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GPs fail to pick up eating disorders, says NICE guidance

The National Institute for Clinical Excellence has criticised GPs for trivialising symptoms of patients with eating disorders and failing to pick up cases before they become serious.

In draft guidance published this month NICE stated: 'GPs may think issues and symptoms are trivial, partly because they often have little experience of eating disorders.'

GPs may also be 'unsympathetic towards an illness that may appear in part self-inflicted', it added, and even though 5 per cent of women have an eating disorder and most present first in primary care, GPs could be missing half the cases.

NICE recommended GPs ask patients with a suspected eating disorder 'one or two' simple questions such as whether they thought they had an eating problem or worried excessively about weight.

It said they should target young women with a low body mass index for their age, those with unfounded weight concerns and patients with type 1 diabetes who are poor at adhering to treatment.

Other signs include menstrual disturbances or amenorrhoea and gastrointestinal symptoms.

NICE also recognised the 'postcode lottery' provision of specialist services for eating disorders, highlighting the wide variations in staffing levels, service configuration and interventions offered.

It advised GPs take responsibility for the initial assessment and care co-ordination of eating disorder patients and should offer enduring anorexics annual physical and mental health checks.

Dr Ann McPherson CBE, chair of the RCGP adolescent task group and part-time lecturer in general practice at the University of Oxford, backed the findings. 'Just because it's a criticism we can't be saying it's not fair,' said Dr McPherson, a GP in Oxford. While specialist access was a problem, GPs should address eating disorders urgently, she added.

'It's making sure we don't allow a minor eating disorder to become a major problem. We need to be more aware of it,' she said.

Prompt diagnosis was particularly important in anorexia and GPs with a high proportion of children and young people on their list should be especially vigilant, she said.

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