Eating Disorders Review is now entering its 20th year of publication. It’s difficult to believe that the newsletter we launched at UCLA in 1989 would survive and thrive for two decades. The success of this venture is primarily due to the efforts and devotion of Mary K. Stein, our managing editor, Leigh Cohn, our extremely supportive publisher, and to the many outstanding people who have been diligently serving as members of the editorial board, a virtual “Who’s Who” of the eating disorders world (see box).

How exciting and productive these years have been for the field! While we’ve all wished for greater progress in numerous areas, the advances made have been considerable and promise better years to come for patients and families, with many hopes for better ways of diagnosing, understanding, assessing, and, ultimately treating and perhaps curing patients with eating disorders.

What’s transpired since 1989? To start at the big-picture level, the eating disorders field has become better organized and more substantial in its advocacy, professional development, research and treatments. The past 20 years have witnessed the birth and substantial growth of the National Eating Disorders Association (NEDA), the Academy for Eating Disorders (AED), the Eating Disorders Research Society, and other associated and affiliated organizations around the world. In 1989, the International Journal of Eating Disorders was a fledgling publication. It’s now in its 41st volume, and since that time several additional American and international professional journals devoted to eating disorders have emerged.

Research and publications on eating disorders have been increasingly lively.  Since 1989 to the end of November 2008, 14,730 new journal citations for eating disorders appeared on PubMed for articles in the medical literature. We now have a better understanding of eating disorders, ranging from basic genetics, neurobiology, and pathophysiology through epidemiology. We have seen the approval by the FDA for the first medication shown to be effective for bulimia nervosa, and now several antidepressant and other medications have shown value for treating bulimia nervosa and binge eating disorder. In addition, cognitive behavior therapy and several other psychotherapies have proven helpful in treating bulimia nervosa and binge eating disorder. Web-based, tele-medicine and self-guided treatments have been employed to deliver services remotely and at less cost than more traditional approaches, carrying the promise that even greater degrees of assistance will reach a much larger number of patients and families. For adolescents with anorexia nervosa, therapies utilizing techniques employed in the Maudsley family treatment model appear to be effective. We remain optimistic that medical treatments and other psychotherapeutic and psychosocial treatments for anorexia nervosa will improve as well.

As a result of these efforts, greater organization in the field and better attempts to ascertain expert consensus, we’ve seen the evolution of professional practice guidelines by the American Psychiatric Association and Society for Adolescent Pediatrics in the U.S., the National Institute of Clinical Excellence (NICE) in Great Britain, the Royal Psychiatric Society of Australia and New Zealand, and by other professional groups elsewhere around the world.

Helping to make these discoveries, research funding for eating disorders research has increased substantially. The National Institutes of Health now has a special study section devoted to reviewing research proposals concerning eating disorders, and private foundations as well as other funding in the U.S. and elsewhere has fueled robust research initiatives. And the sophistication of the research is increasing. At this point, we can anticipate that multi-site studies of increasing complexity will permit randomized trials of greater power, and that analysis of data collected from ever-larger practice research networks, a large array of practitioners who contribute to data collection, will further add to the evidence base for effective treatments.

At the same time, the climate in favor of insurance funding for eating disorders treatment may be improving, both with the passage of the national parity legislation and as the result of several successfully fought legal battles with third-party payers. We not only can hope, but we can be political.

Nevertheless, despite these advances, our patients and their families continue to have serious, and sometimes grave, struggles. There are few laurels to rest on. Researchers, clinicians, advocates and administrators all have much to do. Over the next few years we can expect a refinement and upgrading of our diagnostic understanding of the eating disorders as the DSM-V tools up. These conceptual advances will contribute to the vitality of ongoing research in all spheres of inquiry and, as a result, we know that we can expect increasing productivity in the field. It is our pleasurable service to continue to inform our readers about these developments.