The National Health Service has issued a significant new directive to frontline health staff, advising them not to let a child's Body Mass Index (BMI) be the deciding factor in whether they receive help for a potential eating disorder.
Moving Beyond a Single Metric
In guidance sent to GPs and nurses across England, NHS England states that "single measures such as BMI centiles should not be a barrier" to children and young people accessing early or preventative support. This shift follows sustained criticism that an over-reliance on BMI thresholds has led to misdiagnoses, with some young people suffering from conditions like anorexia or bulimia being denied care because their weight was not deemed low enough.
The document instructs clinicians to consider a broader range of indicators. These include noticeable changes in a young person's behaviour and specific concerns raised by their family, which should now play a central role in guiding decisions about referrals and treatment.
Charity Welcome and Campaigner Concerns
The new guidance has been welcomed by leading mental health organisations. Both the eating disorders charity Beat and the Royal College of Psychiatrists, which helped formulate the advice, endorsed the move. A spokesperson for Beat described it as "an encouraging step in the right direction" and called for its immediate implementation, warning it must not be left "in limbo."
However, the change has also sparked alarm from some quarters. Hope Virgo, a prominent eating disorders campaigner and author, voiced significant reservations. "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," she said.
Virgo argued that disregarding BMI could dismiss cases where a person's body is in a life-threatening state due to malnutrition and fail to account for the impact of starvation on the brain. She expressed a fear that the NHS might be creating an "out" to avoid treating people, adding: "We have seen far too many people with eating disorders being marked as terminal, too ill, complex or not sick enough."
Rising Demand and Treatment Waits
The policy update comes against a backdrop of sharply rising demand for eating disorder services. Prevalence was increasing before the Covid-19 pandemic but has accelerated since, leading to long delays for some patients seeking NHS care.
In response, the health service has expanded its specialist teams. There are now 93 community-based care teams and 54 inpatient service units for seriously ill under-18s. The NHS stresses that most young people begin treatment on time.
Nevertheless, recent research commissioned by the NHS reveals a stark disparity in waiting times. While the median wait for a child to start treatment is just four days, some face delays of up to 450 days. Furthermore, the scale of the issue is believed to be significant, with an estimated 1.3% of adults in England having an eating disorder—a figure described by researchers as a "conservative estimate."
This guidance marks a pivotal attempt to improve early intervention by changing the clinical lens through which these complex mental health conditions are viewed in young people.
