Primary care protocol for the
management of adults with eating disorders
The National Service Framework specifies that primary care
protocols for the management of eating disorders should be in place
by the first of April 2001.
The attached primary care protocol was adapted by the Eating
Disorders Special Interest Group with permission from Primary Care
Protocols for Common Mental Illnesses April 2001, developed for use
in Croydon by Dr Maggie Bruce, Croydon Health Authority.
Individuals wishing to use this protocol in their area may need to
adapted it further to fit their local circumstances. They should
also bear in mind the following points:
- The protocol does not mention specifically the needs of
patients with the diagnosis of eating disorder not otherwise
specified (EDNOS) - at least a third of patients seen in clinical
practice fit into this clinically heterogeneous category. However,
it should always be possible to make a clinical decision on whether
an EDNOS case is more similar to anorexia nervosa or bulimia
nervosa and to follow the paths outlined for either of these two
- The protocol does not cover the management of children and
adolescents with eating disorders. Anorexia nervosa in children
often requires more rapid intervention than advocated here, as
children are more vulnerable to rapid physical deterioration.
- The protocol as it stands does assume that access to an eating
disorder unit is available to the referring General practitioner.
We are aware that this is not the case in many parts of the country
and the protocol may need to be altered accordingly to fit local
This guideline makes recommendations for the identification,
treatment and management of anorexia nervosa, bulimia nervosa and
atypical eating disorders (including binge eating disorder) in
primary, secondary and tertiary care. The guideline applies to
adults, adolescents and children aged 8 years and older.
The Intercollegiate Group on Nutrition (ICGN) was established in
December 1996 with a primary aim of improving the competence in
human nutrition of doctors and other health professionals. The
Group now has formal representation from 11 medical Royal Colleges,
including the Royal College of Psychiatrists, together with
nursing, dietetic and pharmacist representatives. It issued its
first report to the parent medical Royal Colleges in July 1997,
where it recommended addressing two levels of competence through
intercollegiate qualifications - a Certificate in Human Nutrition
which would define a minimal level of core competence in the
principles of nutrition, whereas a Diploma in Clinical Nutrition
would ensure possession of competence relevant to an individual's
clinical practice. Since that time, the group has been working
mainly on a course to achieve the first level of core
A pilot course was held at the University of Southampton in
September 1998, to bring together members of the ICGN (including
the undersigned) and also some individuals who would wish to be
future trainers, to help clarify content and methods of delivery.
The course was also attended by an educational task force,
supported by Rank Prize Funds, who provide support in co-ordinating
and standardising the delivery of the course. Some of the key
points from this meeting included unanimous agreement of the need
for such a course to complement the present level of education in
human nutrition. Specific aims of the course will be:
- To enable doctors to extend their knowledge of nutritional
- To bring together sub-specialities to study nutrition in
relation to disease processes and across boundaries of care.
- To encourage the application of effective nutrition in relation
to the promotion of health and in the treatment of disease.
- The course design will balance nutritional concepts and
supporting science with practical examples, real life experience,
and cases relevant to all participants.
- Evidence based human nutrition will provide one of several
- The course will take place over 5 days, shortened on the first
and last days to facilitate travel. The course will be residential,
allowing time for informal inter-disciplinary discussion and
- The most likely participants will be trainees with an interest
in nutrition, usually at SpR level. In addition, some consultants
and GPs who are developing a special interest in nutrition are
likely to attend. Within psychiatry, doctors with an interest in
growth and development, eating disorders, the physical health of
patients with psychiatric disorder, mental health of the elderly
and others will find this course very helpful. The course will also
be open to other professional groups with an equivalent interest
and background in nutrition.
The Group held two courses in 1999, one in Glasgow on May 24-28,
and the second in Southampton on September 13-17, both well
attended by trainees and consultants. The interactive nature of the
course limits the number able to attend to about 25-30.
Extensive feedback was obtained from the participants and from
the trainers at these two courses and this has been used to
re-evaluate the course content and delivery, and modifications have
been proposed for future courses. It is intended to hold a rolling
programme of 3-4 courses each year, the basic structure and content
of the course being similar at all sites throughout the UK. The
number of courses will be determined partly by demand and partly by
the availability of funding. A number of Post Graduate Deans have
already recognised this course and Training Subcommittees are
beginning to include it in training programmes. There are not, as
yet, formal arrangements for an Intercollegiate qualification, but
participants receive a Certificate of Attendance, and, where
relevant, a CPD/CME.
Intercollegiate Group on
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