Eating Disorders

St George’s Eating Disorders Service has two large research teams led respectively by Professor J Hubert Lacey (adult) and Professor Bryan Lask (child and adolescent).The research programme aims to develop effective and cost-effective treatment programmes for children, adolescent and adults with anorexia nervosa, bulimia nervosa and related eating disorders.The teams have had success in attracting competitive external funding in the past year, with total research funding since 2001 exceeding £900,000.

A major study, recently started on severe and enduring anorexia nervosa, is developing and testing two treatment techniques to assist severely damaged patients to remain ill, but safely.The study is being conducted jointly with the Universities of Chicago and Sydney, funded by an MRC grant.The aim is to develop the most effective treatment to improve quality of life and prevent repeated admissions to hospital.

A multi-centre randomised control trial of family therapy and multi-family day treatment has improved the efficacy of treatment for adolescent anorectics.It has assisted in keeping patients within the home environment thereby avoiding disruptive and expensive inpatient treatment.The initial results were incorporated in the NICE Guidelines on Eating Disorders.This has led to a change of NHS practice.More recent findings from this study will enhance the advice (and its rating) in the upcoming NICE Review.

Studies, recently completed, on the use of pelvic ultrasound to investigate the effects of anorexia on pelvic organ functioning has led to the team devising an algorithm for clinical use.This demonstrates how much weight-gain is required, depending on pelvic ultrasound appearance to restore pelvic organ maturity.This method is having a signi-ficant effect on clinical practice in the UK, allowing the necessary weight-gain in anorexia to be based on a biological marker.It also means the patient and her family can be reassured that fertility potential is restored.

A comparison study of inpatient and day-care has demonstrated that weight gain can be as effectively achieved in day-care as in inpatients, with the advantages of a patient remaining within her home environment.This is improving local NHS care.The model of day-care is being introduced to other centres in Sussex, Yorkshire and possibly, Northern Ireland.This research, still ongoing, is affecting clinical practice and will almost certainly be picked up in the upcoming NICE review of eating disorders treat-ment.Associated with this study is a comparison of models of treatment within the community which address not only the acute phase of eating disorders, but also severe and enduring anorexia.

Another study, done in conjunction with the University of Sydney, is testing the validity of staging of anorexia nervosa.The initial results are indicating that the hypothesis is sound and will allow the focusing of resources where they can have the most clinical effect.

An externally funded study is examining eating disorders and associated psychiatric morbidity amongst female prisoners.This is now moving to initiating treatment approaches (including self-help) which can be conducted in prisons, thereby supporting Government Healthcare Policy in Prisons.

A study on the use of nasogastric feeding, and its dietetic, ethical and psychological aspects has led to the production of a standards document which has been circulated amongst other eating disorders services in the UK.This is changing NHS procedures.

The development from an empirical research of a short screening questionnaire (the SCOFF for eating disorders) has shown to be a reliable measure to raise the index of suspicion of an eating disorder when examining larger clinical populations.This is now being used in a number of NHS clinical services.A recent joint study with the University of Utah has demonstrated that the SCOFF is the most cost-effective measure and an international trial is being put together involving clinical services in Australia, the United States, Spain and the UK.

The Chief Executives of the South West London & St George’s Mental Health Trust, Leeds Mental Health Trust and the Devon Partnership Trust have set up a tripartite research and clinical management group.The aim is to establish jointly funded clinical research and training amongst their staff.The three — all inpatient and day-patient services — form clinical hubs respectively in London and the South East, Yorkshire in the North and the English Peninsula to disseminate research based and audit based clinical practice.