NHS England has issued new guidance instructing GPs and nurses to stop using a child's Body Mass Index (BMI) as the primary factor for diagnosing eating disorders. The directive aims to prevent children and young people with conditions like anorexia or bulimia from being misdiagnosed and missing out on vital care due to an over-reliance on weight metrics.
Moving Beyond a Single Metric
The guidance, sent to health professionals across England, states that "single measures such as BMI centiles should not be a barrier" to children accessing early or preventative support. This shift in policy follows sustained criticism that a narrow focus on BMI has led to incorrect assessments, where some seriously ill children were deemed not sick enough for treatment, while others in critical condition may have been overlooked.
Instead, clinicians are now urged to consider a broader range of indicators. Changes in a young person's behaviour and concerns raised by their family should play a central role in guiding decisions about referrals and care. The document was developed with input from the eating disorders charity Beat and the Royal College of Psychiatrists, both of which have welcomed its publication.
A Welcome Step or a Dangerous Slope?
Tom Quinn, director of external affairs at Beat, described the guidance as "an encouraging step in the right direction" and called for its immediate implementation to ensure it is not "left in limbo." This view aligns with a growing medical consensus that questions the use of BMI as a standalone diagnostic tool for obesity and related conditions.
However, the move has sparked concern from some campaigners. Hope Virgo, a prominent eating disorders campaigner and author, warned that removing BMI completely "may be a dangerous step." She argued that while eating disorders are not solely about weight, BMI can be a crucial indicator of life-threatening malnutrition and its impact on the brain. Virgo expressed fear that the change could provide the NHS with an "'out' in treating people," leading to a situation where clinicians are not effectively monitored in helping patients recover.
Rising Demand and Treatment Challenges
The update comes against a backdrop of sharply increasing demand for eating disorder services. Prevalence was rising before the Covid-19 pandemic and has accelerated since, resulting in significant treatment delays for some patients. In response, the NHS has expanded its capacity, increasing the number of community-based care teams to 93 and specialist inpatient services for seriously ill under-18s to 54.
The health service stresses that most young people now start treatment on time. However, recent NHS-commissioned research reveals a stark disparity in waiting times. While the median wait for under-18s to begin treatment is just four days, some face delays of up to 450 days. Official estimates suggest 1.3% of adults in England have an eating disorder, though survey authors describe this as a conservative figure.
The new guidance represents a significant shift in how the NHS approaches the complex issue of eating disorders in children, prioritising holistic assessment over a single numerical benchmark.
