Eating Disorder

NICE guideline [NG69] Eating disorders: recognition and treatment. Last updated: Dec 2020.

Guidelines

Core management principle:
  • Reaching healthy body weight or BMI is a key goal
  • Weight gain is key in supporting other psychological, physical and quality of life changes that are needed for improvement or recovery

Pharmacological interventions:
  • Encourage to take an age-appropriate oral multi-vitamin and multi-mineral supplement until their diet includes enough to meet their dietary reference values
  • Do not offer medication as the sole treatment for anorexia nervosa
 

1st line: one of the following psychological treatment:
  • Individual eating-disorder-focused cognitive behavioural therapy (CBT‑ED)
  • Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
  • Specialist supportive clinical management (SSCM)

2nd line:
  • Consider one that has not been attempted (one of the 3 above), or
  • Eating-disorder-focused focal psychodynamic therapy (FPT)

1st line:
  • Anorexia-nervosa-focused family therapy (FT-AN) (give patient the option to have some single-family sessions - separate and together with family members or carers)

2nd line:
  • Individual eating-disorder-focused cognitive behavioural therapy (CBT‑ED), or
  • Adolescent-focused psychotherapy for anorexia nervosa

Consider DEXA scan if
  • After 1 year of underweight in children and young people
  • After 2 years of underweight in adults

Consider treatment in those with long-term low body weight and low bone mineral density:
  • <15 y/o → consider incremental oestrogen (physiological doses), if there is delayed puberty as well
  • >15 y/o → consider transdermal 17‑beta‑estradiol with cyclic progesterone
  • >18 y/o → consider bisphosphonates

Do not offer medication as the sole treatment for binge eating disorder.

The following applies for both adults and children:
  • 1st line: binge-eating disorder-focused guided self-help programme
  • 2nd line: group eating-disorder-focused cognitive behavioural therapy (CBT-ED)
  • 3rd line: Individual eating-disorder-focused cognitive behavioural therapy (CBT‑ED)

Do not offer medication as the sole treatment for bulimia nervosa.

 

1st line:
  • Bulimia-nervosa-focused guided self-help

2nd line:
  • Individual eating-disorder-focused cognitive behavioural therapy (CBT‑ED)

1st line: 
  • Bulimia-nervosa-focused family therapy (FT-BN)

2nd line:
  • Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
Author: Adams Lau
Reviewer:
Last edited: 26/07/25