Clinical update

Quality standard for eating disorders highlights need for closer liaison between teams

Eating disorders guidance from NICE calls for better coordination and earlier access to care

Eating disorders guidance from NICE calls for better coordination and earlier access to care

The earlier intervention begins, the faster patients recover, says NICE

Essential facts

More than 725,000 people in the UK are estimated to have an eating disorder, the majority of whom are women and girls, according to eating disorder charity BEAT.

Eating disorders are characterised by individuals' negative beliefs and behaviours in relation to their eating, body shape and weight, the National Institute for Health and Care Excellence (NICE) says.

These beliefs and behaviours can lead to restricted or binge eating, and compensatory behaviours such as vomiting and excessive exercise. Eating disorders can lead to death from malnutrition, suicide and physical issues, such as electrolyte imbalances.

The conditions most commonly begin in adolescence.

What’s new

A new quality standard to improve the treatment of people with eating disorders focuses on increasing early access to well-coordinated care.

NICE says children and young people with suspected eating disorders who are referred to a specialist service should receive assessment and begin treatment within four weeks. There should be a locally agreed timeframe for adults.

Those who receive swifter treatment have better recovery rates and a reduced risk of relapse. Early intervention may also reduce the need for hospitalisation, and therefore save money, NICE says.

The charity BEAT says people with an eating disorder wait an average of three and a half years for treatment, and a lack of funding for eating disorder services means the length of time patients wait is a postcode lottery.

The quality standard calls for people with eating disorders who are being supported by more than one service to have a care plan that explains how the teams will work together.

Currently, a lack of coordination of services can cause confusion, add to the burden of the person with an eating disorder and their family or carers, and has the potential to delay recovery.

A 2017 report by the health ombudsman called for this issue to be addressed in the quality standard after it investigated the deaths of three women. There was poor planning and coordination in all three cases and too few specialist staff, the ombudsman concluded.

Implications for nurses

  • Be aware of the importance of early recognition and treatment for eating disorders in improving outcomes.
  • Be aware people with an eating disorder may find it difficult or distressing to discuss it with healthcare professionals. They may be vulnerable to stigma and shame and need information and interventions tailored to their age and level of development.
  • Healthcare professionals should discuss with the patient their options for psychological treatment, so that they received tailored care.
  • People who are moved between services must be risk-assessed. Poor communication between services can lead to inconsistent messages and management approaches.

Expert comment

Andrea Morrall, clinical nurse specialist in eating disorders for Sheffield Health and Social Care NHS Foundation Trust and a member of the NICE quality standard team, says: ‘Eating disorders are debilitating and frightening for individuals and their loved ones. Early recognition and treatment is essential for positive prognosis and recovery. As nurses, we need to understand that symptoms present themselves in a number of ways and people may not be identified easily. Quite often a person with an eating disorder may present in primary care with ongoing concerns about their physical health, such as gastrointestinal issues, irregular menstruation or fatigue.

‘Be aware of groups in primary care, non-mental health settings and schools who have an increased risk of developing an eating disorder. This could be young women with unusually low BMIs, people with other mental health issues and young people with type 1 diabetes. We also know there are increasing numbers of males developing eating disorders who often go unrecognised.’


NICE eating disorders quality standard

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