It’s estimated that 9% of Americans will have a diagnosable eating disorder (ED) throughout their lives. These mental illnesses are a pervasive epidemic, yet are treatable. However, only 20% of people with eating disorders receive care. This disparity is disturbing, but not unexpected. Barriers to eating disorder treatment exist at institutional, social, and physical levels, creating an interconnected system that’s difficult to navigate, even for folks with privilege and traditional access to healthcare systems. For people of marginalized identities, these barriers have more serious impacts, often worsening long-term outcomes of EDs. Here, we dissect some of these layers to understand the hidden geography of eating disorder care, why the disparity in treatment access exists, and how we can support more equitable access in the future.

Missing Foundations: The Research-to-Practice Gap

Before we dig into identity and eating disorder access, let’s start with the first barrier to care: the research-to-practice gap. Essentially, this refers to a lag between the most contemporary research on eating disorder treatment and the techniques that practitioners are using with patients. 

This trend was documented in the National Comorbidity Survey Replication for mental health services in general. Over 9,000 participants with a mental illness shared their experiences with treatment. Just over 20% of respondents received treatment from a mental health specialist. If all health care providers were included, the number of participants treated would only jump to about 40%. And based on evidence-based treatment guidelines, only 32.7% of all participants were noted to receive the minimum level of treatment. 

How is Evidence-Based Treatment Used in Eating Disorder Care?

We see this pattern specifically in eating disorder treatment. In an assessment of eating disorder care, between 6 and 35% of clinicians reported using evidence-based psychosocial interventions in their treatment strategies. This is despite evidence that treatments like cognitive behavioral therapy (CBT) and family-based treatment (FBT) have improved patient outcomes more so than “treatment as usual,” including non-specific individual therapy and pharmacological treatments.

So what does this all mean for access to eating disorder treatment? The existence of the research-to-practice gap brings to light a stark truth: even those in some form of ED treatment may not be receiving the most reliable type of care. 

Stereotypes, Stigma, and the Narrow Story of Eating Disorders

Due to the research-to-practice gap, a disconnect already exists between the most effective treatment of eating disorders and the care patients receive. But barriers to accessing quality care don’t end there. Now, we take a look at another obstacle: who has easy access to treatment?

The Harm of a Single Story

There is an unhelpful and misleading narrative around who has an eating disorder: that they primarily affect thin, young, affluent white women. This story shapes who is perceived as “at risk,” who gets screened, and who gets care. Diet culture and mainstream media continuously reinforce this image, and unfortunately, this same narrative has seeped into clinical training, healthcare research, and even the design of screening tools.

When the public and the medical field are taught that there’s only one body type or identity associated with eating disorders, everyone outside that image becomes less visible. People whose symptoms don’t match the stereotype may be dismissed or misdiagnosed. Others may never seek help at all, internalizing the idea that they “don’t look sick enough.” And layered on top of these misconceptions is a broader stigma that getting treated for a mental illness signifies weakness, embarrassment, or personal failure. This combination of invisibility and stigma may prevent folks from pursuing care altogether.

Identity, Visibility, and Who Gets Recognized

What are the aspects of identity that influence who accesses care? This is a nuanced topic because most individuals hold a combination of privileged and oppressed identities. But in an attempt to isolate these patterns, researchers have identified trends in how race, gender, age, and body size all impact one’s experience with an eating disorder. In looking at this data, we see how stereotypes cause more harm than just misrepresenting EDs; they distort whose experiences are validated and who receives intervention. 

Race

Research consistently shows that Black, Latinx, Indigenous, and other people of color experience eating disorders at similar or higher rates than white individuals. Yet they are less likely to be asked about symptoms, less likely to receive an eating disorder diagnosis, and less likely to receive appropriate care than their white peers. Black girls and women in particular have been historically overlooked, with symptoms often attributed to stress, discipline issues, or unrelated medical concerns rather than disordered eating.

Gender

With the focus on women with eating disorders, men, nonbinary, and transgender individuals are overlooked. Cisgender men remain significantly underdiagnosed, as their symptoms may be reframed as fitness goals or discipline rather than signs of illness. In fact, the rates of eating disorders in men are increasing more quickly than for females. Transgender and nonbinary individuals, who face elevated stress, discrimination, and body dissatisfaction, have disproportionately high rates of EDs. Yet they also encounter unique barriers to care, including misgendering, a lack of affirming treatment programs, and provider assumptions about who develops EDs.

Age

Eating disorders affect people across the lifespan, yet the focus is often exclusively on youth. There is some grounding to this assumption. According to research that estimated eating disorder prevalence in a group of 100,000 people, the development of EDs was most highly concentrated among adolescents and young adults. This reinforces the need for prevention efforts to be targeted to this demographic. 

However, the study also found both a recurrence and development of EDs in older adults. A lack of screening in older adults can be dangerous. Often, disordered eating symptoms may be attributed to aging, grief, or medical conditions, and they are not given the same attention as they are for youth. Meanwhile, very young children who can develop restrictive eating disorders like ARFID (Avoidant/Restrictive Food Intake Disorder) may be dismissed as “picky” and risk becoming malnourished. 

Body Size

Another aspect of identity that creates an obstacle to getting ED treatment is body size. Many healthcare providers overrely on BMI to be an indicator of disordered eating. But weight bias is one of the most pervasive obstacles in ED recognition, even though these disorders affect people of all sizes. People in larger bodies may be praised for weight loss rather than assessed for disordered eating.

