Lives are being lost and destroyed by the failure of the NHS in England to provide care for people with eating disorders, MPs and campaigners say.
They say more than a million people have an eating disorder, but specialist help is often difficult to access.
It leaves patients relying on GPs who lack the skills and training to help.
The warnings have been made in two separate reports – by charity Beat and the cross-party Public Administration and Constitutional Affairs Committee.
They acknowledged improvements had been made to children’s services, but said adult care remained more problematic.
Research by Beat showed some specialist services had waiting times of more than five months.
Chief executive Andrew Radford said: “This research should set alarm bells ringing.
“Eating disorders have among the highest mortality rates of any mental illness, yet people’s chances of recovery are being subjected to a lottery, and lives are at risk.”
‘I was so unwell I couldn’t carry on’
Hannah, 30, from south London, developed bulimia in her early 20s. It got so bad that she had several suicide attempts.
But her only treatment was one hour of group therapy a week – and she had to wait months before it started.
“It just wasn’t enough,” she said. “I was so unwell I couldn’t carry on. I couldn’t see a way forward.”
After being diagnosed with depression and bulimia, the treatment was still inadequate, Hannah said.
“It wasn’t done in a meaningful way – there was no care plan.”
She finally got the help she needed from a charity, but over the following three to four years she developed anorexia.
This time, she went for private treatment because it was available more quickly.
“If I had accessed the right care back in my 20s, I might have been OK.
“The model is flawed. You are asking people to wait months for treatment when they are already sick walking through the door of their GP.”
What is the scale of the problem?
Estimates suggest more than one million people have an eating disorder, although campaigners believe the true figure could be even higher.
Around three-quarters of them are female.
There is a range of different conditions.
Anorexia and bulimia – where bouts of over-eating are compensated by steps such as enforced vomiting or taking laxatives – account for around half of all cases.
Many cases start during adolescence, but treatment can take years, so most patients need support during adulthood.
Fewer than half of patients with anorexia and bulimia fully recover.
Anorexia has the highest mortality rate of any mental illness.
People with the condition have a five-fold increased risk of death which is linked to complications such as a weakened immune system and heart problems.
Where is the NHS failing?
GPs are often the first point of call for patients.
But the committee warned they lack training, with some research suggesting doctors get little more than “a couple of hours in medical school”.
The committee was told that it resulted in doctors simply relying on body mass index (BMI) as an indicator of problems.
It echoes the research carried out by Beat, with patients complaining they find it difficult to get help.
GPs can refer on to specialist support provided by community mental health teams.
This normally involves some form of talking therapy.
But information provided under the Freedom of Information Act found a seven-fold variation in the numbers getting help across different services.
Waiting times varied between two weeks and five-and-a-half months.
And even when they are referred for help, significant numbers have to rely on the support of general community health teams because of a lack of specialist staff.
While both reports looked at services in England, Beat said the rest of the UK had similar – if not worse – problems.
What is being done to tackle the problems?
The committee’s report was a follow-up to a 2017 review by the Parliamentary and Health Service Ombudsman in 2017.
It highlighted serious failings which contributed to the death of 19-year-old Averil Hart – who died after moving away from home to go to university – and two other young women.
The committee said the findings of their review two years on showed there had been a lack of progress.
But NHS England insisted it has been taking steps.
The health service has been investing in services specifically for under-19s, with a new waiting time target due to come into force next year.
It demands that 95% of those referred for help for an eating disorder should receive help within one week for urgent cases, and four weeks for non-urgent cases.
Funding for mental health services generally is also being increased at a faster rate than the overall budget.
Some £2.3bn of the extra £20bn available for the NHS in England by 2020, will go towards mental health.
Dr Helen Stokes-Lampard, of the Royal College of GPs, said more resources were needed to help doctors support patients with eating disorders.
“This is an incredibly complex area and the standard 10-minute appointment is simply not long enough for us to unravel the many complex issues.”