Beneath the tip of the iceberg: why so many people with eating disorders are not referred for treatment

Eating disorders contribute substantially to global disability burden in terms of prevalence (Australian estimate is 17.2%),1 mental and physical morbidity, duration of illness and early mortality.2 With figures suggesting that 77% of people with an eating disorder never receive specialised treatment,3 it is clear that eating disorder clinicians are only treating patients who are on the ‘tip of the iceberg’. The broad scope of a general practitioner’s (GP’s) practice inhibits the detection of each and every underlying condition, yet low referral rates are a part of this issue. People with eating disorders do present to primary care for treatment of associated health conditions;4 thus, improving detection within this setting represents an opportunity to increase access to evidence-based treatment. We attempt to unravel two prevailing stereotypes that have an impact on how eating disorders are perceived, ultimately influencing detection and referral behaviours.