Empowering Eating Disorder Recovery Through Digital Support

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Digital interventions were viewed as practical; flexible; and effective for self-help, mindfulness, and reducing disordered-eating thoughts and behaviors among patients with mild to moderate eating disorders.

However, users stressed that these tools cannot fully replace traditional face-to-face therapy and need more personalization to address individual needs.

Healthcare systems are struggling to keep up with the demand for eating disorder treatment — which currently affects 8.4% of women and 2.2% of men worldwide — particularly after COVID-19, which led to more cases and referrals. Long waitlists force specialists to focus on the most severe cases, leaving those with mild to moderate eating disorders untreated. This delay can worsen symptoms, leading to dangerous health outcomes like extremely low body mass index and life-threatening emergencies.

“Similarly, people with eating disorders may have difficulty accessing treatment due to logistical barriers such as lack of transport, financial barriers to private psychotherapy and language barriers,” wrote lead author Lauryn Gar-Mun Cheung, BSc, MSc, and a team of investigators from the Division of Psychiatry at University College London in the United Kingdom. “For those who struggle to access traditional treatment, digital interventions can offer a more accessible means of managing eating disorder symptoms and distress.”

These digital tools — which often include self-help, symptom monitoring, cognitive restructuring and psychoeducation — can address these barriers by providing more flexibility and accessibility, as patients can connect with these interventions using their smartphone or computer, generally at a low cost. They can also lessen the fear of judgment associated with face-to-face approaches as they are more discreet.

To better understand the user preferences for interventions and how patients with eating disorders experience them, investigators conducted a database search to identify studies that focused on self-help with minimal or no guided support.

Eligible studies were those that were conducted between 2013 and 2024; included patients aged 18 or older with self-reported, subclinical or diagnosed eating disorder symptoms; and used digital tools such as apps, smartphones or tablets. Although limited contact with clinicians or therapists was allowed, they could not include regular two-way communication during every session.

A total of 8 studies were selected, with 75% including all-female subjects. Only 4% of all participants were male. Four studies were rated as high quality and four were appraised as moderate.

Investigators identified 7 meta-themes and 13 subthemes, including the appeal of the intervention, the role of digital interventions in treatment, the value of support, the importance of engagement, the design of the intervention, communication, and shaping knowledge to improve behaviors.

Accessibility and flexibility were rated highly among users, citing practicality, compatibility with their lifestyles, and their ability to address previous barriers. They also enjoyed the discreet method of help provided with this form of treatment. However, participants thought these tools were better suited for use as a complementary tool alongside psychotherapy as opposed to a treatment to be used independently.

Users mentioned they highly valued the support from both professionals and peers that this method of treatment allowed for, with one study reporting increased motivation to continue managing their eating disorder. Users said interventions that were interactive and engaging were more likely to lead to continued engagement, and personalization and customization were heavily preferred.

“These insights provide clear direction for future codesign and development of digital interventions,” investigators concluded. “Further involvement of end users from early research through to final testing will allow developers to create more engaging, personalized and effective tools that better meet user needs, ultimately reducing dropout rates and closing the treatment gap for those with mild to moderate eating disorders.”