Factors that may influence future approaches to the eating disorders.

The past thirty years have seen dramatic changes in our approach to the eating disorders. These include marked improvements in the recognition and understanding of the disorders, and the reduction of the morbidity and mortality of anorexia and bulimia nervosa. Bulimia nervosa itself, now the focus of so much attention, was described less than twenty years ago. While these gains, including those in the level of knowledge and appreciation by the public, have been transmitted to the benefit of patients, there remain significant difficulties in treating people with eating disorders. Critical research may address gaps in knowledge and lead to more efficacious treatments. At the same time, however, changes in the health care system are occurring rapidly and these will have an effect on both research and treatment. The purpose of the present article is to highlight scientific and systemic factors that the authors feel will play an important role in how people with eating disorders are responded to in the coming years. In addressing the eating disorders we are confining our remarks to anorexia and bulimia nervosa, and not to obesity; the latter would require consideration of many other issues, beyond the scope of this review.