Eating Disorder Patients Discharged with Dangerously Low BMIs, Experts Horrified
Eating disorder patients are being discharged from NHS mental health units while still at dangerously low body mass index levels, with some cases involving BMIs as low as 12.5. This practice starkly contrasts with usual clinical standards, which typically aim for a BMI of 18 or 19 before discharge, indicating a healthy weight range.
Revelations from Freedom of Information Requests
The alarming data emerged through freedom of information requests submitted to NHS mental health trusts in England by Hope Virgo, a prominent eating disorders campaigner. Between January and November of last year, nine trusts discharged 119 patients with conditions like anorexia nervosa and avoidant restrictive food intake disorder, despite their BMIs being below 15. These figures are likely an underestimate, as only nine of the 54 specialist mental health trusts provided the requested information.
Expert Warnings and Clinical Concerns
Dr Agnes Ayton, an NHS consultant psychiatrist and vice-chair of the eating disorders faculty at the Royal College of Psychiatrists, emphasized that a BMI of 15 signifies severe malnutrition according to the World Health Organization. Discharge at this level leaves patients seriously unwell, requiring ongoing monitoring by general practitioners. She highlighted that mortality risks in anorexia nervosa increase substantially at very low BMIs due to physical complications or suicide, with discharge carrying high risks of relapse, chronic progression, or further deterioration.
Dr Ashish Kumar, chair of the eating disorders faculty, noted that discharge decisions are based on multiple clinical, psychiatric, medical, and social risk factors, not solely on BMI. However, he acknowledged that a BMI of 19 is generally considered healthy for discharge. Despite this, experts like dietitian Bethany Francois argue that no patient she has worked with has been well enough for discharge at a BMI of 15, citing concerns over cardiovascular stability, hormonal disruption, immune function compromise, and bone density loss.
Specific Trust Cases and Broader Implications
Notable cases include the South London and Maudsley trust, which discharged nine patients with BMIs below 15, including one at 12.5—the lowest recorded. Other trusts, such as Central and North West London, Gloucestershire Health and Care, and Cumbria, Northumberland, Tyne and Wear, also reported multiple discharges with BMIs under 15. Hope Virgo described these figures as exposing a deeply troubling pattern, where patients are sent home at weights associated with extreme severity and high mortality risk, often blamed for not wanting to recover.
Dr David Viljoen, a consultant clinical psychologist at private provider Ellern Mede, expressed concern over discharges below BMI 15, stating it contradicts research evidence and increases risks of relapse, chronic disorders, or premature death. An NHS England spokesperson defended existing practices, asserting that discharge decisions are made by expert clinicians based on multiple factors, including weight progress and recovery support plans, not BMI alone.
Context of NHS Service Struggles
Experts link these horrifying revelations to NHS services grappling with surging demand, which may be compromising patient care. The situation underscores broader challenges in mental health provision, where resource constraints and high caseloads potentially lead to premature discharges. As eating disorder cases rise, the need for adequate funding and staffing in specialist units becomes increasingly critical to ensure safe and effective treatment outcomes.
