Addressing Unmet Needs in Eating Disorders Requires Systemic Change and Co-Production: A Commentary on Ali et al....

The treatment gap for eating disorders varies significantly across healthcare systems owing to structural, cultural, and systemic barriers. A recent systematic review by Ali et al. highlighted this disparity, with treatment rates ranging from 2.3% in some US populations to 65.7% in Switzerland, reflecting differences in methodology, healthcare funding, and accessibility. These gaps are exacerbated by inadequate primary care recognition, long waiting lists, and the prioritization of underweight cases, which marginalize individuals with higher body weights or complex comorbidities. Systemic barriers include fragmented care and insufficient interdisciplinary collaboration, especially for individuals with co-occurring conditions such as diabetes, other mental disorders, or neurodivergence. Variations in access to evidence-based treatment also disproportionately affect men, ethnic minorities, and those with newer diagnoses, where a lack of funding and expertise hampers effective intervention. Geographic inequities and reliance on out-of-pocket payments further limit access in some systems. Addressing these disparities requires systemic reforms, including improved training and funding, integrated treatment models, and public prevention programs. Embedding lived experience in research, service design, and policy development can ensure inclusive and culturally sensitive interventions. By targeting the unique challenges of each healthcare system, tailored approaches can reduce inequities, improve access to treatment and outcomes.