Risk assessment in eating disorders: using MEED to reduce mortality

Eating disorders (EDs) are potentially fatal illnesses. Sadly, over the years, we have become aware of several deaths where detailed review suggests that they could have been avoided. This was the motivation to write what is now known as MEED, Medical Emergencies in Eating Disorders, published in 2022. MEED is the most developed guidance on treating severely medically ill patients with EDs and should be used by all clinicians having contact with ED patients. This article documents the physical risks that EDs present, and the preventable deaths, particularly of the most unwell patients. It introduces MEED as a system which has the potential to avoid some of those deaths and improve management. A new website is introduced, meed.org.uk, which may make MEED more accessible to frontline staff and improve its uptake. Staff are encouraged to be trained to use MEED and to familiarise themselves with the Risk Assessment Framework it contains. Each group of clinical staff as well as patients and carers will find summary sheets and specific advice in MEED. In this article, we have provided links to each problem area we anticipate will be encountered and links to the summary sheets for clinicians, patients and carers. We also provide two clinical vignettes, one a child and one a young adult, to demonstrate how MEED can be used in real-life situations with substantial clinical risk. We strongly advocate for training to be made mandatory for any staff likely to be assessing or treating a patient with an ED so that the avoidable deaths, mostly in adults, which continue to be reported by coroners, can be eliminated. Refeeding of severely malnourished patients often takes place in medical or paediatric settings, and previous guidance has led to overcautious refeeding, resulting in "underfeeding syndrome". MEED provides clear, up-to-date, evidence-based guidance which allows essential treatment of low weight by safe refeeding, thereby avoiding refeeding syndrome while avoiding underfeeding syndrome, which has resulted in several documented deaths.