Identification and Management of Binge-Eating Disorder and Bulimia Nervosa in Primary Care Settings - A Qualitative Systematic Review of Healthcare Professionals' and Patients' Perceptions

Sep 29, 2026

Objective: To understand how identification and management of binge-eating disorder (BED) and bulimia nervosa (BN) in primary care are perceived by patients and healthcare professionals, and how identification and referral rates for support can be improved. Methods: Qualitative systematic review of studies searched across eight databases in August 2025, with thematic synthesis and quality appraisal using the CASP checklist. Results and discussion synthesize key influences and research gaps.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages19

Reading Time48 min

AccessFree to download

Introduction

Methods

Results

Discussion

Summary

International Journal of Eating Disorders REVIEW OPEN ACCESS Identification and Management of Binge-Eating Disorder and Bulimia Nervosa in Primary Care Settings: A Qualitative Systematic Review of Healthcare Professionals' and Patients' Perceptions Stella Kozmér1 | Christopher O'Rouke2 | Natalia S. Lawrence3 | Jane R. Smith1 | Samantha B. van Beurden1 1University of Exeter Medical School, University of Exeter, Exeter, UK | 2Dorset Healthcare NHS University Foundation Trust, Bournemouth, UK | 3Department of Psychology, University of Exeter, Exeter, UK Correspondence: Stella Kozmér ([s.kozmer@exeter.ac.uk](s.kozmer@exeter.ac.uk)) Received: 11 June 2025 | Revised: 23 September 2025 | Accepted: 27 September 2025 Action Editor: Kelly L. Klump Funding: This work was supported by the National Institute for Health and Care Research (NIHR) School for Primary Care Research (C062) . The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Keywords: binge-eating disorder | bulimia nervosa | identification | management | primary care | qualitative | systematic review ABSTRACT Objective: To understand how the identification and management of binge-eating disorder (BED) and bulimia nervosa (BN) in primary care settings are perceived by both patients and healthcare professionals, and how rates of identification and referral for support may be improved. Methods: A systematic review of qualitative studies was conducted. Eight databases were searched in August 2025. Studies were excluded if they focused on secondary or tertiary care, patients under the age of 16, or anorexia nervosa. Data on sample, typeof eating disorder, year of publication, and country were extracted, and thematic synthesis was used to synthesize the data. The quality of studies was assessed using the Critical Appraisal Skills Programme checklist for qualitative research. Results: Twenty-five studies were included. Four articles were of high quality; the rest (N = 21) were medium with a moderate risk of bias. Most of the studies were from the United Kingdom (N = 9), with 14 focusing on healthcare professionals' and 13 on patients' perspectives. The main factors influencing the identification and management of BED/BN were identified to be knowledge and understanding of the conditions, healthcare professional–patient interactions, attitudes and emotions toward BED/BNand the healthcare system, and the existence and accessibility of treatment and referral pathways. Discussion: The interaction of these factors is discussed in relation to the literature, and gaps in research and clinical practice are identified, such as a limited separation of eating disorder categories, which could help inform the development of strategies to improve the identification and management of BED and BN. 1 | Introduction Eating disorders (EDs) that involve binge eating, such as bingeeating disorder (BED) and bulimia nervosa (BN), are among the top three most common EDs globally, affecting approximately 4.2% of the population (Galmiche et al. 2019), with suggestions of a higher true prevalence (Hay et al. 2023) . Both BED and BN represent significant public health concerns with profound implications for both physical and mental health outcomes (Giel et al. 2022; Milano et al. 2018) . If BED and BN are This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. © 2025 The Author(s). International Journal of Eating Disorders published by Wiley Periodicals LLC. 16 International Journal of Eating Disorders, 2026; 59:16–34 [https://doi.org/10.1002/eat.24568](https://doi.org/10.1002/eat.24568) Summary • Many healthcare professionals in primary care do not feel confident identifying or managing binge-eating disorder and bulimia nervosa, partly due

FAQs

What is the main objective of the review?

To understand how primary care identification and management of BED and BN are perceived by patients and healthcare professionals, and how support identification and referral could be improved.

How were studies selected and synthesized?

A systematic review of qualitative studies searched eight databases in August 2025. Studies were excluded based on care setting and age criteria, and thematic synthesis was used, with study quality assessed using the CASP checklist.

What factors most influenced identification and management of BED/BN in primary care?

Knowledge and understanding of the conditions, healthcare professional–patient interactions, attitudes and emotions toward BED/BN and the healthcare system, and the existence and accessibility of treatment and referral pathways.

What research and clinical gaps does the review highlight?

Gaps include limited separation of eating disorder categories, which could inform strategies to improve identification and management of BED and BN.

Sep 29, 2026

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