GPs told not to restrict eating disorder referral based on BMI in new guidance

Body mass index (BMI) alone should not be used to restrict care to children and young people with an eating disorder, according to new guidance from NHS England which puts more emphasis on early intervention.

All staff should be trained to identify early signs of possible eating difficulties with early prevention and support available, the new advice states.

It follows warnings from some experts and charities that over-reliance on BMI has led to children with anorexia or bulimia being misdiagnosed and or missing out on care.

‘Single measures such as BMI centiles should not be a barrier to children and young people accessing early and/or preventative care and support,’ the NHS guidance for ICBs and healthcare professionals says.

The guidance, developed with eating disorder charity Beat and the Royal College of Psychiatrists, also includes avoidant/restrictive food intake disorder (ARFID), a group that can often struggle to access treatment.

It comes as NICE has conditionally recommended an online therapy programme for people over the age of 16 with eating disorders while they wait for specialist treatment today.

NICE said the programme, called Overcoming Bulimia Online, can be offered for the next two years while more evidence is collected on its clinical and cost effectiveness.

It offers eight sessions for users to go through at their own pace but in order to access on the NHS, individuals must at least have had an eating disorder assessment from their GP. It can be used alongside regular waiting list care and monitoring, NICE added.

The committee said two other online tools its evaluated cannot be recommended until more research is done.

Unguided self-help is not intended for people with severe eating disorders or at a high medical risk and self-help is not suitable for people with any form of anorexia nervosa, NICE said.

In its guidance for children and young people, NHS England said service should be integrated and collaborative with patients cared for in the community whenever possible.

Clinicians are advised to use a range of factors to assess young people taking into account behaviour changes and family concerns rather than relying on rigid measures.

NHS England said every local area in England now has a specialist eating disorder service for children and young people, compared to a handful of areas a decade ago, with patients now seen and offered treatment within three weeks of a referral on average.

Rising demand has seen the number of children and young people treated rising two fifths since the pandemic.

Dr Adrian James, national medical director for mental health and neurodiversity at NHS England, said growing numbers of young people are turning to the NHS for eating disorder support and it’s ‘vital that everyone knows how to access this treatment which is why we will be offering training to teachers, GPs and school nurses to spot the signs and refer children for specialist help faster’.

Tom Quinn, director of external affairs at eating disorder charity Beat, said the new guidance was an ‘encouraging step in the right direction’.

‘We’re pleased by the focus upon issues we’ve long been campaigning on, including early intervention, addressing inequalities in care, access to intensive community and day treatment options, and support for families and carers.’

Dr Ashish Kumar, chair of the Royal College of Psychiatrists’ Eating Disorders Faculty, said: ‘These conditions can be extremely serious and even life-threatening when left untreated, so it is imperative that we are bold in our efforts to innovate the support that is available.

‘Community eating disorder services should use this guidance to establish day care and outreach initiatives that can prevent young people from becoming unwell and help others recover more quickly.’

Commenting on the new NICE recommendation, Dr Anastasia Chalkidou, HealthTech programme director at NICE, said it would be really important for eating disorder care at a time when services are under huge pressure.

‘The research shows real benefits for patients, with reduced binge eating episodes and less severe symptoms.

‘What’s particularly encouraging is that this digital therapy can work alongside existing NHS care, providing extra support without needing more healthcare staff.’