As Altum Health turns twenty, I’ve found myself reflecting on just how much has changed, not only in our practice, but in the wider world of eating disorders. The past two decades have brought enormous progress: in how we understand recovery, how we train professionals, how we talk about bodies, and how we think about weight. It’s been a privilege to witness – and to grow alongside this transformation.
When I first started working in the NHS in the early 2000s, treatment for eating disorders looked very different. The field was narrowly focused on young, white women, and our understanding of who struggled with eating disorders was, frankly, far too limited.
Much of the treatment was shaped by the revolutionary work of Fairburn and CBT-E, which was, and still is, a truly transformative therapy that has helped countless people. Over time, CBT-E itself has evolved, becoming more flexible, more formulation-driven, and more sensitive to issues like weight stigma and diversity. And alongside this, the field has broadened considerably – we now have a much richer range of evidence-based therapies to draw from, each offering something unique. That expansion has mirrored a broader shift in the field: a recognition that recovery looks different for everyone, and that therapy must adapt to the individual, not the other way around.
The landscape has broadened significantly. Eating disorders are now recognised to affect men and people from all backgrounds, though minority groups remain underrepresented in both research and services. Our understanding of neurodiversity has also transformed how we work. We now know that a significant proportion of people diagnosed with anorexia also meet criteria for autism, and that some traditional treatment settings can inadvertently cause harm. There’s growing awareness that neurodivergent individuals may need different kinds of structure, communication, and sensory consideration in treatment – and, encouragingly, more compassion and care in how services are delivered.
Alongside this, conditions that were once little known – like ARFID – have received more attention, and there’s far greater awareness of how to support individuals with avoidant or restrictive eating patterns.
In 2013, the publication of the DSM-5 marked another turning point. It moved us away from rigid BMI thresholds and overly narrow diagnostic criteria, toward language that is less stigmatising and more reflective of lived experience – the thoughts, behaviours, and emotions that define these conditions. This shift has influenced how new generations of professionals are trained, with greater emphasis on nuance, formulation, and compassion – on seeing the person behind the diagnosis.
Beyond the clinical realm, we’ve witnessed a profound cultural shift. The rise of the body positivity movement has transformed how we think and talk about bodies. Representation has widened, stigma has reduced, and the visibility of diverse bodies in the media has helped countless people feel seen. More recently, we’ve evolved towards body neutrality – a gentler, more grounded stance that emphasises respect and care for the body, even on days when love feels out of reach. It feels right for where we are today – less performative, more authentic.
But this progress hasn’t been without its complexities. The body acceptance movement has given many people a sense of freedom they never thought possible, yet it’s also faced challenges in holding space for those who want to pursue physical change without shame or judgment. And with the rapid rise of GLP-1 medications, that tension has intensified.
For some, these medications are life-changing – improving health, mobility, and quality of life in ways that diet culture never could. For others, particularly when used for cosmetic weight loss, they risk undoing some of the hard-won progress we’ve made in reducing stigma and widening representation. It’s an uneasy balance, raising difficult questions about how we define health, choice, and wellbeing.
These complexities are something I’ve been witnessing firsthand through my work with bariatric services – where I’ve seen, up close, the psychological complexity of obesity and the courage it takes to pursue change in a world that still holds so much stigma around weight. As we navigate this new era of medical intervention alongside body acceptance, we’re being asked to hold multiple truths at once – to celebrate diversity, support autonomy, and ensure that compassion remains at the heart of every conversation about food, body, and health.
It can be easy in this field to get stuck, to cling to what we know rather than stay open to what’s emerging. Over the years, I’ve tried to surround myself with people who challenge and inspire me – a team that keeps me young, keeps my finger on the pulse, and reminds me that growth is an ongoing practice. I hope that we’ll continue to do that going forward: to stay open, stay collaborative, and keep evolving together.
Here’s to the next chapter! Dr Courtney xx
