Aims and method This service evaluation was conducted to find out: (1) if mixed gender accommodation in eating disorder units is perceived to be helpful or unhelpful for recovery, and (2) if men were being discriminated against by the implementation of the 2010 Department of Health (DoH) guidelines on the elimination of mixed gender wards. All 32 in-patient units accredited on the Quality Network for Eating Disorders were contacted via a survey. Results We received 38 responses from professionals from 26 units and 53 responses from patients (46 female, 7 male) from 7 units. Four units had closed admissions to male patients due to DoH guidelines. Clinical implications We found that it is possible to provide admission for men with eating disorders, while respecting the single gender accommodation rules, and that doing so is likely to be helpful for both genders and prevents discrimination against men.

Aim: To Improve the Service User Feedback of the Food Availability/Choice at the Aspen Centre. Monthly Food Group Meetings with service users highlighted that the topic raised most regularly was requests for more variety. Service user feedback questionnaires also recognised that the highest frequency of disagreement was with the statements about there being enough variety and quantity of snacks available to choose from, followed by snacks and meals always being in stock on the inpatient unit. Change ideas were tested to see if there would be any differences in feedback. Tools Used: PDSA Cycles - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-pdsa-cycles-model-for-improvement.pdf Driver Diagram - https://aqua.nhs.uk/wp-content/uploads/2023/07/qsir-driver-diagrams.pdf Service User Questionnaires. Project Impact: The project showed a reduction in requests from service users for more variety on the menus. There was also improved communication between facilities staff, dietetic staff and service users. There was an improvement with updating menus to reflect permanent changes. Service users more involved with snack options. The project also led to a reduction in waste with less food being thrown away, which resulted in a cost saving, with a saving of £3,679 for 2022/23 and a projected saving of £5,419 for 2023/24. Next steps: • Continue improved communication between all staff and service users regarding menu updates. • Encourage wider staff attendance in monthly Food Group Meetings. • Continue exploring patient involvement with menus where appropriate. • Continue to monitor expenditure.

Introduction: Self-harm is highly prevalent among young people with eating disorders. However, why a young person may develop and continue to experience both an eating disorder and self-harm is unclear. This study will investigate the frequency, intensity, duration, function, context and processes of self-harm among people aged 16-25 diagnosed with an eating disorder. It will explore participants' perspectives on the genesis and functions of both their self-harm and eating disorder, as well as their support needs. The study was designed with the input of members of a Young Persons' Advisory Group, who will be key to study delivery and dissemination. Methods and analysis: This exploratory study has a sequential mixed-methods explanatory design. Between 70 and 100 young people aged 16-25 with both an eating disorder diagnosis and self-harm thoughts and/or behaviours will be recruited from three NHS Eating Disorder outpatient services in England. Phase 1: a 14-day (six prompts per day) ecological momentary assessment (EMA) of participants' feelings, thoughts, motivations, behaviours and experiences of self-harm. Phase 2: 20-30 participants from phase 1 will be reapproached to take part in an in-depth qualitative interview on the psychological, emotional and social factors that underlie their self-harm and eating disorder as well as their support needs. EMA data from phase 1 will be analysed using descriptive and multilevel statistics. Qualitative interview data from phase 2 will be analysed using inductive and deductive thematic analysis. Results from both phases will be integrated using a mixed-methods matrix, with each participant's data from both phases compared alongside comparative analysis of the datasets as a whole. Ethics and dissemination: The study gained ethical approval from the NHS HRA West Midlands-Black Country Research Ethics Committee (number: 296032). We anticipate disseminating findings to clinical, academic and lived experience audiences, at academic conferences, through peer-reviewed articles, and through various public engagement activities (eg, infographics, podcasts).

