Children and Young People's Eating Disorder team

We are part of Leeds Community CYPMHS integrated with wider NHS services.

We work closely with paediatricians based at Leeds General Infirmary (LGI) and have a close working relationship with St James’ University Hospital (SJUH) and CONNECT (Leeds Adult Eating Disorder Service).

Links with other services

• Paediatrics: medical monitoring and risk management
• Dietetics: nutritional assessment and guidance
• CYPMHS teams: broader mental health support
• GP: ongoing physical health care

Why: Eating disorders affect both physical and mental health, requiring coordinated multidisciplinary care.

A family approach is the “best fit” for young people because it combines clinical intervention with the people who have the greatest influence, opportunity, and commitment to support recovery every day.

• Eating disorders impact the whole family system, not just the young person. Mealtimes, relationships, routines and emotional wellbeing are often disrupted, meaning recovery needs to consider the wider context.
• Families are uniquely placed to support recovery because they are present in the young person’s day-to-day environment, where eating, exercise, and behaviour patterns actually occur. This allows change to be embedded in real life, not just in clinic sessions.
• A family-based approach empowers parents and caregivers to take an active, practical role in restoring eating, weight, and routine. This is particularly important when the young person feels unable to make changes independently due to the influence of the eating disorder.
• Young people with eating disorders often experience reduced capacity for decision-making around food, weight, and health due to the impact of malnutrition and the illness itself. A family approach provides essential support and containment during this phase.
• The model helps families to externalise the eating disorder, reducing blame, conflict, and guilt, and enabling everyone to work together against the illness rather than against each other.
• It builds long-term skills within the family, increasing confidence in identifying early warning signs, responding quickly to relapse, and maintaining recovery beyond treatment.
• Family-based treatments (such as FT-AN and FT-BN) are evidence-based and recommended as first-line interventions for children and young people, with strong outcomes in weight restoration, symptom reduction, and sustained recovery.
• The model helps families to externalise the eating disorder, reducing blame, conflict, and guilt, and enabling everyone to work together against the illness rather than against each other.
• It builds long-term skills within the family, increasing confidence in identifying early warning signs, responding quickly to relapse, and maintaining recovery beyond treatment.
• Family-based treatments (such as FT-AN and FT-BN) are evidence-based and recommended as first-line interventions for children and young people, with strong outcomes in weight restoration, symptom reduction, and sustained recovery.

The key therapies we offer are:

• Family Therapy for Anorexia Nervosa (FT-AN)
• Family Therapy for Bulimia Nervosa (FT-BN)
• Cognitive Behavioural Therapy for Eating Disorders (CBT-ED)
• MANTRA

We also offer various adjunct therapies that compliment the above key pathways, such as distress tolerance, obsessive compulsive disorder (OCD), body image and medication.

Conditions treated

• Anorexia Nervosa
• Bulimia Nervosa
• Binge Eating Disorder
• Disordered Eating (with the exception of avoidant restrictive food intake disorder (ARFID))

• Young people and families are supported by a whole team. Each professional brings something different, and together we make sure care is safe, joined‑up, and tailored to what the young person needs.
• In children and young people’s eating disorder service (CYPEDS), our team includes mental health nurses, paediatricians, psychologists, psychiatrists, assistant psychologists and dieticians
• We also occasionally have students and junior doctors shadowing the team to gain an understanding of eating disorders and how they are assessed and treated.

Mental health practitioners and senior mental health practitioners

All of our mental health practitioners hold qualifications in mental health nursing and have significant experience of working with children and young people with eating disorders to deliver high quality, evidence-based treatment.

Mental health nurses help with the day‑to‑day emotional and physical wellbeing of the young person. They:

• conduct assessments
• offer therapy to help the young person cope with thoughts, feelings, and urges
• support families to understand the eating disorder and respond in helpful ways
• monitor physical health and safety
• support with managing distress, anxiety, or difficult moments
• help families understand what to look out for
• work closely with the wider team to keep care consistent

They’re often a steady, calming presence who help things feel more manageable.

Specialist dietitian

A specialist dietitian helps young people and families understand the nutritional side of eating disorders and supports safe, steady progress with food. They work closely with the whole team to make sure the young person’s body is getting what it needs to recover.

They:

• support families to understand how eating disorders affect the body
• create safe, personalised nutrition plans that match the young person’s needs
• work with parents to build regular eating routines at home
• offer guidance on portioning, meal structure, and managing tricky foods
• monitor physical health markers linked to nutrition
• liaise with paediatricians, nurses, and the therapy team to keep care joined‑up
• help young people and families understand hunger, fullness, and the impact of symptoms like restriction, bingeing, or purging
• provide reassurance and clear information during times of uncertainty

The dietitian’s role is to make the nutritional side of recovery feel clearer, safer, and more manageable for everyone involved.

CAMHS assistants and senior CAMHS assistants

Support workers offer practical, hands‑on help. They:

• provide emotional support to the young person
• help with meal support or routines if needed
• offer skills‑based sessions (for example, coping strategies, planning for tricky situations)
• support parents with day‑to‑day challenges

They’re often the people families see most regularly and can be a real anchor during treatment.  Our assistants work across the hospital wards and with families at the Reginald Centre.

Paediatricians

Paediatricians look after the young person’s physical health. They:

• monitor growth, nutrition, and medical stability
• check for any complications linked to eating difficulties
• advise the team and family on what is medically safe
• help decide when hospital care is needed or when it’s safe to be at home

They make sure the young person’s body is safe while the therapy team supports recovery.

We are lucky enough to be supported by two consultant paediatricians from the LGI who work with the team on Tuesdays and Thursdays.

Psychologists

Psychologists focus on understanding the emotional and behavioural side of the eating disorder. They:

• offer therapy to help the young person cope with thoughts, feelings, and urges
• support families to understand the eating disorder and respond in helpful ways
• help shape the overall treatment plan

Assistant psychologists

Assistant psychologists work under the supervision of a qualified psychologist. They:

• support assessments and therapeutic work
• run guided self‑help or skills‑based sessions
• help families practise strategies between appointments
• collect information that helps shape the care plan

They help make sure families get timely, consistent support.

Psychiatrists

• Understands your mental health, including how the eating disorder affects thoughts and feelings.
• Helps plan your care with the whole team and your family.
• Talks about medication if it might help with things like anxiety or low mood.
• Explains what’s happening in your body and why certain checks or treatments are needed.
• Works with other services (like your GP or school) so everyone supports you together.
• Keeps an eye on safety and helps decide what support you need.

How to get referred

• Most referrals come through the MindMate Single Point of Access (MindMate SPA).
  This service helps children and young people in Leeds find the right emotional wellbeing or mental health support.

Who it’s for

• Children and young people of school age, up to their 18th birthday who has a Leeds GP

How referrals work

• MindMate SPA looks at the information provided and decides which service can best support you.
• MindMate SPA works closely with CYPMHS and other local services to make sure your referral goes to the right place.

Consent

• For children under 13, a parent or carer must give consent for the referral.
• Young people aged 13 and over can give consent themselves if they choose to.

Information we need with each referral

• Current weight and height
• Speed and amount of recent weight loss
• Any concerns on physical examination, including pulse, blood pressure, and other vital signs
• Whether the young person is bradycardic, and if an ECG has been completed and is normal
• Whether blood tests are within normal limits, especially potassium, U+Es, phosphate, and magnesium (important for refeeding risk)
• Please check that bloods were taken using the paediatric medicine “eating disorders under 18” ICE panel. If not, please arrange for these to be completed.
• This information helps us understand the urgency of the referral so we can offer the right level of support as quickly as possible.

Outcome measures: On the day of your appointment, someone from the team will meet with you to go through what the day will look like. They will also bring some outcome measures for you to complete. We use a few short questionnaires to help us understand how things are going for you and what support might help.

Family involvement: We usually meet with you and your family or carers, as working together often leads to the best support. We’ll always involve you in decisions about who comes into sessions.

