Eating disorder patients discharged at dangerously low bmis, raising concerns

Alarming trend: premature discharges reported

A troubling pattern has emerged within the National Health Service (NHS) in England, revealing that patients battling eating disorders are being discharged from Mental Health units despite maintaining dangerously low body mass index (BMI) levels. Freedom of information requests, spearheaded by eating disorder campaigner Hope Virgo, exposed instances where individuals with BMIs as low as 12.5 were sent home, a figure significantly below the NHS’s usual clinical practice target of 18 or 19. This raises serious concerns about patient safety and the adequacy of care provided.

The scope of the problem: data reveals a system under pressure

The concerning data, gathered from just nine of the 54 specialist Mental Health trusts in England, indicates that a total of 119 patients with conditions like anorexia nervosa and Avoidant Restrictive Food Intake Disorder (ARFID) were discharged between January and November last year with BMIs below 15. These figures are likely an underestimate, suggesting a broader systemic issue. Experts suggest the premature discharges are linked to the immense pressure on NHS services struggling to meet a surge in demand.

Why a low bmi is critical: understanding the risks

Dr. Agnes Ayton, an NHS consultant psychiatrist, emphasizes that a BMI of 15 signifies severe malnutrition according to the World Health Organization. While discharge at this level may occasionally occur, it signifies that the individual remains seriously unwell and necessitates ongoing monitoring by their General Practitioner (GP). She further highlights the increased mortality risk associated with low BMIs in anorexia nervosa, stemming from both physical complications and the heightened risk of suicide.

Beyond bmi: a holistic approach to recovery

While Dr. Ashish Kumar, chair of the eating disorders faculty of the Royal College of Psychiatrists, acknowledges that discharge decisions are based on a range of clinical, psychiatric, medical, and social “risk factors,” rather than solely on BMI, he concedes that a BMI of 19 is generally considered a healthy threshold. This underscores the need for a comprehensive assessment, moving beyond a single numerical value to evaluate a patient’s overall progress and readiness for discharge.

Expert concerns: the potential for relapse and long-term damage

Bethany Francois, a dietitian specializing in eating disorders, stated unequivocally that “no individual” she has worked with would be considered well enough for discharge at a BMI of 15. She detailed the associated health risks, including cardiovascular instability, hormonal disruption, compromised immune function, and bone density loss. Similarly, Dr. David Viljoen, a clinical psychologist, expressed concern about discharging patients with BMIs below 15, citing research evidence that warns of relapse, chronic eating disorders, or premature death.

Trust-specific data: a breakdown of discharges

The freedom of information requests revealed significant variations in discharge practices across different trusts. Here's a breakdown of some key findings:

Hope Virgo powerfully summarized the situation: