The Lothian Eating Disorders Service (LEDS) is an outpatient service based at the Cullen Centre, close to the Royal Edinburgh Hospital. The service also makes onward referrals for inpatient treatment at the Regional Eating Disorders Service (REDU) based at St John’s Hospital.
Appointments usually take place at the Cullen Centre or virtually, via Near Me.
Urgent referrals will be offered an assessment appointment within 2 – 8 weeks by the Cullen Centre if they meet criteria for a primary eating disorder diagnosis.
LEDS offers:
- Medical and psychiatric assessment, monitoring and review
- Dietetic assessment and follow up
- Individual and group therapy (including Cognitive Behavioural Therapy, Cognitive Analytic Therapy, Interpersonal Therapy, and Schema Therapy)
- Guided self-help and psychoeducation
- Direct support (e.g. with eating, welfare advice, developing social networks)
- Facilitated self-help group work
- Carer and family support
- Home and community visits if it is not medically safe for the patient to travel
- Liaison advice and consultation for primary and secondary care
- A medical and dietetic liaison service, specific to eating disorders, to acute medical services
- Referral to inpatient services at the Regional Eating Disorders Unit (REDU). REDU is located in St John’s Hospital, Livingston. Further information about services can be found on the REDU webpage.
The Outpatient Team specialises in Cognitive Behavioural Therapy but can also offer a variety of other psychotherapeutic techniques dependent on individual needs. The centre adopts a matched care approach, matching the intensity and model of therapy to individual clinical needs.
People under the age of 18 should be referred to the CAMHS ED service.
If there is uncertainty about suitability of a referral, please telephone the referrals co-ordinator on 0131 537 6655 for a preliminary discussion.
For medical liaison (referrers to use if they want advice about an investigation or if the patient is ill but refuses referral), please e-mail: loth.cullenadmin@nhs.scot and your query will be directed to the relevant professional.
DIAGNOSTIC CRITERIA
Please see the diagnostic criteria for eating disorders, but note that patients with eating disorders may not have all the symptoms:
| Anorexia Nervosa | Bulimia Nervosa | Binge Eating Disorder | Avoidant Restrictive Food Intake Disorder (ARFID) |
| Significantly low body weight (e.g. BMI<18.5kg/m2) Rapid weight loss (>20% of total body weight in 6-month period) Low weight or weight loss is not better explained by another medical or psychiatric condition or unavailability of food | Frequent recurring binge eating episodes Individual subjective experience of losing control overeating Binges may involve consuming an objectively large number of calories or may be ‘subjective’ | Frequent recurring binge eating episodes Individual subjective experience of losing control overeating Binges may involve consuming an objectively large number of calories or may be ‘subjective’ The binges are not better explained by another medical condition (e.g., Prader-Willi syndrome) or psychiatric condition (e.g., depression) or by the effects of a substance or medication. | Please see: Avoidant Restrictive Food Intake Disorder (ARFID) – RefHelp |
| Behaviours intended to maintain an abnormally low body weight. Examples include: Reducing energy intake through: Restrictive eating Self-induced vomiting Use of laxatives, diuretics or enemas Omission of insulin doses Increasing energy expenditure through: Excessive exercise Motor hyperactivity Use of medication (such as stimulants or thyroid hormones) | Recurring compensatory behaviours to prevent weight gain. Examples include: Reducing energy intake through: Periods of restricted eating Self-induced vomiting Use of laxatives, diuretics or enemas Omission of insulin doses Increasing energy expenditure through: Excessive exercise Motor hyperactivity Use of medication (such as stimulants or thyroid hormones) | ||
| Excessive preoccupation with body weight or shape Intense fear of weight gain | Excessive preoccupation with body weight or shape Marked distress about the pattern of binge eating and compensatory behaviours | Marked distress or significant functional impairment due to the pattern of binge eating |
Who can refer:
Referrals are accepted from GPs, Community Mental Health Teams, or other medical or mental health professionals.
Where a patient is already known to a mental health service, referral should come from that service.
