An over-reliance on Body Mass Index (BMI) and body weight to assess recovery from eating disorders may be obscuring meaningful changes in nutrition, according to researchers from the University of Queensland. Their findings highlight the need to rethink how progress is measured during treatment and to develop more individualised approaches that better capture changes in food, eating behaviours, and nutritional health.
Researchers reviewed 60 studies drawn from five databases and covering 16 countries between 1990 and 2025 to examine how nutrition outcomes are assessed in eating disorder treatment. PhD candidate Lauren Pearson, from UQ’s School of Human Movement and Nutrition Sciences, said current approaches were inadequate and frequently placed disproportionate emphasis on BMI or weight. “We found international guidelines lack tools that effectively reflect the complexity of nutrition-focused interventions or dietary changes in eating disorder treatment,” Pearson said.
The review found considerable variation in how nutrition was measured across studies, even among patients with similar diagnoses or receiving treatment in comparable settings. This inconsistency is particularly concerning when care is delivered by clinicians without specialised nutrition training, Pearson said, as BMI and weight may then become convenient proxies for recovery. Yet changes in food choices, eating patterns, and nutrition can extend far beyond numbers on a scale. “Anyone who has sought support knows changes to food, eating and nutrition extend far beyond this and are frustrated when their efforts are reduced to weight or BMI,” she said. “We need better ways to measure and communicate nutrition-related change so treatment can be tailored to the individual.”
Eating disorders are serious, complex, and potentially life-threatening mental health conditions that have increased significantly over the past two decades. They involve disturbances in behaviours, thoughts, and feelings related to body weight and shape, food, or eating. According to Pearson, the research is believed to be the first review specifically examining how food and nutrition outcomes are measured in the eating disorder field. Treatment outcomes are currently assessed using measures such as BMI and weight alongside psychometric tools, including questionnaires designed to evaluate psychological symptoms and behaviours.
However, the researchers warn that an excessive focus on predetermined weight targets could have unintended consequences, particularly given concerns surrounding weight stigma and bias. “Our hope is the research will lead to a re-examination of ‘gold-standard’ treatments by better understanding what effective treatment looks like through individualised measures,” Pearson said. While weight and BMI can provide useful information in some circumstances, she stressed that they represent only one component of recovery. “I’m not saying BMI and weight isn’t important, but it’s not the only piece of the puzzle we need to pay attention to. For some people it shouldn’t even be in the puzzle.”
More meaningful indicators of progress may include being able to eat socially again, going out for a meal or snack, celebrating a birthday, or gaining confidence in choosing, preparing, and consuming an adequate meal. Improvements in concentration, digestive function, blood test results, and athletic performance may also reflect nutritional recovery. The researchers argue that recognising these diverse outcomes could help clinicians provide more personalised and effective care. “Eating disorders can affect anyone – regardless of size, age, race or background – and we encourage anyone who is concerned for themselves or others to seek help early,” Pearson said.
More information: Lauren Pearson et al, Validity of nutrition-related outcome measures in eating disorder treatment: a scoping review, Journal of Treatment & Prevention. DOI: 10.1080/10640266.2026.2669112
Journal information: Journal of Treatment & Prevention Provided by University of Queensland
