When should I consider referring a patient with binge eating disorder to a specialist for further management?

Consider referring a patient with binge eating disorder to a specialist for further management if:

• Initial guided self-help treatment is unacceptable, contraindicated, or ineffective after 4 weeks.
• There are concerns about physical health complications, such as malnutrition, electrolyte imbalance, or other physical signs related to the eating disorder.
• The patient has significant mental health comorbidities (e.g., depression, anxiety, self-harm, obsessive-compulsive disorder) or substance misuse that complicate management.
• There is a need for emergency care due to compromised physical health or suicide risk.
• The patient’s eating disorder symptoms are severe, complex, or not responding to initial interventions in primary care.
• There are concerns raised by the patient, family members, or carers about eating behaviours, rapid weight changes, or social withdrawal related to food.

Referral should be made immediately to a community-based, age-appropriate eating disorder service for further assessment or treatment once an eating disorder is suspected after initial assessment.

Psychological treatments such as binge-eating-disorder-focused guided self-help or cognitive behavioural therapy (CBT-ED) are first-line, but specialist referral is warranted if these are not suitable or effective.

Medication should not be offered as sole treatment for binge eating disorder.

Weight loss is not a primary treatment target and should be managed according to obesity guidelines separately.

Specialist services provide multidisciplinary care including psychological therapies tailored to the patient’s needs.