Recognizing Eating Disorders Earlier: UCSF Leads a National Approach
A fourteen-year-old comes in for a sports physical. Weight is down slightly from the last visit — easy to explain away as a growth spurt or a new practice schedule. The visit runs its usual ten minutes: growth chart, vitals, a few questions about school. Nothing here reads as urgent. Fewer than 6 percent of people with an eating disorder are medically underweight, so often, nothing may look wrong at first.
By the time someone with an eating disorder reaches a specialist, they've typically been unwell for an average of two and a half years.
UC San Francisco is establishing a national Center of Excellence for Eating Disorders to close that gap, backed by a five-year, $9+ million grant from the Substance Abuse and Mental Health Services Administration. The Center is housed in the Division of Adolescent and Young Adult Medicine, within the Department of Pediatrics.
Rather than focusing only on training eating-disorder specialists, the Center's strategy is to move recognition further upstream, to the many adults who see a young person before any specialist does.
Recognition Starts Before Specialty Care
Eating disorders sit at the intersection of medical and behavioral health, and treatment already draws on close collaboration with psychiatry. But the encounter that can set someone on a path to care usually happens somewhere else — in a pediatrician's exam room, during a physical therapy appointment, or at school or sports practice. Each of those encounters can be an opportunity to recognize that something may be wrong — if the adult knows what to look for.
“The goal isn’t to turn every care provider and coach into an eating disorder specialist,” says Jennifer Carlson, MD, UCSF pediatrician and project director of the new center. “We want to give them the tools to recognize when someone may need help and know what to do next.”
That means reaching health professionals across disciplines, including pediatricians, dietitians, physical therapists, and child life specialists, while extending training and resources to school staff and coaches.
The Center intends to train more than 1,000 health care providers annually, alongside separate outreach to teachers, coaches, and other community members.
Built to Reach Beyond UCSF
The new Center builds on two longstanding strengths at UCSF’s Department of Pediatrics: an Eating Disorders Program that brings together clinical care and research across pediatrics and psychiatry, and nearly five decades of experience training specialists through the Division of Adolescent and Young Adult Medicine's Leadership Education in Adolescent Health (LEAH) program.
“The opportunity now is to extend what we’ve learned to providers and communities across the country,” says Sara Buckelew, MD, MPH, chief of the division, physician lead of UCSF's Eating Disorders Program, and curriculum director for the new Center. “By bringing our clinical, research, and training expertise together, we’ll turn that knowledge into tools people can use in everyday practice.”
The Center will put that approach into practice in several ways: inside clinics, through EHR-embedded screening support and provider education; beyond them, through resources for coaches, teachers, and community programs; and across the field, through a research network designed to move new findings into clinical practice more quickly.
The proposal drew more than 60 letters of commitment from organizations across the country — including the National Eating Disorders Association, the National Alliance for Eating Disorders, and Families Empowered and Supporting Treatment of Eating Disorders (FEAST) — giving the Center a national network through which to develop and share that work.
Reaching People Earlier
Recognizing eating disorders earlier also means challenging assumptions about who develops them. Emerging research points to increases among historically underdiagnosed populations, including Latino youth and adolescent males. The Center will also draw on UCSF expertise focused on improving access to care for veterans and other underserved populations.
At the same time, the need for eating disorder awareness has grown sharply. Adolescent hospitalizations for eating disorders rose more than sevenfold between 2010 and 2021, including a 70 percent jump in the COVID-19 pandemic.
Against that growing need, expanding specialty care remains essential. But the path to treatment often begins somewhere much more ordinary — during a physical, at school, at practice, or anywhere else someone has an opportunity to recognize that something may be wrong.
The new Center is designed to make more of those opportunities count — so recognition comes earlier, and the path to appropriate care can begin sooner.