Development of recommendations to improve the identification and management of binge eating disorder and bulimia nervosa in primary care in the UK: a qualitative investigation

Background Binge Eating Disorder (BED) and Bulimia Nervosa (BN) are the most common eating disorders. Our previous review highlighted that limited knowledge and understanding of BED/BN amongst primary care professionals may negatively impact their identification and management. Our subsequent UK-wide survey highlighted limited active identification in practice and significant differences in the management of BED/BN. Aim To explore ways to improve the identification and management of BED/BN in UK primary care. Design & setting Online individual interviews and focus groups. Method Sample comprised healthcare professionals (HCPs) working in primary care and individuals aged 16+years with lived experience (LE) of BED/BN who were purposively sampled from respondents to our survey and advertisements. Reflexive inductive-deductive thematic analysis was used to identify barriers and facilitators to identification and management, and to develop strategies for improvement and overcoming barriers to implementation. Results Interviews and focus groups with twenty-six participants (14 HCPs, 12 LE; 20 [76·9%] female, six [23·1%] male) uncovered four overarching strategies reflecting the need for: BED/BN-specific education; development of primary care-appropriate screening tools and referral and treatment pathways, including improved communication and interim management options; and co-designed, specific national guidelines to support consistent care. Participants emphasised that strategies are only feasible and implementable if underpinned by the development of education and guidelines. Conclusion Improving care for BED/BN in UK primary care requires coordinated, system-level changes starting with education and co-designed guidelines. Our findings provide a pragmatic framework to potentially support earlier identification, enhance care coordination, and inform policy and future research.