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Brennan, Cliona (2024) Managing emergencies in eating disorders: an evaluation of the UK national guidance for children and adolescents with typical and atypical anorexia nervosa. Doctoral thesis, London Metropolitan University.
Despite vast improvements in the assessment and management of young people with AN and AAN over the past decade, empirical evidence is still lacking on the assessment of physical risk and need for medical admission in this group. Evaluation of UK national guidance for eating disorders (the MEED) is necessary for further defining characteristics of young people at highest risk of medical admission and medical instability. Little is known about how the guidance is used across eating disorder services in the UK, although the decision to admit is often based on its recommendations. Similarly, large variation in admission practices has been highlighted as an issue in this patient group.
The project was divided in to five core phases, designed to gather retrospective and prospective data related to assessment and treatment in young people with typical and atypical anorexia nervosa. Phase one was a systematics review and meta-analysis of retrospective data from published studies related to risk parameters of physical health indices in young people with AN and AAN. Phase two consisted of a prospective observational study investigating predictors of medical admission in young people with AN and AAN. The third and fourth phases used data collected as part of the observational study to compare rates of medical instability between young people with AN and AAN and to investigate rates of refeeding syndrome in young people with AN and AAN. The final phase consisted of a reflexive thematic analysis of clinicians' experiences of using the MEED guidance in clinical practice.
The overall results of this research indicated that rapid rate of weight loss independently predicts medical admissions in young people with AN and AAN, and that although underweight adolescents were significantly more likely to have lower blood pressures and lower serum phosphorus levels than non-underweight adolescents, medical compromise was largely similar between groups. Episodes of refeeding syndrome rates were non-existent in this sample. However, clinicians who had experienced young people developing RS agreed that, although rare, it can be associated with life threatening consequences. Findings confirmed that the MEED risk assessment framework was widely used by clinicians in the assessment of medical risk in young people with AN and AAN. Themes generated through reflective thematic analysis with data evidenced the important role of the MEED guidance in child and adolescent eating disorders and highlighted both strengths and limitations of the current guidance.
In this thesis, the UK national eating disorder guidance for eating disorders was evaluated, for the first time since its creation, in terms of its utility, ability to predict risk of medical instability and medical admission in young people with AN and AAN, and its implementation and acceptance amongst clinicians in this field. These findings make an important contribution to current literature by providing novel insights on the implementation of the guidance in clinical practice, its limitations, and its strengths.
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