Box 2 Weight loss and health in people with higher weight

It is common for people with an eating disorder to present seeking weight loss and to weight loss clinical programs [118]. The management of weight loss is outside the scope of this guideline and eating disorder providers should be cautious about engaging in weight loss advice. This guideline also acknowledges that this is an area of high contention in the field of eating disorders. Notwithstanding this caution, clinicians should be aware of the current evidence-based information that non-surgical weight loss is unlikely to be sustained in the longer-term [including behavioural weight loss interventions; 21, 22, 23] and impacts such as metabolic slowing, potential activation of a genetic predisposition to weight regain after weight loss, and the risk of relapse of the eating disorder. Whilst there is broad consensus that medically unsupervised weight loss regimes are likely to be unhelpful for people with eating disorders, no consensus was reached to make a recommendation in this guideline that a person with an eating disorder and higher weight should never attempt a medically supervised weight loss program. However, whilst there may be health benefits of moderate weight loss of 5–10% of body weight, clinicians should be aware of alternative approaches including non-diet weight-neutral approaches [e.g., HAES; 24, 25] with potentially similar health benefits such as improvements in lipid profiles and hypertension. Longer-term studies are needed of such weight-neutral approaches.

Eating disorder clinicians may advise and/or work in a multi-disciplinary metabolic, bariatric or similar medical clinic. This may be appropriate to support the essential need for screening, assessment and care of people with eating disorders presenting to such providers, and to increase awareness of weight stigma impacting on practice in such settings. In this context it is important to emphasise the importance of interprofessional collaborative practice (ICP; see “Management overview” section) and respecting the preferences of the person with the eating disorder and those who care for them. The presence of an eating disorder should not delay and does not preclude treatment for other medical/psychological conditions.