Management of eating disorders for people with higher weight: clinical practice guideline

Abstract

Introduction The prevalence of eating disorders is high in people with higher weight. However, despite this, eating disorders experienced by people with higher weight have been consistently under-recognised and under-treated, and there is little to guide clinicians in the management of eating disorders in this population. Aim The aim of this guideline is to synthesise the current best practice approaches to the management of eating disorders in people with higher weight and make evidence-based clinical practice recommendations. Methods The National Eating Disorders Collaboration Steering Committee auspiced a Development Group for a Clinical Practice Guideline for the treatment of eating disorders for people with higher weight. The Development Group followed the ‘Guidelines for Guidelines’ process outlined by the National Health and Medical Research Council and aim to meet their Standards to be: 1. relevant and useful for decision making; 2. transparent; 3. overseen by a guideline development group; 4. identifying and managing conflicts of interest; 5. focused on health and related outcomes; 6. evidence informed; 7. making actionable recommendations; 8. up-to-date; and, 9. accessible. The development group included people with clinical and/or academic expertise and/or lived experience. The guideline has undergone extensive peer review and consultation over an 18-month period involving reviews by key stakeholders, including experts and organisations with clinical academic and/or lived experience. Recommendations Twenty-one clinical recommendations are made and graded according to the National Health and Medical Research Council evidence levels. Strong recommendations were supported for psychological treatment as a first-line treatment approach adults (with bulimia nervosa or binge-eating disorder), adolescents and children. Clinical considerations such as weight stigma, interprofessional collaborative practice and cultural considerations are also discussed. Conclusions This guideline will fill an important gap in the need to better understand and care for people experiencing eating disorders who also have higher weight. This guideline acknowledges deficits in knowledge and consequently the reliance on consensus and lower levels of evidence for many recommendations, and the need for research particularly evaluating weight-neutral and other more recent approaches in this field.

Eating disorder patients with and without PTSD treated in residential care: discharge and 6-month follow-up results

“…There was also a trend for a similar effect on MDD symptoms. These results are in keeping with the importance of tailoring interventions for ED patients with higher weights, which have often been under-recognized and under-treated [92].…”

Weighing in: qualitative explorations of weight restoration as recovery in anorexia nervosa

“…Continued deliberation needs to be given to the ways that current DSM-5 criteria, as well as public and private insurance criteria in the USA, centers low weight as a requisite for diagnosis and treatment. Certainly, weight stigma hindering access to eating disorder treatment for individuals in higher weight bodies is not limited to the USA [ 66 ]. Requiring a certain weight for treatment may cause iatrogenic harm if people set that weight as a goal, refuse to gain weight above it, or more simply never weigh so little that they qualify for treatment.…”

Reimagining eating disorder spaces: a qualitative study exploring Māori experiences of accessing treatment for eating disorders in Aotearoa New Zealand

“…Referring to specialist care early is essential [ 35 ]. Although AN is less likely to be missed due to visual evidence of underweight status, there is evidence that BN and BED and subthreshold but clinically significant variants in other specified feeding or eating disorders are likely to be missed [ 36 ]. This may be particularly so in those with EDs and higher body weight.…”

“…This may be particularly so in those with EDs and higher body weight. It was recognized in recent guidelines that those with ED and higher body weight, are more likely to be offered weight loss advice but not screened for an ED [ 36 ], which reinforces stigma. Untreated BED is associated with increasing weight over time so early treatment has important long-term health benefits for individuals [ 37 ].…”