Evolving evidence and continuing uncertainties for eating disorders

To the Editor: We are writing in response to the editorial of Ben-Tovim et al.1 Although we agree that more research into treatment efficacy in eating disorders is needed, we believe that the study to which reference is made2 is seriously flawed. The study should not be presumed to provide evidence about the effect of treatment on outcome, particularly as the majority of patients studied received no treatment. The high death rate (3/95 [3.2%] among patients with anorexia nervosa and 2/37 [5.4%] among patients with "eating disorders not otherwise specified") in such mildly ill patients (few of whom would have warranted hospitalisation on the basis of their weight) approximates that of seriously emaciated patients in longer-term studies of treatment outcome3,4 and could more properly be said to illustrate the results of having no treatment or inadequate treatment.