Behaviour and Agency in Eating Disorders: New Research
A new "Journal of Eating Disorders" article on improving eating disorder treatment.
Updated April 23, 2026 | Reviewed by Monica Vilhauer Ph.D.
The Journal of Eating Disorders has a “Comment” article type: “short, narrowly focused articles of contemporary interest.” This felt like a good fit for some thinking about eating disorder treatment that, together with a neurobiologist colleague Michael Leon , had been percolating for me for a while: I had a sense that the ED field had lost its way.
The stats about recovery success rates are reliably disappointing: Meta-analysis after meta-analysis come to frustrating conclusions and make urgent calls for innovation . So this paper ( Troscianko & Leon, 2026 ), which came out last month, was our response.
How does a field like this lose its way? Well, we suggest that the problem in this case is that things have grown radically over-complicated. When one looks at the way things are done in ED wards and clinics, with multidisciplinary treatment teams involving physicians, nurses, psychiatrists, clinical psychologists and psychotherapists, dieticians, and other specialists for supplementary therapeutic interventions, the whole thing can feel almost surreally labyrinthine—especially when one remembers what the point of it all is to help someone relearn how to eat.
And so, we propose going back to first principles, and we identify two in particular that have come to be more often overlooked as the evidence-based protocols have been refined and the professional support structures expanded: behaviour and agency.
What do we mean by these? By behaviour we mean eating and other everyday actions and habits, and by agency we mean an individual’s capacity to set priorities and intentions, generate insights, draw conclusions, make decisions, and perform actions. The two are tightly linked: one of the main things that exercising personal agency involves is making choices about everyday behaviours. And both are crucial to eating disorder recovery in very straightforward ways.
Behaviour is obviously central in the sense I touched on earlier: Eating disorders are eating problems, so recovering from one must centre on learning how to eat well. And agency is central because an individual with an eating disorder knows their own eating disorder better than anyone else does, so they should take the lead in the process of learning how to eat well.
The more my practice as a recovery coach has matured, the more sensitized I’ve become to the importance of these two factors. Recognising their importance means, for example, continuing to bring interesting explorations of psychological complexities back around to where the insights can crystallize and be tested out in practical experiments. It means resisting the natural human impulse to help someone by giving them good advice, and instead offering questions, invitations, provocations, and reminders to help them cultivate their own capacities to learn, decide, and act.
A previous version of this paper, submitted to a different journal, made more of the coaching versus therapy distinction, treating the two as dichotomous. But in the revised version for the JED , we softened the polarity: Actually, what matters isn’t whether you call something therapy or coaching, or what precise modality you were trained in. In our view, what matters is how conducive the structures you use are for emphasising behaviour and agency. And there’s an interesting precedent for doing both in the therapeutic world, for example, in the context of “solution-focused brief therapy”, which we offer as a reference point in the article. The approach is one that “views the client as the expert on his or her own life” and “proceeds by helping the client develop his or her own solutions” ( O’Halloran, 1999 , p. 384). Another way to characterize the approach is that “solution-focused brief therapy is seen as a perfectly logical and straightforward process and eating disorders are seen as ways of behaving that can be changed” (Jacob, 2001, p. 5). The vibe of these descriptions is strikingly similar to the angle taken by popular coaching handbooks. For example: “Solution-focused coaching is a practice that places primary emphasis on assisting the client to define a desired future state and to construct a pathway in both thinking and action to move toward that future state. […] “the solution-focused coaching approach sees the client as fundamentally capable of solving their problem” ( Cavanagh & Grant , 2010, p. 52).
Of course, many of those coaching handbooks caution against applying coaching methods in cases of illness where therapy is called for—but this warning is arguably misplaced when gold-standard therapies simply aren’t reliably doing what practitioners or clients would like them to be doing. This is not to say that high-behaviour, high-agency methods will “work” all of the time, where work means helping someone to efficiently and lastingly recover from their eating disorder. But, by trusting and helping the individual to decide what they want to change and for what purpose, and then trusting and helping them to do so, such methods are, I think, very unlikely to do serious harm by coercing, re-traumatizing, or disempowering. And they have the potential to do all kinds of exciting good, by prioritizing exploration, discovery, and the powerful feedback loops that can be sparked and nurtured between mind, body, and behaviour.
Michael and I see the kinds of professional practice that support ED recovery in high-behaviour, high-agency ways as part of a broader movement away from talk therapies in which generating personal narratives about the past overshadows creating personal change in the present for the future, and also away from the paternalistic model of medicine in which the strong and knowledgeable doctor rescues the weak and ignorant patient by telling them what to do. It makes sense that such shifts would be playing out most conspicuously in the field of eating disorders, where questions of gendered power dynamics and control-related ambivalence about illness and recovery are often centre stage. But this field also shares much with all the other areas of healthcare where patient advocacy, AI therapists, cost-of-living crises, backlashes against over-medicalization, and boundary -blurring between health, wellness, and lifestyle make the old medic-patient power dynamics ever more obviously obsolete. As I discussed through a wider lens in a blog series on why the drabness of mental healthcare matters, there’s lots to be interrogated and transformed. And much of the transformation might come from daring to simplify.
We hope that whether you have an eating disorder and want to stop having one, or you’re a professional working with eating disorders, feeling curious about how the field might do things differently, this paper will have something of value for you.
By adding personal agency into the mix, this paper builds on our 2020 Frontiers paper “Treating eating: A dynamical systems model of eating disorders” (Troscianko & Leon, 2020). The new one, entitled “Can methods that focus on eating behaviour and individual agency improve success rates in eating disorder recovery?”, is open-access .
If you’re interested in the process of writing and publishing the article, you could also check out a trio of pieces on my Substack: on writing lessons learned or confirmed; on how the argument changed between journal submissions; and on cognitive dissonance and the peer-review process .
Jacob, F. (2001). Solution focused recovery from eating distress . London: BT Press. PDF sample here: https://btpress.co.uk/wp-content/uploads/2021/01/0006Sample.pdf
Cavanagh, M. J., & Grant, A. M. (2010). The solution-focused approach to coaching. In D. Clutterbuck, E. Cox, & T. Bachkirova (eds), The complete handbook of coaching , pp. 51–64. London: Sage. https://www.google.co.uk/books/edition/The_Complete_Handbook_of_Coaching/wmVHrqIIM8MC
O’Halloran, M. S. (1999). Family involvement in the treatment of anorexia nervosa: A solution-focused approach. The Family Journal , 7 (4), 384–388. Paywall-protected journal record here: https://doi.org/10.1177/10664807990740
Troscianko, E. T., & Leon, M. (2020). Treating eating: A dynamical systems model of eating disorders. Frontiers in psychology , 11 , 1801.Open-access full text here: https://doi.org/10.3389/fpsyg.2020.01801
Troscianko, E., & Leon, M. (2026). Can methods that focus on eating behaviour and individual agency improve success rates in eating disorder recovery? Journal of Eating Disorders , 14 (1), 59. Open-access full text here: https://doi.org/10.1186/s40337-026-01537-6
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Emily T. Troscianko, Ph.D., is a researcher and writer with a particular interest in the links between fiction-reading and mental health.
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