Staying on course with early intervention for eating disorders: beware of dilution and drift. Comment on Downs, J. ‘Redefining prevention and early intervention to include longstanding and severe eating disorders’

In a thought-provoking opinion piece written largely from his own lived experience, James Downs calls for a ‘re-imagination’ and broadening of the concepts, principles and practices of early intervention and prevention of eating disorders (EDs), to extend their application to the treatment of people with longstanding severe EDs. In this context, he cites the First Episode Rapid Early Intervention (FREED) model/care pathway as an exemplar of how early intervention has led to tangible improvements in clinical outcomes. He posits that the proposed broadening of concepts, principles and practice will lead to more inclusive and improved care for people with severe and longstanding EDs. In this Matters Arising piece, we examine some of the points he makes about diagnostic categorisations and illness staging, along with patient prioritisation under conditions of resource constraints. We also address some misconceptions about FREED and early intervention. We conclude that whilst all people with EDs should have access to timely, personalised and evidence-based high-quality treatment and care, the well-defined concept of early intervention should stay focused on its intended population, i.e. young people with emerging or recent onset of EDs, to avoid dilution or drift from its intended purpose.