Eating disorders: recognition and treatment

Context

Eating disorders are defined by the negative beliefs and behaviours they cause people to have about themselves and their eating, body shape and weight. They can cause people to adopt restricted eating, binge eating and compensatory behaviours (such as vomiting and excessive exercise). The emotional and physical consequences of these beliefs and behaviours maintain the disorder and result in a high mortality rate from malnutrition, suicide and physical issues (such as electrolyte imbalances). This is most common in people with anorexia nervosa. There are also other physical complications (such as osteoporosis) and psychiatric comorbidities (such as anxiety disorders) that affect the wellbeing and recovery of people with an eating disorder and raise the cost of treatment.

Using figures for UK hospital admissions from 2012 to 2013, the eating disorders charity BEAT estimated that there were over 725,000 people with an eating disorder in the UK, approximately 90% of whom were female. However, recent community-based epidemiological studies suggest that as many as 25% of people with an eating disorder are male. Eating disorders most commonly start in adolescence, but can also start during childhood or adulthood. About 15% of people with an eating disorder have anorexia nervosa, which is also more common in younger people. Most people with an eating disorder meet diagnostic criteria for bulimia nervosa, binge eating disorder, or other specified feeding and eating disorder (OSFED). Each disorder is associated with poor quality of life, social isolation, and a substantial impact for family members and carers. Eating disorders are long-lasting conditions if they are not treated.

This guideline covers identifying, assessing, diagnosing, treating and managing eating disorders in people of all ages. It does not cover avoidant/restrictive food intake disorder (ARFID), pica, rumination disorder, or obesity in people who do not have an eating disorder. The guideline makes recommendations for different stages of the care process on identifying eating disorders, ensuring patient safety, supporting people with an eating disorder and their family members and carers, and ensuring people have access to evidence-based care. Given the high level of physical complications and psychological comorbidities, recommendations on care cover both physical care and psychological interventions. The guideline applies to all settings in which NHS care is provided, and to settings in which eating disorders might be identified.