Identification and Management of Binge-Eating Disorder and Bulimia Nervosa in Primary Care Settings: A Qualitative Systematic Review of Healthcare Professionals' and Patients' Perceptions.

Abstract

Objective: To understand how the identification and management of binge-eating disorder (BED) and bulimia nervosa (BN) in primary care settings are perceived by both patients and healthcare professionals, and how rates of identification and referral for support may be improved.

Methods: A systematic review of qualitative studies was conducted. Eight databases were searched in August 2025. Studies were excluded if they focused on secondary or tertiary care, patients under the age of 16, or anorexia nervosa. Data on sample, type of eating disorder, year of publication, and country were extracted, and thematic synthesis was used to synthesize the data. The quality of studies was assessed using the Critical Appraisal Skills Programme checklist for qualitative research.

Results: Twenty-five studies were included. Four articles were of high quality; the rest (N = 21) were medium with a moderate risk of bias. Most of the studies were from the United Kingdom (N = 9), with 14 focusing on healthcare professionals' and 13 on patients' perspectives. The main factors influencing the identification and management of BED/BN were identified to be knowledge and understanding of the conditions, healthcare professional-patient interactions, attitudes and emotions toward BED/BN and the healthcare system, and the existence and accessibility of treatment and referral pathways.

Discussion: The interaction of these factors is discussed in relation to the literature, and gaps in research and clinical practice are identified, such as a limited separation of eating disorder categories, which could help inform the development of strategies to improve the identification and management of BED and BN.