In a significant shift, the NHS in England has issued new guidance to healthcare professionals, emphasising that a child’s body mass index (BMI) should not be the sole factor in determining access to early intervention and support for eating disorders. The guidance, co-developed with eating disorder charities and the Royal College of Psychiatrists, aims to address concerns that an over-reliance on BMI has led to misdiagnosis and delayed care for young people struggling with conditions like anorexia and bulimia.
“Single measures such as BMI centiles should not be a barrier to children and young people accessing early and/or preventative care and support,” the guidance states. Instead, healthcare providers are encouraged to consider a range of factors, including changes in the young person’s behaviour and concerns raised by their family.
This shift in approach has been welcomed by Beat, a leading eating disorder charity, as “an encouraging step in the right direction.” However, the guidance has also sparked some debate, with eating disorder campaigner and author Hope Virgo voicing concerns about completely removing BMI from the diagnostic process.
“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. She argued that BMI can still be an important indicator of a life-threatening state of survival in some cases and that the impact of malnutrition on the brain should not be overlooked.
The prevalence of eating disorders has been on the rise, both before and during the COVID-19 pandemic, leading to increased demand for NHS care. In response, the health service has expanded community-based support teams and inpatient services for the most severely affected young people. However, some patients still face lengthy delays in accessing treatment, with recent research finding that the median wait time for under-18s is four days, but some wait as long as 450 days.
As the NHS navigates this complex landscape, the new guidance aims to ensure that young people with eating disorders are not denied access to crucial early intervention and support based solely on a single metric like BMI. By taking a more holistic approach, healthcare professionals can better identify and address the needs of this vulnerable population.