Excerpt

There are over 700,000 individuals in the UK with an eating disorder (Beat, 2015). While the prevalence is relatively stable, the number of cases identified in clinical settings is increasing as clinicians become more aware of these disorders and patients come forward more readily (Currin et al., 2005; Soundy et al., 1995). However, many cases remain unidentified.

Eating disorders are poorly identified in non-specialist NHS settings. These disorders are usually long-lasting and have serious implications, including risk of death, impaired health, psychiatric comorbidity and poor quality of life for the patient and those around them. Since the 2004 NICE guideline, two strands of evidence have emerged that necessitate a new eating disorders guideline in 2017. First, there is now far more evidence of efficacious treatments (both physical and psychological). Second, it has become clear that clinicians vary substantially in their identification of cases and their delivery of the evidence-based treatments that are recommended.

Contents

• 1. Guideline summary
  • 1.1. Preface
  • 1.2. Committee membership, National Guideline Alliance (NGA) staff and acknowledgements
  • 1.3. Other versions of the guideline
  • 1.4. Schedule for updating the guideline
• 2. Introduction
  • 2.1. What is an eating disorder?
  • 2.2. Epidemiology
  • 2.3. Anorexia Nervosa
  • 2.4. Bulimia Nervosa
  • 2.5. Binge Eating Disorder
  • 2.6. Atypical eating disorders (eating disorders not otherwise specified/other specified feeding and eating disorders)
  • 2.7. Physical Complications
  • 2.8. Comorbidities
  • 2.9. The treatment and management of eating disorders in the NHS
  • 2.10. Use of health service resources
• 3. Methods used to develop this guideline
  • 3.1. What is a NICE clinical guideline?
  • 3.2. Remit
  • 3.3. Who developed the guideline?
  • 3.4. What this guideline covers
  • 3.5. What this guideline does not cover
  • 3.6. Relationships between the guideline and other NICE guidance
  • 3.7. Methodology
  • 3.8. Developing the scope
  • 3.9. The Guideline Committee
  • 3.10. Review protocols
  • 3.11. Clinical review methods
  • 3.12. The search process
  • 3.13. Health economics methods
  • 3.14. From evidence to recommendations
  • 3.15. Stakeholder contributions
  • 3.16. Validation of the guideline
  • 3.17. Disclaimer
• 4. Identification and management of eating disorders
  • 4.1. Introduction
  • 4.2. Case identification of eating disorders
  • 4.3. Assessment and monitoring of eating disorders
• 5. Coordinating care of eating disorders
  • 5.1. Introduction
  • 5.2. Coordinating care
• 6. Treatment and management of anorexia nervosa
  • 6.1. Introduction
  • 6.2. Psychological interventions
  • 6.3. Carer interventions
  • 6.4. Pharmacological interventions
  • 6.5. Nutritional interventions
  • 6.6. Physical interventions
  • 6.7. Management of long- and short-term physical complications of eating disorders
  • 6.8. Management of comorbidities
• 7. Treatment and management of bulimia nervosa
  • 7.1. Introduction
  • 7.2. Psychological interventions
  • 7.3. Carer interventions
  • 7.4. Pharmacological interventions
  • 7.5. Nutritional interventions
  • 7.6. Physical interventions
  • 7.7. Management of long- and short-term complications
  • 7.8. Management of comorbidities
• 8. Treatment and management of binge eating disorder
  • 8.1. Introduction
  • 8.2. Psychological interventions
  • 8.3. Carer interventions
  • 8.4. Pharmacological interventions
  • 8.5. Nutritional interventions
  • 8.6. Physical interventions
  • 8.7. Management of long- and short-term complications
  • 8.8. Management of comorbidities
• 9. Treatment and management of atypical eating disorders (eating disorders not otherwise specified)
  • 9.1. Introduction
  • 9.2. Psychological interventions
  • 9.3. Carer interventions
  • 9.4. Pharmacological interventions
  • 9.5. Nutritional interventions
  • 9.6. Physical interventions
  • 9.7. Management of long- and short-term complications
  • 9.8. Management of comorbidities
• 10. Coordinating care and compulsory treatment
  • 10.1. Introduction
  • 10.2. Compulsory treatment
• 11. References
• Glossary
• Abbreviations
• Recommendations
• Research recommendations
• Appendices
  • Appendix A. Scope
  • Appendix B. Declarations of Interest
  • Appendix C. Special advisors to the committee
  • Appendix D. Stakeholders for the Guideline
  • Appendix E. Researchers contacted to request information about unpublished or soon to be published studies
  • Appendix F. Review questions and protocols
  • Appendix G. Research recommendations
  • Appendix H. Search Strategies
  • Appendix I. Search Strategies
  • Appendix J. Excluded Studies
  • Appendix K. Flow charts
  • Appendix L. GRADE evidence profiles
  • Appendix M. Forest Plots
  • Appendix N. Bulimia Nervosa: NMA on Remission Outcome, Inconsistency Checks and Bias Adjustment
  • Appendix O. Health economic evidence – completed health economic checklists
  • Appendix P. Health economic evidence – evidence tables
  • Appendix Q. Health economic profiles
  • Appendix R. Network (Mixed Treatment Comparison) Meta-Analytic Methods
  • Appendix S. Economic modelling interventions for people with bulimia nervosa
  • Appendix T
  • Appendix U
  • Appendix X

Version: 2.0

Developed by the National Guideline Alliance, hosted by the Royal College of Obstetricians and Gynaecologists

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.