Stakeholder consultation (ended)

On the draft Guidance on Recognising and Managing Medical Emergencies in Eating Disorders 

The stakeholder consultation on the draft Guidance on Recognising and Managing Medical Emergencies in Eating Disorders (replacing MaRSiPAN and Junior MaRSiPAN) has now ended. Thank you to everyone who sent us comments and feedback.

Who can take part in the consultation?

Though this is a targeted stakeholder consultation (see list at the bottom of this page), we welcome responses from other organisations.

We cannot accept responses from individuals: individuals who wish to comment can submit responses through any organisation to which they are affiliated. 

About the guidance

The purpose of this guidance is to make preventable deaths due to eating disorders a thing of the past, by addressing eating disorder presentations likely to lead the patient to an emergency department or a medical/paediatric ward. Its emphasis is on medical management in physical and psychiatric care.

The working group that produced this guidance is the fourth to address these issues, succeeding the Management of Really Sick Patients with Anorexia Nervosa (MaRSiPAN) and Junior MaRSiPAN groups. 

The project arose out of concerns that patients with severe anorexia nervosa were being admitted to general medical units and sometimes deteriorating and dying on those units because of psychiatric (such as non-adherence to nutritional treatment) and medical complications (such as re-feeding syndrome or due to underfeeding).

This guidance includes other eating disorders that pose a risk to life, in a widening of the scope from that of MaRSiPAN.

Draft documents for consultation

Guidance on Recognising and Managing Medical Emergencies in Eating Disorders (replacing MaRSiPAN and Junior MaRSiPAN)

  • Contains review and synthesis of the evidence on which the guidance is based, including a comparison with international guidance on medical management in eating disorders.
  • Provides advice on assessment and management of all eating disorders that can lead patients to present as a clinical emergency.
  • Provides a new eating disorders risk assessment tool using the ‘traffic light’ approach that can be applied to all ages.
  • Updates practice guidance on the medical, nutritional and psychiatric management of patients with severe eating disorders in medical units, including the appropriate use of mental health legislation.
  • Provides advice for commissioners on required services for this patient group. 
  • Contains appendices, which include:
    • A national survey of MaRSiPAN utilisation by professionals
    • Literature reviews and guideline comparisons
    • An eating disorders risk checklist for emergencies.

Annexe 1: Summary sheets for assessing and managing patients with severe eating disorders 

Quick reference guides written for 13 different specific interest groups (including physicians, psychiatrists, dietitians, GPs and nurses, as well as people with eating disorders, families and managers), which also signpost to key areas in the main guidance.

Annexe 2: Type 1 diabetes and eating disorders 

A standalone supplementary document that contains a detailed risk assessment table, and discusses the interaction between elements of type 1 diabetes and eating disorders.

How to give feedback

  • Add your feedback to the comments table (available below), including which document and section you are referring to.
  • If you are suggesting changes, please suggest specific text/content that you think we should use, and indicate clearly where it should be.
  • Please send your completed comments table to
  • The deadline has been extended until 5pm, Monday 18 October 2021.
  • Feedback will not be accepted if it is (a) received after this date, (b) not submitted by an organisation, or (c) submitted in any format other than the comments table provided. 
  • If you have any queries about the consultation or feedback process, or any general queries about the project, please email 

Questions to consider when reviewing the documents:

  • What are your overall thoughts on the draft guidance, including the language and tone?
  • Is there anything substantial missing from the guidance that should be included? If so, please specify and indicate the text or content that could be included.
  • Is there any text/content you think does not belong in the guidance? If you think something should be removed, please explain why.
  • Are there any sections or topics that you think should be changed? If so, please suggest specific changes that can be made to the text or content.

We would like to thank you in advance for your time in reviewing and responding to the consultation documents.

Stakeholder organisations

  • Academy of Medical Royal Colleges 
  • Anorexia and Bulimia Care
  • The British Association for Parenteral and Enteral Nutrition 
  • British Dietetic Association
  • BEAT
  • Bodywhys – Eating Disorders Association of Ireland
  • The British Psychological Society
  • The British Society of Gastroenterology
  • Department of Health and Social Care 
  • Diabetes UK
  • Diabetes with Eating Disorders
  • FirstStepsED
  • Health Education England 
  • Irish Nutrition & Dietetic Institute
  • MaleVoicED
  • Mind
  • National Centre for Eating Disorders
  • NHS England
  • NHS Improvement
  • Overeaters Anonymous
  • Royal College of Emergency Medicine
  • Royal College of General Practitioners
  • Royal College of Nurses
  • Royal College of Physicians
  • Royal College of Paediatrics and Child Health
  • Scottish Eating Disorders Interest Group
  • Eating Disorder Support Service
  • Special Interest Group in Eating Disorders
  • Welsh Diabetes Network

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