Most Ellern Mede readers will be familiar with the term ‘Marsipan’ which has, for 14 years, been important guidance for professionals treating eating disorders. It stands for ‘Management of Really Sick Patients with Anorexia Nervosa’. There is an Adult and a Junior version. The Royal College of Psychiatry (RCPsych) developed and championed Marsipan and is going a step further with new guidance, MEED. Link to draft guidance.

MEED, which is hoped to be published in 2022, stands for – Medical Emergencies in Eating Disorders. The consultation document published in July 2021, is called Recognising and Managing Medical Emergencies in Eating Disorders.

While Marsipan was extremely useful, the college noted that the practical application of both the Adult and Junior Marsipan guidance, across acute hospitals and practitioners, was “not consistent“. RCPsych has therefore revised the guidance, with the help of the National Collaborating Centre for Mental Health (NCCMH). NCCMH is a collaboration between RCPsych and University College London (UCL). This means MEED is as rigorous as NICE guidelines.

The new guidance is applicable to all ages. Its aim is wider adoption. It now is awaiting endorsement by the Academy of Royal Colleges. The key audience for this document is GPs and professional clinicians. MEED seeks to augment the training of professionals and GPs in this highly specialist area. Currently, this training is not a focus in general undergraduate GP experience. The document also has a section on Diabetes and Type 1 Diabetes with Disordered Eating, T1DE.

The following are some of the main points about MEED, as it replaces MARSIPAN.

  • When launched, it will be available on its own stand-alone website
  • It is an ALL AGE document
  • It is for ALL eating disorders
  • It has a Red/Amber/Green rated Risk Assessment Framework
  • It includes extensive information about refeeding syndrome
  • It contains advice for GPs, and also for families and managers of services
  • All evidence refers to supporting research.

Researchers behind MEED say that improving medical education is the single most cost-effective intervention to improve recognition and managing risks associated with severe eating disorders. This view was supported in a report published in 2017 by the Parliamentary and Health Service Ombudsman. The report called for improved medical education and more funding across all patient age groups.

Why is it that undergraduate and postgraduate training of doctors is considered inadequate?

It is reported* that only 2 hours is devoted to eating disorders in a training that spans 10-16 years. Yet eating disorders affects about 6% of the population. *See  Paper: Ayton A, Nicholls D, Robinson P. Improving core skills and competence in risk assessment and management of people with eating disorders: What all doctors need to know. Royal College of Psychiatrists, 2020.

The launch of MEED by RCPsych Faculty of Eating Disorders is planned at the online Spring Conference of the Faculty on 19 May 2022. See Twitter: Link

If you have any general queries about the project, please email