An online therapy programme can be offered to people aged 16 or over with eating disorders while they wait for specialist NHS treatment, the National Institute for Health and Care Excellence (NICE) has said.
In new guidance, the regulator said the programme could be used in the NHS in England while further clinical and cost-effectiveness evidence is generated.
The Overcoming Bulimia Online unguided self-help programme is aimed at people who binge eat, including those with bulimia nervosa, binge eating disorder, and similar conditions. It is based on eating-disorder-focused cognitive behavioural therapy and is designed to be completed independently over eight sessions.
NICE said early access to treatment could help prevent symptoms from becoming more severe, particularly for patients facing long waits for specialist care. Unguided digital self-help could begin as soon as an eating problem is identified.
“This recommendation is really important for eating disorder care at a time when services are under huge pressure,” said Dr Anastasia Chalkidou, health technology programme director at NICE.
She said the programme could give patients immediate access to evidence-based therapy, rather than having to wait months for specialist treatment.
Used Alongside Waiting List Care
At least 1.25 million people in the UK have an eating disorder. Guided self-help is currently the first treatment offered, or considered, for people with binge eating disorder and for adults with bulimia nervosa.
NICE assessed three digital technologies: Digital CBTe, Overcoming Bulimia Online, and Worth Warrior. It said Digital CBTe and Worth Warrior required more evidence before they could be recommended for NHS funding, although they may be available through research studies.
NICE said Overcoming Bulimia Online could be used during the evidence-generation period for people with binge eating disorder, bulimia nervosa, and related conditions with similar clinical features, including other specified feeding or eating disorder.
The programme should only be offered after an initial assessment in primary care or by specialist eating disorder services, and alongside usual waiting list care, including regular check-ins and routine physical monitoring.
NICE added that use would be conditional on ongoing evidence generation and appropriate regulatory approval, including meeting NHS England’s Digital Technology Assessment Criteria.
Unguided self-help is not intended for people with severe eating disorders or those at high medical risk, and it is not suitable for anyone with anorexia nervosa, NICE said.
Programme Complements NHS Care
Evidence reviewed by NICE showed that people using Overcoming Bulimia Online had fewer binge-eating episodes and reduced symptom severity compared with those on waiting lists.
The programme could give people support “sooner and at their own pace,” said Dr Adrian James, NHS England’s national medical director for mental health and neurodiversity.
“Wait times can still vary wildly between age groups and locations,” said Umairah Malik, clinical and co-production manager at the eating disorder charity Beat. “Digital treatment can help to address some of these gaps, allowing more people to access support on a waiting list, whilst still benefiting from regular check-ins and routine monitoring.”
Rob Hicks is a retired National Health Service doctor. A well-known TV and radio broadcaster, he has written several books and has regularly contributed to national newspapers, magazines, and online publications. He is based in the United Kingdom.
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