Who you might meet

Our team includes therapists, paediatricians, psychiatrists, dietitians and support workers so there may be a few members of the team present for the assessment. This is so we can ensure that as much information as possible is gathered to inform the plan for next steps of your care.

Team discussions

Once we have met with you and your family, our whole team talks together to make sure you’re getting the right support and that everyone is working towards the same goals.

Feedback from us

At the end of the assessment, we give you and your family immediate feedback about what we’ve found, what it means, and what the next steps will be.

After the appointment

After the appointment we send out a letter summarising the assessment and recommendations for next steps. A copy of this letter is sent to your GP. It can also be sent to school, clubs or any other professionals involved in your care.

How long will the appointment take?

Most assessments last between 60 and 90 minutes. If we need more time, we’ll discuss this with you so you’re not left wondering.

Will my child be seen alone?

Often, yes but only for a short part of the assessment. This gives your child space to speak privately if they wish. You’ll also have time to share your perspective. We explain this clearly on the day so everyone knows what to expect.

Is everything we say confidential?

Information is kept private within the clinical team. The only time we would share information outside the team is if we’re worried about someone’s safety. If that ever becomes relevant, we explain clearly what we need to share and why.

What is our role as parents or carers?

You are central to your child’s recovery. We’ll ask about what you’ve noticed, what’s been difficult, and what’s helped so far. We work collaboratively with families, and your insights are invaluable.

What if my child doesn’t want to attend?

This is very common. We’ll do our best to make the appointment feel safe and manageable. You can let us know any worries in advance so we can adapt the session.

What if we’re not sure it’s an eating disorder?

That’s completely okay. Part of the assessment is to explore what’s going on and whether an eating disorder is the best way to understand it. You don’t need a diagnosis to attend.

What is MANTRA?

MANTRA is a specialist integrative therapy that has been developed specifically for the treatment of anorexia nervosa. MANTRA consists of seven core modules conducted over 20 to 40 sessions. MANTRA aims to address the cognitive, emotional, relational, and biological factors which tend to maintain AN by working out what keeps people stuck in their anorexia and gradually helping them to find alternative and more adaptive ways of coping. This might include developing motivation to change and recover, improving food intake and nutrition, addressing interpersonal difficulties, developing more helpful styles of thinking, learning new ways of managing emotions; and developing a sense of identity that is separate to AN. Which modules and factors are addressed in treatment depends on individual needs and preferences. You and your therapist will work together on the aspects of your eating difficulties that you feel are the most relevant and (or) problematic for you, with a view to making lasting changes that will improve your overall quality of life.

Who might benefit from MANTRA?

MANTRA is a treatment that was specifically developed for the treatment of anorexia nervosa. MANTRA is generally recommended for people who report an extremely rigid thinking style (for example, little flexibility in their thinking, difficulties in emotional processing or in relationships with others), positive beliefs about their anorexia (low motivation or high ambivalence for recovery or full recovery), and either no support network or a support network that does not always feel helpful to the client. MANTRA may also be offered if other evidence-based treatments have been offered before and haven’t been found helpful, or if a client does not believe that other evidence-based treatments will be helpful.

How long will MANTRA take?

MANTRA is designed to take between 20 and 40 sessions although a key component of MANTRA is that modules can be worked through at a client’s own pace and speed. This means that clinicians tend not to be too specific about how long a client will be in therapy and instead will be led by a client’s needs and preferences.

What is the format of MANTRA?

The format of both group and individual sessions will be:

Getting started on anorexia: Who, what, when, where, why?

This part of treatment looks at motivation to change and creating early behaviour change alongside getting to know and understand what the eating disorder beliefs are, where they came from and why it’s sticking around.

Sessions look to create a working understanding of how anorexia developed and what is keeping is going. There will also be time spent looking to the future and how you can show up differently and create ways of coping that are more helpful and supportive.

Identity

This module starts to think about who you are without anorexia. What are your likes, dislikes, interests and hobbies? How much time do you get to enjoy the things that make you, you? In this module, if anorexia is still a big feature of your identity, you will be encouraged to put it aside for these sessions and be curious about what life might be like for you if you were able to listen to and act on the side of you beyond anorexia. If you are further in your recovery journey, these sessions may be a chance for you to re-engage with some previously held hobbies and interests or try something new. The identity module is about being bold, curious, and having a go.

