The MARSIPAN (Management of really sick patients with anorexia nervosa) protocol issued by the Royal College of Psychiatrists was superseded by the MEED (Medical emergencies in eating disorders) guidance on recognition and management in May 2022.¹⁴

This places an expectation on the primary care team to monitor patients with eating disorders and make an early referral to eating disorder services (EDS) when appropriate. Primary care should also provide monitoring after discharge, in collaboration with medical services and the EDS.

MEED says that as eating disorders are considered severe mental illnesses, physical checks should be performed in primary care, even if the patient is under specialist outpatient care. “Patients with eating disorders not presenting in an emergency may nevertheless require urgent referral.”

Physical risk assessment should include:

• nutritional status (including current intake);
• disordered eating behaviours;
• physical examination;
• blood tests;