Adults - Eating Disorders

This guideline applies to adults aged 18+

Introduction

Eating disorders (EDs) have the highest mortality of all psychiatric conditions. Early identification and intervention are key to reducing long-term harm and improving outcomes.

In scope:

Bulimia Nervosa
Anorexia Nervosa
Other Specified Feeding and Eating Disorders (OSFED)

Not in scope:

Avoidant-restrictive food intake disorder (ARFID)
Binge Eating Disorder
Pica
Rumination-regurgitation disorder
Feeding or eating disorders, unspecified
Emetophobia
Psychogenic loss of appetite

The Adult Eating Disorder Service is a weekday, in-hours, primarily psychology-based service. There is medical cover and a weekly triage meeting.

Red Flags:

BMI <14
BP <80/50
Postural drop >20 mmHg
Postural tachycardia >30bpm
QTc >450ms (females) or >430ms (male), unless due to known other cause such as medication
New ventricular arrhythmia
HR <40bpm
Temperature <34.5c
Electrolyte abnormalities: K <2.5, Na <130, Po4 <0.5

This list is not exhaustive

Primary Care assessment and management

NICE Guidance on identifying and assessing patients suspected to have an eating disorder.

AcuteGP – Low BMI guidance and Interpreting Physical Health Data in Adult Eating Disorders: A guide for clinicians

Where unexplained weight loss is suspected, consider:

Ruling out organic causes of weight loss (e.g. malignancy, endocrine, GI causes – this list is not exhaustive)
Performing a basic physical examination and risk assessment, to include:
- BMI
- Blood pressure and pulse lying and standing
- Muscle Strength
- Examination of the skin
- Temperature
Initiate relevant baseline investigations (see investigation section below)

Where an eating disorder is suspected, alongside usual primary care assessment consider:

Any relevant potential safeguarding concerns if the patient is in a caring role
Risk of self-neglect or harm

For patients that do not meet the referral criteria below, weekly monitoring is recommended¹. If areas of concern are increasing or unstable, then a referral may be required.

Advice and Guidance

Specialist Advice & Guidance (A&G) is available via cft.edsreferrals@nhs.net and encouraged for:

Diagnostic uncertainty
Questions regarding risk stratification or management in primary care
Seeking input on borderline referral cases or relapse management
Interim management plans while awaiting specialist assessment

Investigations required prior to referral

Bloods

FBC, U&Es, LFTs, glucose, calcium, phosphate, magnesium, TFTs, CRP, B12/folate

If BMI <17 or there is a history of purging or electrolyte abnormalities

Referral Criteria

Emergency and red flags

Consider need for medical admission for physical stabilisation, urgent weight restoration and management of refeeding syndrome risk. Discuss with Acute GP as needed.

BMI <14
BP <80/50
Postural drop >20 mmHg
Postural tachycardia >30bpm
QTc >450ms (females) or >430ms (male), unless due to known other cause such as medication
New ventricular arrhythmia
HR <40bpm
Temperature <34.5c
Electrolyte abnormalities: K <2.5, Na <130, Po4 <0.5

Consider MHA/MCA if patient declines admission and urgent need identified.

The eating disorder service is not an acute service but can be contacted for advice on concerning presentations.

Urgent Referral

Current average wait time to assessment 1-2 months.

Criteria for urgent referral, (in the absence of red flags above):

Dangerously low body weight – BMI <15
Weight loss of up to 1kg or more per week
Abnormal electrolyte disturbance or renal impairment (in the absence of red flag results above)
Cardiovascular compromise not requiring acute admission such as:
- Bradycardia and/or symptomatic hypotension
- Significant postural tachycardia
- Recurrent syncope
- Abnormal ECG
Pregnancy

Please ensure concurrent urgent referral to the Perinatal mental health team and Obstetrics

Type-1 Diabetes

Please ensure concurrent urgent referral to Diabetes and Diabetes Specialist Nurse involvement

Consider checking ketones as needed

High psychiatric risk

Consider Crisis team or CMHT involvement as needed

Routine Referral

Current average wait time to assessment 3-4 months.

Criteria for routine referral:

Body weight BMI >15 (no upper limit)
Consistent pattern of weight loss of up to 0.5 kg per week
No evidence of medical compromise

Referral Instructions

Depending upon the complexity of presentation please consider referral to the local Community Mental Health Team if considered more appropriate.

Send referrals to cft.edsreferrals@nhs.net

01872 246884 - EDS office line at Truro Health Park

Please include the following information when referring to the Adult Eating Disorder Service, where available:

Duration and nature of eating difficulties
Weight and BMI history (including recent changes)
Physical observations (heart rate, blood pressure, postural drop)
Relevant baseline investigations performed in primary care: Bloods and ECG (see investigations required section above)
Mental health risk assessment, including suicidal ideation or self-harm
Any current or past mental health diagnoses
Current medications and relevant physical health comorbidities
Impact on daily functioning (e.g. work, education, social withdrawal)
Support network and any involvement of carers or family

Please also include any other information you feel may be relevant, such as clinical concerns, observations from others, safeguarding issues, or previous service involvement.

Useful Information

Patient

The UK's Eating Disorder Charity - Beat

Professional

References

Recommendations | Eating disorders: recognition and treatment | Guidance | NICE

Page Review Information

Review date 01 September 2026

Next review date 01 September 2028

Speciality Lead GP Dr Kate Northridge

Contributors Dr Ali Pan, GP Consultant in Eating Disorders, Adult Eating Disorder Service, CFT