Don’t rely on BMI alone when diagnosing eating disorders in children, says NHS England

A child’s body mass index should not be the key factor when deciding which under-18s get help for an eating disorder, the NHS has told health professionals.The new guidance from NHS-england" class="entity-link entity-organization" data-entity-id="722" data-entity-type="organization">NHS England to GPs and nurses follows criticism that over-reliance on BMI has led to children who have an illness such as anorexia or bulimia being misdiagnosed and missing out on care.“Single measures such as BMI centiles should not be a barrier to children and young people accessing early and/or preventative care and support,” it says.Other factors, such as changes in behaviour by the young person and concerns raised by their family, should help guide decision-making, according to the document. It was welcomed by Beat, an eating disorders charity, and the Royal College of Psychiatrists, both of which helped draw it up.Medical experts have already cast doubt on using BMI as a way of diagnosing obesity.Beat said the guidance was “an encouraging step in the right direction”, which should be implemented at once and not “left in limbo”.However, eating disorders campaigner and author Hope Virgo voiced alarm about the plan.“Whilst I have been actively campaigning for a decade to get clinicians and society to view eating disorders as more than just a BMI issue, removing BMI completely may be a dangerous step,” Virgo said.Not only would it “dismiss the fact that in some cases BMI will show a person whose body is in a life-threatening state of survival”, she added, it would also fail to “take into account the impact of malnutrition on the brain”.She added: “I am concerned the NHS are doing it to give them an ‘out’ in treating people. We have seen far too many people with eating disorders being marked as terminal, too ill, complex or not sick enough in the last few years.“I think it is a slippery slope and one which will mean clinicians are not being monitored effectively on helping those with eating disorders recover.”The prevalence of eating disorders was increasing before the pandemic but has risen even more sharply since, leading to some patients facing long delays to access NHS care.The NHS has responded to the surge in demand by increasing the number of community-based care teams to 93, and inpatient services for very ill under-18s to 54. It stressed that most young people were being treated on time.However, recent NHS-commissioned research found that while the median wait for under-18s starting treatment is four days, some wait as long as 450 days.An estimated 1.3% of adults in England are thought to have an eating disorder, according to the recent official adult psychiatric morbidity survey. However, that was described as a “conservative estimate” by the authors.