The study was led by Renee D. Rienecke of the Eating Disorders Education Institute in Miami and Northwestern University’s Department of Psychiatry and Behavioral Sciences, together with colleagues at the University of Calgary, Nova Southeastern University, and Galen Hope. The research team included clinicians, academic researchers, and individuals with lived experience of an eating disorder, a composition the authors viewed as critical. Training curricula have historically been designed largely by and for specialists, often leaving out the perspectives of patients and families who navigate the treatment system firsthand. By weighting the judgments of all three groups equally in a formal consensus process, the study sought to build a curriculum that reflects the realities of care rather than the preferences of any single professional community.

The Delphi method, the technique at the heart of the study, is a well-established approach for building consensus among experts who never meet face to face. Participants rate a series of statements independently, the results are aggregated and fed back to the group, and the rating process repeats until stability emerges. This design minimizes the influence of dominant personalities and institutional hierarchies that can distort in-person consensus meetings. In this study, the panel worked through 124 candidate items in the first round, rating each on a five-point scale of importance for inclusion in an introductory course. Predefined quantitative thresholds determined whether an item was endorsed, rejected, or sent forward for re-rating, and participants could also propose topics the researchers had not thought to include.

Those write-in options proved to be one of the study’s most revealing features. Content analysis of the free-text suggestions generated new categories and items that the original item pool had overlooked, including a cluster the researchers labeled myths, misconceptions, and stereotypes about eating disorders. That addition underscores a persistent problem in the field: eating disorders are still widely mischaracterized as illnesses of affluent young women, as vanity-driven choices, or as attention-seeking behaviors, misconceptions that delay diagnosis and discourage help-seeking across demographics. Panelists evidently judged that dismantling these stereotypes belongs at the very beginning of training, before any discussion of diagnostic criteria or treatment technique.

The quantitative results traced a clear arc across the three rounds. In round one, 49 of the 124 items met the endorsement threshold while 41 were rejected outright, with the remainder held for further evaluation. Round two added 25 more endorsed items and 10 more rejections, and the final round contributed 11 additional endorsements and 21 rejections, bringing the totals to 85 endorsed and 72 rejected items. The re-rating rounds were not merely mechanical: in round three, participants received feedback on how the full panel had rated each item in the previous round, allowing them to calibrate their own judgments against the collective view. This iterative feedback loop is precisely what gives the Delphi method its power to converge on genuine group consensus rather than averaging isolated opinions.

Perhaps the most striking single finding concerned treatment modalities. Of 20 treatment approaches or components presented to the panel, only two survived the consensus process: family-based treatment, often abbreviated FBT, and psychoeducation. Family-based treatment is an evidence-based approach in which parents are empowered to take a central role in restoring their adolescent’s nutrition and weight, and it has accumulated strong empirical support for adolescent anorexia nervosa in particular. Psychoeducation, the systematic teaching of patients and families about the nature, mechanisms, and course of eating disorders, is a component woven through nearly every credible treatment model. That the panel endorsed only these two from a list that implicitly included modalities such as cognitive-behavioral therapy, enhanced cognitive-behavioral therapy, and dialectical behavior therapy is a deliberate signal about scope: an introductory course, the panel concluded, should teach trainees to recognize these specialized therapies and understand when to refer, not attempt to train novice learners to deliver them.

This distinction between awareness and competence carries real clinical weight. Eating disorders frequently present first in primary care, pediatrics, dentistry, school counseling, and emergency settings, where professionals may have received only hours of relevant education during their entire training. The diagnostic signs can be subtle, including changes in weight or growth curves, ritualized eating, excessive exercise, electrolyte abnormalities, and enamel erosion, and the illnesses themselves are marked by secrecy and minimization. A trainee who has absorbed a well-constructed introductory curriculum can screen effectively, avoid stigmatizing language, initiate a medical risk assessment, and make a timely referral to specialist care. A trainee who has not may miss the illness entirely or, worse, deliver well-intentioned advice that exacerbates it. The consensus list effectively defines the floor of knowledge every such frontline professional should possess.

The study’s methods also reflect contemporary standards for consensus research. Quantitative decisions about endorsement and rejection were governed by criteria fixed in advance, protecting the results from post hoc judgment calls, while the qualitative analysis of write-in items followed structured content-analysis procedures before those items entered the second round. The research received ethics approval from the Biomedical Research Alliance of New York Institutional Review Board, and all participants provided informed consent. The work was funded by the Eating Disorders Education Institute, and the authors declared no competing interests. Published as open access, the full item-level results are available to educators, professional societies, and training programs that wish to build on them.

