New RCP guidance covers the recognition and management of medical emergencies in eating disorders, as hospitalisations rise significantly

sad teenager girl with scales on floor_AS

The Royal College of Psychiatrists (RCP) has published a new guideline, Medical emergencies in eating disorders (MEED): guidance on recognition and management. The new guidance is intended to help healthcare practitioners to identify serious harms associated with eating disorders, up to and including death, at the earliest stage possible so that the appropriate care and treatment can be provided.

Included in the new guidance are recommendations on:

  • Risk assessment
  • Location of care and transfer between services
  • Safe refeeding of malnourished patients with restrictive eating disorders
  • Nasogastric and other routes of feeding
  • Management of behavioural manifestations of eating disorders on medical or paediatric wards
  • Helping parents, relatives, and carers
  • Compulsory admission and treatment
  • Eating disorders and type 1 diabetes
  • Policies and protocols
  • Challenges for commissioners and managers. 

This guideline has been published at a time of increasing hospital admissions related to eating disorders. Recent NHS statistics show that admissions have increased by 83% from 2015/2016 to 2020/2021, from 13,219 to 24,268 in England alone.

According to RCP analysis, children and young people with eating disorders are the worst affected with a rise of 90% in the 5-year period (from 3541 to 6713 episodes) and a 35.4% increase in the last year. A stark rise of 128% is seen in boys and young men, from 280 hospital admissions to 637 over the 5 years.

Eating disorders are known to be devastating mental illnesses. Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Bulimia is associated with severe medical complications as well, and people with binge eating disorder often experience the medical complications associated with obesity.

One in five deaths of people with anorexia nervosa are from suicide, and there are high rates of self-harm and depression across all eating disorder diagnoses.

Dr Dasha Nicholls, who chaired this new guideline’s development group, 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.’

SIGN has also published a new guideline on eating disorders in January this year, which covers anorexia nervosa, bulimia nervosa, binge eating disorder, and eating-disordered psychopathology occurring in the context of type 1 diabetes.

This issue is not unique to the UK, as recent statistics show that hospitalisations for eating disorders in Canada have risen by nearly 60% for young women aged 10–17 years.

Tracy Johnson, MBA, Director of Health System Analytics at the Canadian Institute for Health Information, spoke with Medscape Medical News: ‘One of the key questions throughout the pandemic has focused on the unintended consequences of the pandemic itself, as well as public health measures.’

She added: ‘Hospitalisations and emergency department visits decreased during the first year of the pandemic because of closures and fears about coming in for care. But the need for mental health care maintained. This kind of jump we’re seeing signals that something is happening.’

Lead image: Maya Kruchankova/
Image 1: Maya Kruchankova/