Practice Clinical Updates

Eating disorders in children and young people

BMJ 2017; 359 doi: https://doi.org/10.1136/bmj.j5245 (Published 07 December 2017) Cite this as: BMJ 2017;359:j5245
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Infographic available

Click here for a visual overview of initial assessment of eating disorders in primary care.

  1. Helen Bould, Wellcome Doctoral Training Fellow and specialty training registrar in child and adolescent psychiatry1,
  2. Claudia Newbegin, general practitioner 3,
  3. Anne Stewart, consultant child and adolescent psychiatrist, joint clinical lead for Oxon and Bucks CAMHS eating disorder service and honorary senior clinical lecturer2,
  4. Alan Stein, professor of child and adolescent psychiatry1,
  5. Mina Fazel, associate professor of child and adolescent psychiatry and consultant child and adolescent psychiatrist1
  1. 1Department of Psychiatry, Warneford Hospital, Oxford, UK
  2. 2Raglan House, Oxford, UK
  3. 3Park Medical Group, Newcastle Upon Tyne, UK
  1. Correspondence to H Bould helen.bould{at}psych.ox.ac.uk

What you need to know

  • Prompt referral of patients with suspected eating disorders to specialist services is important as early treatment substantially improves prognosis

  • Eating disorders have relatively high mortality and associated morbidity (resulting from physical health, psychological consequences, and suicide)

  • Indications for urgent referral to specialist mental health services for children and young people include rapid weight loss, body mass index <75% of expected body weight, and binge eating and purging several times a day

Sources and selection criteria

Search date: Sept-Oct 2016; repeated August 2017.

  • We consulted the Cochrane Collaboration database and the BMJ Clinical Evidence website using the search terms “eating disorder”, “anorexia nervosa”, “bulimia nervosa”, “OFSED”, “EDNOS”. We supplemented these searches with our personal archives of references and expert input from our reviewers.

Eating disorders are a group of conditions in which negative beliefs about eating, body shape, and weight accompany behaviours including restricting eating, binge eating, excessive exercise, vomiting, and laxative use. Eating disorders are particularly common among adolescent girls, although they can also occur in boys and men. Eating disorders are associated with high mortality and morbidity but international evidence shows that many patients either do not access or do not receive treatment. Recent Guidelines12 highlight the importance of early intervention for children and adolescents with eating disorders, beginning treatment as early as possible for better treatment response.34 This update presents a structured approach to diagnosis and management of children and young people with eating disorders (with a focus on anorexia nervosa and bulimia nervosa), including risk assessment and when to refer, incorporating recent recommendations from the May 2017 updated NICE guideline.2

How are eating disorders classified?

In anorexia nervosa, weight is “less than minimally expected,” dietary intake is restricted, and there are disturbances in the way weight and shape are experienced. Bulimia nervosa comprises binge eating with compensatory behaviours aimed at reducing …

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