Purpose of review: This review describes the characteristics of patients with eating disorders in both type 1 and type 2 diabetes and the principles of their treatment. Recent findings: The combination of type 1 diabetes and an eating disorder is sometimes known as "diabulimia". The hallmark of the condition is that the patient deliberately takes an inadequate amount of insulin in order control their body weight (insulin restriction). Other disordered eating behaviours, such as dietary restriction, self-induced vomiting and binge eating, may also be present but typical anorexia nervosa is rare. There is an increased prevalence of eating disorders in adolescents with type 1 diabetes, which is estimated at 7%. The combination of type 1 diabetes and an eating disorder leads to elevated levels of HbA1c and an increased risk of both acute and chronic complications. Screening is recommended but rarely carried out. Management requires an understanding of the inter-relationships between eating behaviour, mood, blood glucose and insulin administration. Treatment aims to introduce a regular eating pattern and support the patient to increase their insulin dose gradually. Eating disorders also occur in those with type 2 diabetes, where binge eating disorder is the most common diagnosis. Eating disorders are common in both type 1 and type 2 diabetes, with an increased prevalence of complications in type 1. Treatment requires an understanding of both diabetes and eating behaviour.

This article reviews a Court of Protection case involving a woman, Ms X, with two severe medical conditions: anorexia nervosa and end-stage liver cirrhosis due to alcohol dependence. Each of these conditions alone warranted end-of-life care planning. When combined, they provided a far more unique and complex presentation because of the way they were intertwined. Ms X's life was in imminent danger. The Court implemented methodically the principles of the Mental Capacity Act 2005. Ms X was assessed as lacking capacity to make decisions in relation to treatment for her anorexia. However, she retained capacity to make decisions regarding treatment for her liver disease and the continued harmful use of alcohol. The Court ruled that it was not in Ms X's best interests to be subject to further compulsory treatment for her anorexia, even though this may have prolonged her life. It was also in her best interests and lawful not to provide nutrition and hydration with which she did not comply.

Background Patients with anorexia nervosa frequently show neutropenia, lymphopenia, and a reduced CD8 count; pro-inflammatory cytokines tend to be upregulated. The immunological response to bacterial infection is often impaired, but viral illness appears to be rare. At the beginning of the COVID-19 pandemic, clinicians expected that patients with anorexia nervosa would be at increased risk of severe infection. The present study investigated COVID-19 severity in patients with anorexia nervosa with positive SARS-CoV-2 polymerase chain reaction (PCR) tests. Methods A database was created at NHS England and Improvement, and eating disorders clinicians across the UK reported demographics, clinical characteristics, biomarkers, and outcomes of patients with anorexia nervosa and COVID-19 between May 20, 2020, and May 11, 2021. Eating disorder diagnoses were made by referring clinicians following standard clinical practice. This report follows STROBE guidelines. Findings Data were collected from 47 patients (44 female) aged 13–57 years (mean 26·8 years [SD 12·3]), including 34 adults (body-mass index [BMI] 12·0–21·3 kg/m2, mean 15·6 kg/m2 [SD 2·3]) and 13 children (percentage median BMI 68·5–129%, mean 94·0% [SD 13·4]). 37 patients (79%) had at least one of the typical COVID-19 symptoms of fever, cough, or disturbed smell or taste. One patient was asymptomatic; 44 had mild disease; two developed pneumonia, which for one patient was severe. One patient (2%) required treatment for COVID-19 in a general hospital. In comparison, in the general population of England, between 2·4% and 2·7% of adults aged 18–54 years with a positive SARS-CoV-2 PCR between October, 2020, and February, 2021, were admitted to hospital. Interpretation To our knowledge, this is the first published study investigating effects of COVID-19 on patients with anorexia nervosa. Contrary to expectations, these findings suggest that anorexia nervosa does not increase the risk of severe COVID-19 infection. They also provide an insight into the effect of malnutrition on COVID-19, and viral infection in general, and offer some reassurance for patients with anorexia nervosa and clinicians about the risk from infection. Additionally, they may inform vaccination and infection control recommendations for patients with anorexia nervosa in future pandemics. The sample size was small and dependent on data submitted by clinicians; the results should therefore be treated with caution.