How Stereotypes Become Barriers

The first step to recovering from an eating disorder is recognizing it. However, when stereotypes about who develops an ED overpower other signs and symptoms, this creates a significant barrier to care. Healthcare providers who don’t “expect” eating disorders in certain patients are less likely to screen for them, less likely to believe reported symptoms, and less likely to make referrals for specialized treatment. This means some people suffering never receive an accurate diagnosis, or they receive one only after their illness has become more severe.

Structural Barriers: What Stands Between People and Treatment

Because of the systems of oppression that have plagued our country’s history, we see that aspects of identity impact someone’s access to eating disorder treatment. While marginalized identities may be a common denominator among folks who face more barriers to care, there are structural obstacles at the root of the problem. Finances, geography, provider availability, and more stand between the people suffering and the treatment they need. 

Finances & Health Insurance

Eating disorders have some of the highest mortality rates of any mental illness. As we know, they have both psychological and physical ramifications. Because of the intensity and often chronic nature of these disorders, the cost for treatment is extremely high. Inpatient programs cost, on average, over $50,000, and outpatient programs can be similarly pricey. In many cases, holistic treatment for eating disorders calls for a multifaceted approach, combining physicians, dietitians, and mental health professionals with advanced training. The demand for a range of providers means the costs add up, and not everyone has the ability to pay.

Of course, some people are able to rely on insurance to cover some of their medical bills. But even those who have a medical plan may not have coverage for the care they need. Policies often have restrictive medical-necessity rules that keep patients from receiving care until symptoms are extreme. These policies also tend to use outdated criteria for qualifications, excluding people without the “classic” (i.e. stereotypical) markers of an ED.

Paying for ED treatment isn’t a perfect system, but some people don’t even have that option. Just over 8% of people in the U.S. were uninsured in 2024, with rates slightly higher for Black and Hispanic populations. For much of the uninsured population, paying out-of-pocket for treatment is out of the question. When care costs so much, people get left behind.

Geography & Provider Availability

Where a person lives often determines whether they can access specialized ED treatment. Rural regions face overburdened clinicians, long waitlists, and the need to travel out of state to get treatment. Many counties have no ED-specific services at all, creating “treatment deserts.” This is a pattern across mental healthcare. The U.S. faces a severe shortage of clinicians trained in eating disorders and other mental illnesses. Almost 50% of the population is said to live in a mental health workforce shortage area. 

Even in regions where providers are more available, logistics like transportation, childcare, or time off work can make scheduling and attending doctor appointments challenging. Telehealth has expanded access, but unstable internet or privacy concerns may prevent this from being an option.

Personal & Cultural Barriers

Along with the external factors, many people and their caregivers face internal obstacles that can prevent them from seeking care. In many communities, mental health struggles carry significant stigma. In others, disordered eating may be normalized or dismissed rather than seen as a legitimate illness. Cultural miscommunications during treatment can also impact whether someone sticks with a provider. When providers lack training in culturally responsive care, patients can feel misunderstood or unsafe.

Personal shame can also be a barrier to treatment. Many people may believe they are “not sick enough” to warrant treatment, a sentiment that especially arises for folks who do not match the narrow image of what an eating disorder “looks like.” People who experience high levels of shame around their eating disorders tend to show less progress in treatment than people with less shame. This speaks to a need for additional interventions for folks who have internalized more of the stigmas around mental health. 

The Risks of Leaving Eating Disorders Untreated

We’ve spoken to many of the barriers that stand in the way of someone getting treatment for an eating disorder. There’s the research-to-practice gap, there are ways that identity shapes who can get care, and there are structural obstacles like finances and geography that can make it difficult to access healthcare providers. 

As we acknowledge these challenges, it’s important to ground this information in what is at risk. Eating disorders do not “work themselves out.” They are complex mental health conditions that affect every system of the body.

When these illnesses go untreated, symptoms can escalate quickly. Restriction can lead to cardiovascular instability, electrolyte imbalances, reproductive suppression, bone density loss, and cognitive impairment. Purging behaviors can cause GI damage, tooth decay and gum disease, and consequences of dehydration. Binge eating disorder symptoms may include Type II diabetes, osteoarthritis, heart disease, and some cancers. Beyond the physical symptoms, eating disorders inflict profound psychological harm. Eating disorders often co-occur with other mental illnesses, such as depression and anxiety, and they’re associated with increased suicidality. Ultimately, barriers to treatment delay recovery and potentially cause EDs to become more severe.

Pursuing a More Equitable Path to Care

Creating a future where every person with an eating disorder can access care means reimagining the systems that shape diagnosis, treatment, and recovery. That work begins by integrating culturally responsive training and evidence-based treatments so providers can recognize symptoms across races, body types, genders, and backgrounds. At the policy level, this means improving insurance coverage and increasing treatment access for rural, low-income, and underserved communities. 

Education can be an important piece of this shift, too. Sharing up-to-date research on EDs can reduce stigma, broaden people’s understanding of what these disorders “look like,” and encourage those suffering to reach out for support.

No one’s chance of recovery should hinge on where they live, what they look like, or how much money they have. Untangling the obstacles to treatment should be a priority for mental health care as a whole. The National Alliance for Eating Disorders is here to support those impacted by eating disorders through our free, therapist-staffed helpline; free, therapist-led support groups (both virtual and in-person), and education and advocacy efforts aimed at improving access and equity. The Alliance remains committed to this work so that every person can receive the care and support they need and deserve.