The international context sharpens the significance of the findings. Bodies such as the Australia and New Zealand Academy for Eating Disorders have moved further than their American counterparts in codifying expectations for eating disorder competency among clinicians, and workforce documents in the United Kingdom have similarly articulated core capabilities. The United States, by contrast, has had no widely agreed-upon guideline for what introductory eating disorder education should contain, leaving curriculum design to individual institutions and instructors with predictably uneven results. A consensus-derived topic list of 85 items gives American educators, and educators elsewhere, an evidence-informed starting point that can be adapted for medical students, nursing curricula, psychology internships, dietetic programs, social work training, and continuing education for practicing clinicians.

The authors are candid that the list is a foundation rather than a finished curriculum. Endorsement by a Delphi panel establishes that a topic matters; it does not specify how deeply each topic should be taught, in what sequence, or with what pedagogical methods, and the panel’s conclusions describe an introductory course rather than advanced specialist training. Future work will need to translate the 85 endorsed topics into actual course content, evaluate learning outcomes, and test whether graduates of such courses demonstrably improve detection and referral of eating disorders in real clinical settings. Still, the study resolves a deceptively simple question that the field had never systematically answered: what must every newcomer to this area know? With a diverse panel of clinicians, researchers, and people with lived experience now on record, the answer no longer depends on who happens to be designing the syllabus. For a field in which early intervention measurably improves outcomes, a shared, expert-validated map of essential knowledge may prove to be one of the most consequential educational tools the eating disorders community has produced.

Subject of Research: Expert consensus on essential topics for an introductory training course on identifying and treating eating disorders

Article Title: Identifying Essential Topics for an Introductory Training Course on Eating Disorders:

Article References: Rienecke, R. D., Borkenhagen, D., Carde, B., Dimitropoulos, G., Singh, M., Mensinger, J., Turner, C., & Oliver-Pyatt, W. (2026). Identifying Essential Topics for an Introductory Training Course on Eating Disorders:. Journal of Eating Disorders. https://doi.org/10.1186/s40337-026-01758-9

Image Credits: AI Generated

DOI: 10.1186/s40337-026-01758-9

Keywords: eating disorders, Delphi study, training curriculum, family-based treatment, psychoeducation, consensus methods, clinician education, anorexia nervosa, lived experience, medical education, early intervention, stigma

The commercial landscape that prompted the study is expanding rapidly. Companies exemplified by TALLY Health in the United States, co-founded by Harvard researcher David Sinclair, offer at-home kits that analyze methylation rates across the genome to produce a biological age estimate. Biological age, in this framework, is a mathematical prediction derived from biomarkers, and the gap between biological and chronological age is presented as a window into how genetics, environment and socioeconomic circumstances shape health. Many firms go further, pairing tests with anti-aging supplements containing compounds such as calcium alpha-ketoglutarate, quercetin, trans-resveratrol, spermidine and fisetin, and encouraging customers to retest repeatedly to track whether their protocols are working. While distinct from true epigenomic editing with tools like CRISPR-dCas9, these strategies similarly aim to reprogram biological processes at the molecular level, blurring the line between science, medicine and commerce.

Methodologically, the study employed a real-time Delphi approach, an iterative survey technique that lets participants see the group’s collective responses and revise their own answers asynchronously. The panel, recruited through purposive sampling from the Francophone research community, included experts in philosophy, chemistry, biology, law, sociology, geriatrics, bioinformatics and genetic discrimination, with professional experience ranging from two to twenty-one years. Of thirty-seven people invited, thirteen began the consultation and ten completed it. They rated thirteen items on a seven-point Likert scale, with a deliberately high consensus threshold of eighty percent, reflecting the ethically sensitive nature of the domain. To interpret the results, the team applied the RULE framework proposed by Matthias Wienroth, which evaluates emerging technologies through three intersecting lenses: Reliability, Utility and LEgitimacy.

On reliability, the panel voiced substantial doubt. No formal consensus was reached on any of the thirteen items, signaling persistent disagreement about the likelihood and severity of emerging problems, but the pattern of responses revealed a general climate of concern. Participants questioned whether current epigenetic tests can deliver on their promises. One panelist argued that treating biological aging as a reversible phenomenon is problematic in itself, given the complexity documented across the epigenetics literature. The study highlights that construct validity remains an active debate: many first-generation epigenetic clocks, including the widely used Horvath and Hannum models, were trained to predict chronological age, not to measure the biological processes of aging. When companies relabel this output as biological age, they may be overstating what the measurement actually captures.

