Intended for healthcare professionals

Letters Prioritising nutrition education in medical school

Appropriate training in eating disorders could save many lives

BMJ 2017; 359 doi: (Published 30 November 2017) Cite this as: BMJ 2017;359:j5459
  1. Agnes Ayton, consultant psychiatrist1,
  2. Ali Ibrahim, ST4 Trainee in CAMHS2
  1. 1Oxford Health NHS Trust, Warneford Hospital, Oxford OX3 7JX, UK
  2. 2South London and Maudsley NHS Foundation Trust, Croydon, UK
  1. agnes.ayton{at}

We agree with Womersley and Ripullone that nutrition should be prioritised in medical education.1 This is essential not only for prevention, but also for recognising and managing malnutrition in all patient groups, including people with mental disorders. People with eating disorders, in particular, are often overlooked in medical education. Eating disorders are often regarded as rare and self limiting conditions.2 In fact, the cumulative lifetime risk by age 80 of anorexia nervosa, bulimia nervosa, and binge eating disorder is estimated to be 4.6%,3 and 725 000 people are affected in the UK, according to B-EAT, the leading eating disorder charity.4

The number of eating disorder psychiatrists in the UK is small, and people with eating disorders are often first seen when they have severe complications by other doctors, either in primary care or in acute hospitals. The physical complications of eating disorders are mainly related to malnutrition,5 include all systems, and account for raised mortality risk. If all doctors were appropriately trained in the recognition and treatment of malnutrition and eating disorders, many lives could be saved.

The assessment of theoretical and clinical knowledge of eating disorders is minimal throughout medical training, not just in the UK, but internationally.6 Given that assessment drives learning, it is not surprising that most doctors, including most psychiatrists, do not feel confident managing this patient population.78 Patient safety is at the centre of the General Medical Council standards for undergraduate and postgraduate education and training.9 Severe malnutrition is an acute medical emergency, which is entirely reversible. For the benefit of our patients, we need to make sure that future doctors are confident in managing nutrition related disorders, in both the physically and the mentally ill.