Clinical guidance for the use of nasogastric tube feeding under restraint in eating disorders care: a systematic scoping review

Persistent dietary restriction can result in people with eating disorders becoming so severely physically and mentally compromised that they are considered a risk to their own life. In these circumstances, individuals may be subjected to involuntary treatments, including nasogastric tube (NGT) feeding under restraint. This systematic scoping review identifies and assesses the evidence available to healthcare professionals to inform clinical practice decisions related to NGT feeding under restraint in eating disorder care, and highlights gaps in knowledge to be addressed in future research. Six electronic databases, six grey literature sites, 12 professional bodies, and four eating disorder conference websites were searched in May 2025. 36 sources met inclusion criteria, including: peer reviewed papers and practice guidelines. Peer-reviewed literature (22) included quantitative, qualitative, and mixed methods research studies, and systematic reviews. Grey literature (14) included practice guidance in the form of expert opinion, expert consensus, and practice standards. A narrative review was structured using deductive analysis focused on the following research questions in relation to eating disorders care: (1) where and how is NGT feeding under restraint happening? (2) how are healthcare professionals making decisions about when and how to use NGT feeding under restraint? (3) what are patients, parents/carers, and healthcare professionals’ experiences of NGT feeding under restraint? And (4) what are the patient outcomes of NGT feeding under restraint? There is clear guidance that NGT feeding under restraint should be delivered minimally, as a lifesaving intervention in line with the legal principle of ‘least restrictive practice’. No comprehensive, multi-disciplinary guidelines or frameworks were identified to support achieving this in practice. Further research is required to improve understanding of who is at risk of receiving NGT feeding under restraint, the long- and short-term risks associated with its use, and what care processes can improve patient outcomes. Future research should support development of multi-disciplinary guidance to improve clinical decision-making and patient outcomes. People with eating disorders can sometimes restrict their intake so severely that they are at risk of dying. In such cases, mental health law can be used to justify involuntary treatments, such as tube feeding under restraint. This review aims to gather and evaluate evidence that healthcare professionals can use to make decisions about when to use tube feeding with restraint in eating disorders care. Researchers searched various information sources, including academic papers, guidelines, and reports from professional organisations, to assess what information already exists and where the gaps in knowledge are. The information was then reviewed with a focus on four areas: (1) Current Practice, (2) Practice Guidance and Decision Making (3) Patient, parent/carer and healthcare professionals experiences and (4) Patient Outcomes. Findings show that there is clear guidance that tube feeding with restraint should be used minimally and only when it would be a lifesaving intervention. No comprehensive guidelines were found that would help healthcare professionals to decide when tube feeding with restraint was justifiable and beneficial and when it is not.