This is guidance for healthcare professionals who wish to refer patients to Leicestershire Adult Eating Disorders Service
We accept referrals from healthcare professionals including
- Adult Psychiatric Services
- Community Services
- Child and Adolescent Mental Health Services
- IAPT Services
Patient self-referrals are not accepted currently
A useful guide for identifying and managing eating disorder whilst waiting for specialist eating disorder input is the Eating Disorder pocket guide for Primary Care
Who we see:
We see patients aged 18 and above. If your patient is within a few months of their 18th birthday then we will consider a referral.
We have no BMI cut-off.
We offer assessment and treatment for patients with the following eating disorders
- Anorexia nervosa - and its milder variants (however, please see section below if your patient is BMI 13 or under)
- Bulimia nervosa - and its milder variants
- Binge eating disorder - and its milder variants
Some information about the key features of these three disorders is given below.
Key features of anorexia nervosa
- Typically, the patient will be underweight, with BMI<18.5*
- There will be intentional weight loss, through dieting, vomiting, laxatives, exercise etc.
- The patient may see themselves as normal weight or fat.
- The patient is fearful of weight gain and usually desires weight loss.
- In females, there may be amenorrhoea, but not always.
*some patients can have features of anorexia nervosa at BMI > 18.5. Often, the patient will have been previously been overweight.
Key features of bulimia nervosa
- Patient will normally be of a normal weight, or slightly overweight.
- Patient will have BINGES
- Binges are episodes of food consumption, which are rapid (perhaps 30-60 mins in length) with large quantities of food, and the patient feels OUT OF CONTROL during the eating. At the time of eating the patient may feel numb/relief. Afterwards the patient usually feels guilty.
- The patient will then attempt to compensate for the binge in some way. Vomiting is the most common method, but patients may also use renewed dieting, exercise, laxatives etc.
- Bingeing and compensatory behaviours will occur at least once a week and for several months.
Key features of binge eating disorder
- The patient is usually overweight
- The patient will have binges similar to those described in bulimia nervosa
- However the patient does not engage in activities to compensate for the binge
Note this is not the same as obesity. Obesity can occur due to general over-eating / poor eating habits / lack of exercise. It is the occurrence of the BINGES which make this binge eating disorder.
Milder variants of eating disorders
Many patients have mild variants of the above 3 eating disorders, but are still very troubled by the problem. If your patient is in this category then you can still refer them and we will consider whether we can assist them.
We do not see disorders such as:
- Selective eating: where the patient eats only certain foods e.g. crisps, but where there is no desire to lose weight. These patients may be low weight but weight loss is not the primary aim if their food choices. This is sometimes associated with autistic spectrum disorders, where certain food textures/ colours are unacceptable. These patients are sometimes diagnosed as ARFID (avoidant/restrictive food intake disorder).
- Weight loss which is solely secondary to depression or anxiety. Here the patient does not desire weight loss, nor pursue it actively, it just happens as a side effect of the other disorders.
- Weight loss due to organic conditions, where there is no desire for low weight or active pursuit of weight loss.
- Obesity per se. We do see obese patients where the obesity is associated with binge eating disorder.
A useful tool for identifying and managing eating disorders is the Eating Disorders Pocket Guide
How to refer
GPs can use the referral form available on PRISM - Eating Disorders Adults
Other services must send a written referral by post or fax.
What to include in your referral letter
For all patients we need to know
Height and weight
If your patient is below BMI 16 we need to know the rate of weight loss e.g. 2kg in the last 4 weeks
Other information to include:
- How the eating problems began
- The method of intentional weight loss
- A description of any anorectic psychopathology (e.g. feeling fat, wanting to be thin, fear of weight gain)
- Any past treatment for eating problems
- If the patient has had anorexia nervosa in the past then what was their lowest weight
- How often the patient binges and vomits
- How the patient feels about referral to the service
- Any other psychiatric problems, particularly depression, anxiety and personality disorder, drug and alcohol misuse
- Any risk factors e.g. suicidal thoughts, DSH, drugs and alcohol
- Medication and physical problems
- Any relevant test results e.g. blood tests, ECG and bone scans
If your patient is BMI 13 or under
These patients, especially if they are losing weight fast, may be at acute medical risk. Specialist eating disorder units are unable to take patients in an emergency and are not set up to manage acute and severe medical complications. Hence a medical ward may be the most appropriate place in an acute medical emergency. Feel free to contact us to discuss if you have a patient in this position.