthcare setting.


Our future

We have started multiple projects, only some of which we have described above.

Ultimately, we hope that by increasing our understanding of how and why eating disorders develop, we can help to identify new treatments or adapt existing ones to work for more people.

Perhaps one day in the future, we will also be able to use this knowledge to predict who is at highest risk of an eating disorder, in order to put preventative strategies in place before the illness develops.

Overall, we are excited to continue our work and contribute to making life better for sufferers in Denmark and elsewhere. We will report back on what we find very soon. Stay tuned!


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