Community Dietetics

Please only refer patients for nutrition support who have been screened using MUST (Malnutrition Universal Screen Tool) who score 2 or more with a minimum of a score of 1 for unintentional weight loss (unless otherwise indicated – please refer to referral criteria below). Please note if a patient has had a consistently chronic low BMI without weight loss alone they do not meet the referral criteria. If you feel they require dietetic input, then please contact the appropriate dietetic department to discuss this prior to making a referral.

The contacts for each department are as follows:

City of Edinburgh

Email: loth.edinburghcitydietitians@nhs.scot
Telephone: 0131 549 7387

East Lothian

Email: loth.eastlothiandietitians@nhs.scot
Telephone: 01620 642 701

Midlothian

Email: loth.midlothiandietitians@nhs.scot
Telephone: 0131 454 1017

West Lothian

Email: loth.westlothiandietitians@nhs.scot
Telephone: 01506 775 553

Please consider the risk of re-feeding syndrome which can be potentially dangerous. Further guidance can be found here

Please note that Oral Nutritional Supplements (ONS) should NOT be prescribed without a dietetic referral. ONS will only be recommended if ACBS criteria are met, such as disease-related malnutrition. Weight loss related to social or non-disease factors are not eligible for prescribed ONS. For more information please see Scottish Government Report – Scottish Oral Nutritional Supplements ShortLife Working Group (ONS SWLG) – April 2018 or the Lothian Formulary

V.H & D.M – 25-9-26

Who to refer:

Individuals aged 16 or over who have any of the following may be referred to the Community Dietetic Service:

Patients who have been screened using MUST (Malnutrition Universal Screen Tool) who score 2 or more with a minimum of a score of 1 for unintentional weight loss (see above).
Weight loss during pregnancy/ Hyperemesis gravidarum
Dietary advice relating to dysphagia
Pressure ulcer – Grade 3 and above or wound healing issues
New Pancreatic Enzyme Replacement Therapy (PERT)
High risk of refeeding syndrome (see introduction for further details about risk factors)

Complex ileostomy/colostomy advice
Newly diagnosed Type 2 diabetes within 12 months of diagnosis who are not suitable for DESMOND see DESMOND – RefHelp for further details
Type 2 diabetic patients with poorly controlled blood sugars
Stable IBD for nutritional support (Malnutrition Care Pathway)
Compensated cirrhosis requiring nutritional support / decompensated requiring DOM visit
Liquid/Texture modified diet non-IBD
Functional GI symptoms (not IBD) for dietary advice [Patients will be offered first line advice and suitability for FODMAP will be assessed]
Current serving member or veteran of Armed Forces (please see Health rights for veterans on the following link: Health rights in Scotland | NHS inform for more details)

Please note care home residents should be referred to us directly by care home staff by following the information on our public-facing Intranet page Dietetics and Nutrition – Care Homes

For condition-specific information and referrals that do not meet criteria, please see primary care management tab.

Disordered Eating Clinic: Who Should Be Referred?

The Disordered Eating Clinic is a small provision providing short episodes of dietetic input (up to 4 appointments).

Please consider referral when:

A comprehensive assessment has identified that the presentation is not primarily driven by a diagnosable eating disorder.
Relevant physical health concerns are being appropriately monitored and managed.
Existing support options have been maximised, including mental health interventions where indicated.
The eating difficulties continue to impact health, wellbeing, nutrition, or daily functioning.

Disordered eating may be associated with:

Emotional dysregulation and distress
Neurodevelopmental differences
Mental health difficulties
Psychosocial stressors
Difficulties with body image and self-esteem

It may be the disordered eating dietitian provides liaison support with the adults existing care team rather than providing a direct appointment.

Please ensure that referrals include information about the wider mental health, neurodevelopmental, social, and family context, rather than focusing solely on eating behaviours.

For those with Binge-purge or restrictive disordered eating that does not yet meet criteria for treatment for anorexia nervosa, bulimia nervosa, binge eating disorder, but who may worsen without support, or is currently not accessing treatment please refer to BEAT’s 1:1 coaching service Recovery coaching for disordered eating For patients who are querying ARFID and seeking support please refer to the Lothian Eating Disorder Ref help pages Eating Disorders (Adult) – RefHelp‘

Who not to refer:

Late stage palliative care – please follow the link for guidance Eating and drinking at the end of someone’s life
Individuals aged 15 and under. Please refer to Paediatric Dietetics Dietetics – RefHelp
Patients with low albumin. This may indicate inflammation or infection is present, therefore should not be used to determine nutritional status.

How to refer:

Please make an electronic referral via SCI Gateway. Select “AHP – Dietetics” then select site based on patient location:

City of Edinburgh – Dietetics > LI Dietetics
- West Lothian – St John’s Hospital > LI Dietetics
- East Lothian – East Lothian Community Hospital > LI Dietetics
- Midlothian – Bonnyrigg Health Centre > LI Dietetics

Weight, height, BMI and weight loss history over the past 3-6 months should be recorded wherever possible on the referral.

For disordered eating:

Professionals can refer via SCI STORE or email Disordered eating: loth.disorderedeatingdietetic@nhs.scot