Assessment and management of medical emergencies in eating disorders: guidance for GPs

BACKGROUND

Eating disorders are common, affect people of all ages, and can present as medical emergencies in community, primary care, or hospital settings.

In 2017, in response to the death of a 19-year-old female with anorexia nervosa, the Parliamentary and Health Service Ombudsman produced a report entitled Ignoring the Alarms: How NHS Eating Disorder Services are Failing Patients.¹ In 2019, the Royal College of Psychiatrists began work to update existing eating disorder guidance (MARSIPAN and Junior MARSIPAN) alongside expert reference groups guided by the National Collaborating Centre for Mental Health; this resulted in the new Medical Emergencies in Eating Disorders [MEED]: Guidance on Recognition and Management report.² This new guidance is intended for people of all ages covering all eating disorders. This practice piece consolidates the key recommendations for GPs and primary care teams.

HOW CAN EATING DISORDERS PRESENT?

Eating disorders present challenges for GPs on recognition and diagnosis because symptoms and signs of eating disorders can have multiple aetiologies, and are often comorbid with other mental and physical health problems.² Presentations may be prompted by parent/carer, partner, school, or employer concern. Symptoms can include a change in weight: either a reduction, gain, or failure to thrive; dietary restriction; binge eating; a fear of gaining weight; body image disturbance; and compensatory behaviours such as purging including self-induced vomiting and laxative or diuretic misuse. Males should be asked about excess training/exercise and use of anabolic or androgenic steroids, and it should be noted that tall males or females may be very unwell and compromised with a reasonable BMI score. In young people weight loss …