THE use of body mass index(BMI) to prioritise eating disorder patients in need of treatment can end up spurring excess weight loss, according to a report today.

In its first investigation into the care, treatment and support for people with conditions such as anorexia, bulimia and binge eating disorder, the Mental Welfare Commission for Scotland said the reliance on low BMI as a threshold to access treatment was "one of the most frequently voiced concerns" from people with eating disorders and their families and carers.

The report said: "They said it meant that people who needed support did not get it and it also made people with eating disorders concentrate on the very thing that they should not concentrate on – in other words, low weight became a target to achieve, in order to access services."

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It added that people with eating disorders "often felt that a service’s focus on weight and BMI either prevented them from accessing support or delayed the provision of support until weight became dangerously low".

One GP told investigators that they had a patient who was controlling calories in a way that was potentially causing harm.

"Their BMI was still acceptable," said the GP. "However, [weight] was decreasing dramatically and I had to send several letters to get them the help they needed.”

Another response from the carers of someone with an eating disorder said the girl's weight "was not considered to be low enough, even though the doctor had suggested it would be too much of a strain on her heart to walk uphill to school”.

The report also included testimony from someone with an eating disorder who said they felt "too fat" to qualify for help.

They said: “There was nothing at all for anyone with a BMI over 13, even in the presence of excessive exercise (eight hours running/gym and 10 hours walking a week).

"When the eating disorder service referred me back to my GP there was no follow up.

"My weight plummeted because I felt like I was too fat to deserve care.”

The report also highlights "lengthy delays" to access some services and a lack of availability at community level, leading to "a deterioration in physical, mental and emotional wellbeing, sometimes resulting in hospital admission".

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The report added that "services are limited in some regions, even more so in rural areas" with some people telling investigators "they had to seek private therapy in the absence of NHS Scotland provision locally".

Recommendations have been made to the Scottish Government.

Claire Lamza, interim executive director, Mental Welfare Commission, said:“We found some excellent examples of care, but we also found issues that need to be addressed, which include making sure that everyone gets access to the same high quality level of care and treatment."