Signs that someone with an eating disorder is dangerously ill are often missed by healthcare professionals due to lack of guidance and training.
The Royal College of Psychiatrists launches new Medical Emergencies in Eating Disorders guidance for frontline staff so that people with eating disorders needing urgent care can be identified and treated earlier.
Hospital admissions for eating disorders have increased by 84% in the last five years reaching a total of 24,268 admissions. New Royal College of Psychiatrists’ analysis of hospital data for eating disorders shows 11,049 more admissions in 2020/21 compared to 2015/16.
Children and young people with eating disorders are the worst affected with a rise of 90% in the five-year period, from 3,541 to 6,713 episodes, and a 35.4% increase in the last year alone. A stark rise of 128% is seen in boys and young men — from 280 hospital admissions in 2015/16 to 637 in 2020/2021.
An alarming increase of 79% is also seen in adults across the five years.
The signs that someone with an eating disorder is severely ill and in need of hospital treatment are often missed in primary care and emergency departments, due to lack of training and accessible guidance for frontline staff. The main barrier to spotting patients at risk is that, even when seriously unwell, people with eating disorders can appear to be healthy, with normal blood tests.
To address the problem the Royal College of Psychiatrists is launching new guidelines to help healthcare professionals identify and manage eating disorders when they become life-threatening.
Dr Dasha Nicholls, who chaired the development of the Medical Emergencies in Eating Disorders Guidelines, said:
“Eating disorders such as anorexia, bulimia and binge eating don’t discriminate, and can affect people of any age and gender. They are mental health disorders, not a ‘lifestyle choice’, and we shouldn’t underestimate how serious they are.
“Even though anorexia nervosa is often referred to as the deadliest mental health condition – most deaths are preventable with early treatment and support.
“Full recovery is possible, if spotted and treated, early.
“We need to raise awareness of common eating disorders symptoms. Our guidance encourages healthcare professionals to spot when someone is dangerously ill, and dispel the myths surrounding them. They remain poorly understood with devastating consequences for thousands of patients and their families.
“If we are to stop the eating disorders epidemic in its tracks, it’s vital that this guidance reaches healthcare professionals urgently and that government backs them with the necessary resources to implement them.”
One in five deaths of people with anorexia nervosa are due to suicide, alongside very high rates of self-harm and comorbid depression across all eating disorder diagnoses.
It took James Downs, 32, who developed anorexia at the age of 15, more than six years from diagnosis to receiving specialist support. He puts this down to a lack of awareness of the signs of eating disorders, amongst non-specialist healthcare professionals, and not knowing how to approach patients with the condition. He says that being a man often means that healthcare professionals don’t see him as someone with an eating disorder and it’s harder to get treatment.
In the six years it took to get support, the illness had taken hold and James’ physical health had deteriorated. He’d been frequently admitted to hospital with low potassium levels, low blood sugar, heart abnormalities and other consequences of malnutrition.
James said: “Getting help early could prevent so many people from being admitted to hospital. All healthcare professionals should be able to spot the signs and have timely and accessible treatments to offer patients."
James would like to see more healthcare professionals being confident that they can offer support to someone with an eating disorder, across all healthcare settings. He said, “recognising that eating disorders are everyone’s business, and not just for some specialist workforce, can change thousands of lives for the better.”
New guidance published
Read the new guidance: Medical emergencies in eating disorders: Guidance on recognition and management.
This guidance is replacing the Management of Really Sick Patients with Anorexia Nervosa (MARSIPAN) and Junior MARSIPAN guidance.
The goal of this guidance is to make preventable deaths from eating disorders a thing of the past. Primarily aimed at any clinician likely to encounter patients with severe eating disorders, the guidance provides advice on assessing all eating disorders that can lead a patient into a state of clinical emergency, and how to manage their physical, nutritional and psychiatric care.
To aid decisions on emergency management, the document provides an eating disorders risk assessment tool using a ‘traffic light’ system. There is also an accompanying set of summary sheets of tailored advice for the different target readers of this document, including different medical professionals, as well as people with eating disorders and their families or carers. Recommendations are also given for commissioners on required services for this group of very ill patients.
The full data set of hospital admissions data, covering both primary and secondary diagnoses of eating disorders is available from NHS Digitial: Hospital admissions for eating disorders.
In this data set, children and young people are defined as aged 18 and under, and adults as aged 19 and over. Hospital admissions are used rather than a count of people, as the same person could be admitted to hospital on more than one occasion. Please also note that data, where the age and sex are unknown, have not been included in these data.
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