Social and emotional mind

This module has 6 key elements and not all of them may be relevant to you. Together with your practitioner, you can explore which parts may be useful for you.

Part 1: What are emotions and why do we have them?

Part 2: Relationships in context

Part 3: Becoming an expert on your emotions

Part 4: Learning to manage extreme and overwhelming emotions

Part 5: The emotional lives of others

Part 6: Learning self-compassion

Finally, there will also be a relapse prevention session with your practitioner to look at how you stay well once the time comes for you to leave the service.

What is FTAN?

• FTAN is one of the most successful treatments for eating disorders in children and teens with anorexia nervosa, bulimia nervosa, and other specified feeding or eating disorder (OSFED). To distinguish it from other forms of family therapy, parents sometimes call it “Maudsley Family Therapy,” a reference to its initial development at the Maudsley Hospital in London. FTAN is a specific treatment that follows a manual.  Parents, supervised by trained professionals, deliver FTAN in an outpatient setting.
• FTAN requires active participation by parents and parents are empowered to become agents of change. In FBT, family meals form the core of the treatment: parents take charge of nourishing their teens with eating disorders by providing energy-dense meals. Parents plan, prepare, serve, and supervise all meals. A typical recovery meal plan includes three meals plus three snacks per day. If purging is an issue, they provide supervision after meals. They implement strategies to prevent purging, excessive exercise, and other eating disorder behaviours. FTAN centralises the role of food in recovery. Your child may fear eating but the cruel irony is that recovery cannot happen without regular energy-dense meals. We often say in FTAN that “Food is medicine.”

FTAN has three distinct phases

• Phase 1: Full parental control to promote weight restoration: Parents are fully in charge of meals helping their child to re-establish regular patterns of eating and interrupting eating disorder behaviours including purging and over-exercising. Parents help their teens to reincorporate foods they have dropped from their repertoire.
• Phase 2: A gradual return of control to the adolescent. This phase usually begins once most weight has been restored, when meals are going more smoothly, and when behaviours are mostly under control. We gradually give the teen more independence over their own eating in an age-appropriate manner.
• Phase 3: Once the adolescent has resumed an age-appropriate level of independence and no longer exhibits eating disorder behaviours, treatment shifts in focus to helping them develop a healthy balanced life and catch up on other developmental issues. Other co-occurring mental health problems can be addressed. Relapse prevention is incorporated.

How long does FTAN take?

It varies and treatment is individualised. Speedy diagnosis and early intervention can drive a faster result. But eating disorders are difficult illnesses. If weight gain is slower than desired, it can take longer. Some teens also struggle with independent eating and so benefit from a longer period of supervised eating. Early behaviour change is key, and parents play a pivotal role in establishing that change.

What is CBT-E?

CBT-E is the abbreviation for “enhanced cognitive behaviour therapy” and is one of the most effective treatments for eating disorders. It is a “transdiagnostic” treatment which means it is suitable for all forms of eating disorder including anorexia nervosa, bulimia nervosa, binge eating disorder and other similar states​.

CBT-E is a highly individualised treatment. The therapist creates a specific version of CBT-E to match the exact eating problem of the person receiving treatment. CBT-E has four stages.

• Stage 1: The focus is on gaining a mutual understanding of the person’s eating problem and helping him or her to modify and stabilise their pattern of eating. There is also emphasis on personalised education and the addressing of concerns about weight.
• Stage 2: In brief, progress is systematically reviewed, and plans are made for the main body of treatment (Stage Three).
• Stage 3: Consists of sessions focused on the processes that are maintaining the person’s eating problem. Usually this involves addressing concerns about shape and eating; enhancing the ability to deal with day-to-day events and moods, and the addressing of extreme dietary restraint.
• Stage 3: Consists of sessions focused on the processes that are maintaining the person’s eating problem. Usually this involves addressing concerns about shape and eating; enhancing the ability to deal with day-to-day events and moods; and the addressing of extreme dietary restraint.

