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