The NICE guideline for the recognition and treatment of eating disorders

The National Institute for Health and Care Excellence (NICE) guidelines are evidence-based recommendations intended to inform clinical decisions on the prevention and management of specific health conditions in the national health services of England and Wales. Recommendations made in the guidelines are based on evidence from systematic reviews of the published literature and expert opinion and are developed by the National Guideline Alliance. The NICE guideline for the recognition and treatment of eating disorders (NG69) was published in 2017, replacing the previous 2004 guideline (CG9) and reflects a substantial increase in the evidence base in the intervening period. The guideline covers assessment, diagnosis, treatment, monitoring and inpatient care for children, young people and adults with eating disorders, specifically anorexia nervosa, binge eating disorder, bulimia nervosa and other specified feeding and eating disorder. Avoidant/restrictive food intake disorder, pica and rumination disorder are not covered. The guideline emphasises the importance of early intervention and treatment by specialist, community-based eating disorder services and the involvement of family and carers in supporting recovery. Psychological treatments, which might be eating disorder–focused cognitive behavioural therapy, eating disorder–focused family therapy or guided self-help, depending on the specific diagnosis, are recommended as the primary intervention for all eating disorders covered by the guideline. Medication is not recommended as the sole treatment for eating disorders but can be used as an adjunct. The guideline suggests collaboration with other specialist healthcare services to manage physical and mental health comorbidities, for example diabetes, and to manage the treatment of eating disorders in individuals who may be at particular risk of adverse outcomes, for example pregnant women, children and young people. Inpatient or day-patient care is recommended for those with severely compromised physical health. The guideline also provides guidance on the delivery of compulsory treatment under the Mental Health Act for individuals whose physical health is at serious risk.