The technical critique extends to measurement stability. Research by Apsley and colleagues found that many DNA methylation probes used in aging algorithms show only average or below-average stability when samples are collected repeatedly within a single five-hour window, with acute stress and early-life adversity further perturbing readings. This instability means that short-term fluctuations in estimated biological age may reflect measurement noise rather than genuine epigenetic change. Consumers who take supplements for a few months and then retest could easily misinterpret such variation as evidence that an intervention is working. The study also notes that second-generation clocks such as PhenoAge and GrimAge, which integrate clinical biomarkers and predict morbidity and mortality, offer stronger construct validity, and some companies have adopted newer models like CheekAge. Yet a 2025 systematic review found no consensus on a standardized method for assessing biological age, underscoring how immature the field remains.

On utility, the panel was split. Four participants were skeptical that knowing one’s biological age offers practical value, three viewed it positively, and three were neutral. Skeptics argued that overall health at a given age is a better indicator and suggested the tests function largely as a way of selling a service. Supporters countered that an unfavorable result might motivate healthier behavior. The discussion also examined whether epigenetic clocks can serve as surrogate endpoints in anti-aging trials, a use that Horvath and Topol caution is not yet validated because changes in epigenetic age have not been shown to reliably predict clinical outcomes. The strongest convergence in the entire consultation, item three, showed eight of ten participants rejecting the scientific justification for marketing supplements alongside epigenetic aging tests, with one panelist calling the practice a potential exploitation of people’s natural anxiety about aging.

Privacy and data governance emerged as critical flashpoints. Epigenetic data can reveal intimate insights, including disease susceptibility and estimated life expectancy, and companies have already expressed interest in using epigenetic age for life insurance underwriting. The information is also being considered for refining DNA phenotyping in forensic investigations, and researchers have warned of potential secondary uses in immigration, employment screening and military contexts. Panelists questioned who would access the data and whether confidentiality assurances could be trusted, echoing long-standing concerns about the direct-to-consumer genetic testing industry. Notably, the item calling for legislation to prevent epigenetic discrimination approached consensus with 79.21 percent stability, the closest any item came to the threshold. Panelists pointed out that existing genetic non-discrimination laws, such as those addressing genetic information in insurance, do not clearly extend to epigenetic data, leaving a regulatory vacuum.

The legitimacy dimension exposed deeper social fault lines. Panelists warned that marketing epigenetic tests as tools of personal empowerment risks shifting responsibility for aging from structural conditions onto individuals. Research by Krieger and colleagues has shown that epigenetic age acceleration is significantly associated with factors such as being born in a Jim Crow state, low parental educational attainment and adult impoverishment, conditions that disproportionately affect Black, Hispanic and socioeconomically marginalized populations. When test results strip away this structural context, accelerated aging caused by racial discrimination and economic injustice gets reframed as a personal deficit with a purchasable solution. Scholars have also warned that epigenetic responsibility narratives disproportionately target mothers and risk reinscribing racialized interpretations of biological difference. Several panelists further argued that the high cost of tests and supplements could worsen health inequities, with one observing that those who can afford repeated testing will demand more follow-up care, effectively privatizing healthcare services.

The consultation also grappled with what the commercialization of epigenetic youth does to collective perceptions of aging. Many participants felt the rhetoric reinforces ageism, pathologizes a natural process, and promotes an individualistic vision of health as capital to be maximized, with one panelist describing the phenomenon as neoliberal biocitizenship and the promise economy. Not all agreed; one participant argued that highlighting the negative aspects of aging is not morally reprehensible and that objecting to longevism is not a valid criticism. This dissent adds nuance, but the majority view held that consumer epigenomics benefits from and contributes to the commodification of longevity while obscuring the social determinants of health. The authors close with six recommendations, including improving public science communication about the limitations of current tests, regulating marketing claims about biological age, strengthening privacy protections, preventing unauthorized secondary uses of epigenetic data, organizing regular scientific guidance on clinical validity, and conducting further research with actual consumers. As epigenetic clocks migrate from laboratories to bathroom counters, the study suggests that the hardest questions are not technical but social: who benefits, who bears the burden, and whether measuring biological age will deepen or distort our understanding of what it means to grow old.

Subject of Research: Ethical, legal and social implications of direct-to-consumer epigenetic biological age testing

Article Title: Consumer epigenomics and biological age editing: ethical, legal, and social implications

Article References: Anvar, S., Dion-Labrie, M., Joly, Y., & Dupras, C. (2026). Consumer epigenomics and biological age editing: ethical, legal, and social implications. Epigenetics Communications, 6(1), Article 3. https://doi.org/10.1186/s43682-026-00044-8

Image Credits: AI Generated

DOI: 10.1186/s43682-026-00044-8

Keywords: epigenetics, biological age, DNA methylation, direct-to-consumer testing, epigenetic clocks, aging, privacy, epigenetic discrimination, health inequities, ageism, supplements, Delphi study