Who to refer:
Referrals are accepted for all those aged 18 or over with eating disorder diagnoses including:
- Anorexia nervosa (AN)
- Binge eating disorder (BED)
- Bulimia nervosa (BN)
- Other specified feeding and eating disorder (OFSED)
- Avoidant Restrictive Food Intake Disorder (ARFID)
Specialist Eating Disorder Unit (SEDU) admission
All referrals to the Regional Eating Disorder Unit (REDU) at St John’s Hospital are made through LEDS. If admission is considered likely, please refer to LEDS in the first instance.
Patients requiring emergency medical treatment linked to an eating disorder should be referred to acute medical services as well as being referred urgently to LEDS.
Patients requiring urgent referral because of their psychiatric risk need to be referred to general adult psychiatry/crisis services as well as LEDS.
They will be offered a routine assessment appointment by the Cullen Centre if they also meet criteria for eating disorder treatment.
If the person is ill, but refuses referral, please e-mail:
loth.cullenadmin@nhs.scot and your query will be directed to the relevant professional.
Who not to refer:
- Simple obesity (see the Weight Management Service)
- Patients with a primary personality disorder or addiction or severe mental health problem who also have bulimia or binge eating disorder should initially be referred to general adult or addiction services for assessment.
- ARFID where physical co-morbidities or GI symptoms have not been assessed and managed – see ARFID for more detail.
How to refer:
Referrals should be via SCI Gateway. If there is no access to SCI Gateway, please send a referral letter to The Cullen Centre, Tipperlinn House, Tipperlinn Road, Royal Edinburgh Hospital, EH10 5HF.
Referral Checklist:
Please note if the answer to any of these 5 questions is ‘Yes’, mark the referral as URGENT and consider acute medical referral if metabolically unstable.
- BMI 15 or under
- BMI under 18.5 and rate of weight loss is 1kg per week or greater
- Pregnant
- Insulin Dependent Diabetes Mellitus
- Medical complications as a result of eating disorder
- Co-morbid alcohol or drug dependence
Please see the MEED guidance for further information about medical emergencies in eating disorders.
| Please specify medical complications. | |
| Please detail any psychiatric co-morbidities | |
| Pulse and BP are helpful | |
| Mandatory information: | – Height – Weight – BMI – Date measured – Does the patient give permission for us to contact them by phone? |
| Required baseline blood tests taken within a month of referral date: | – Full Blood Count – B12 and folate – Urea and Electrolytes – Liver Function Tests – Thyroid Function Tests – Calcium / phosphate – Magnesium – Glucose – Creatinine Kinase |
Please undertake the physical assessments and tests outlined in the Referral Guidelines.
Medical Emergencies in Eating Disorders (MEED):
The Royal College of Psychiatrists guidance on the recognition and management of medical emergencies in eating disorders
Free downloadable self-help manual: The Bulimia self-help manual by Chris Freeman and Gillian Downey.
Websites:
Mental Health Information – iThrive. This is a very useful website which provides mental health information and self-help material.
South East Eating Disorders Scotland. This site, developed by NHS Lothian, provides information for the public and professionals on Eating Disorders and services in Fife, Forth Valley, Lothian and the Borders.
BEAT – beating eating disorders website provides help on all aspects of eating disorders including Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder and related eating disorders. You can contact BEAT on their Helpline: 0800 801 0432 (3pm to 8pm).
National Centre for Eating Disorders is an independent organisation set up to provide solutions for all eating problems, compulsive or “binge” eating, failed or ‘yo-yo’ dieting, bulimia and anorexia.
Anorexia Nervosa and Related Eating Disorders Inc. This is a non-profit organisation that provides information about anorexia nervosa and related eating disorders.
Eating Disorder Expert – awebsite providing help and advice on all eating disorders.
Royal College of Psychiatrists provides information on eating disorders.
Self-help books:
Books on prescription for registered users from local libraries:
Skill-based Learning for Caring for a Loved One with an Eating Disorder – Janet Treasure.
Getting Better Bit(e) by Bit(e) – Ulrike Schmidt + Janet Treasure (for bulimia)
Overcoming Binge Eating – Christopher Fairburn (for bulimia and binge eating)
Overcoming Anorexia Nervosa – Chris Freeman
Anorexia nervosa: a survivor’s guide for families, friends and sufferers – Janet Treasure
