Managing risk

Managing risk image

NICE recommendations on managing risk

  • Health care professionals should monitor physical risk in patients with anorexia nervosa. If this leads to the identification of increased physical risk, the frequency and the monitoring and nature of the investigations should be adjusted accordingly.
  • People with anorexia nervosa and their carers should be informed if the risk to their physical health is high.
  • The involvement of a physician or paediatrician with expertise in the treatment of physically at-risk patients with anorexia nervosa should be considered for all individuals who are physically at risk.
  • Pregnant women with either current or remitted anorexia nervosa may need more intensive prenatal care to ensure adequate prenatal nutrition and foetal development.

NICE recommendations on feeding against the will of the patient

  • Feeding against the will of the patient should be an intervention of last resort in the care and management of anorexia nervosa.
  • Feeding against the will of a patient is a highly specialised procedure requiring expertise in the care and management of those with severe eating disorders and the physical complications associated with it. This should only be done in the context of the Mental Health Act 1983 or Children Act 1989.
  • When making the decision to feed against the will of the patient the legal basis for any such action must be clear.

The role of the GP in anorexia nervosa

NICE recommends that the treatment of anorexia nervosa includes primary, secondary and sometimes tertiary healthcare providers. A multidisciplinary approach is required and the Royal College of Psychiatrists have produced an algorithm for diagnosis and initial management.

The role of the GP is therefore:-

  • Screening of high-risk groups
  • Assessment at initial presentation
  • Evaluation of initial severity
  • To give patients and carers information
  • To refer as appropriate
  • To support patient and carer even if treatment is commenced in secondary care
  • To onwardly  support patients with chronic anorexia nervosa with the least an annual health check

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