How long does CBT-E last?

When working with people who are not significantly underweight, CBT-E generally involves 20 treatment sessions over 20 weeks.

With people who are underweight, treatment needs to be longer, often involving around 40 sessions over 40 weeks. In this version of CBT-E, weight regain is integrated with addressing eating disorder psychopathology. Before embarking on weight regain, patients and therapists spend the first weeks of this treatment carefully considering the reasons for and against this change. The goal in CBT-E is that patients themselves decide to regain weight rather than having this decision imposed upon them. During the final step of weight regain the patient becomes accomplished at maintaining their weight.

What is it?

Guided self help is a manualised treatment pathway for young people with a strong evidence base for anxiety, depression and eating disorders. GSH consists of workbook for young people to own and work through in between sessions, reflecting on this work in subsequent sessions with their guide (practitioner). It is a middleman between self-help and other therapeutic interventions.

How long does it take?

The GSH workbook consists of six sections, with the idea that each section is the equivalent of one session. Sessions will initially be weekly however will then move to fortnightly from session 3 onwards. Therefore it can be expected that GSH will take approximately 12 weeks, including an introductory session and a review at the end.

Who can access GSH?

As GSH requires independent work in between sessions, GSH is indicated for young people aged 13 and over who are motivated to make changes. GSH is suitable for all eating disorders, or young people diagnosed as having disordered eating.

Young people who are physically or cognitively compromised would not be suitable for GSH nor someone with significant low mood, given the difficulties they may face engagement wise.

If a young person is engaging in DSH significantly or increasingly then GSH would not be the recommended treatment either.

What is it?

Four weeks of increased support from the ESP team consisting of weekly group sessions for both parents and carers and young people to attend separately, a weekly home visit during a meal or snack to offer parental or carer meal coaching, and a weekly check in phone call from an ESP practitioner. This is in addition to the usual care coordinator session. Review to be held after four weeks to determine next steps, for example, is further ESP support indicated or not.

Who is it for?

Young people who are at risk of needing a hospital admission, or young people who have been discharged from hospital and need extra support transitioning back home.

How We Support Young People in Hospital: CYPEDS Paediatric In‑Reach Pathway

• When a young person needs medical care on a children’s ward, the Children and Young People’s Eating Disorder Service (CYPEDS) stays closely involved. Our role is to coordinate care, keep communication clear, and make sure the young person and their family feel supported throughout the admission.

Who’s involved

• Your CYPEDS key worker will stay connected with you throughout the admission.
• CYPEDS specialist dietitian: Gemma will work with the hospital dietitians, paediatricians and nursing team to make sure the eating‑related care follows safe, evidence‑based guidelines.
• In‑reach support worker: Rebecca will meet with the young person and their family each week to offer emotional and practical support.

What support looks like

Parents stay in an active role:

Even while in hospital, parents remain central in supporting their child’s eating. You’ll continue to guide and encourage your child around meals, working alongside the ward team and following the medical guidelines in place.

Weekly key worker visits:

The key worker will come to the ward weekly. This helps build a trusting relationship so that psychological support feels easier and more familiar once the young person is well enough to leave hospital.

Weekly sessions with the in‑reach support worker:

Rebecca will meet with the young person every week. What these sessions look like will depend on what they need at the time. They may include:

• Support around meals
• Space for the family to talk things through
• Short, focused psychological interventions to help with coping and motivation

The plan can change as the young person’s needs change.

What we’re working towards

The main aim of this phase is for the young person to become medically stable. That will look different for everyone, however medical stability is typically based on:

• consistent weight restoration
• completion of meal plans
• physical health parameters, for example, BP, pulse, bloods, being within normal range for that person
• When it’s safe and appropriate, the plan is for the young person to return home so that re‑nutrition and recovery can continue in a familiar environment with the right support.

What is FT-BN?

FT‑BN is a treatment where the whole family is supported to help a young person reduce and stop bingeing, purging, and other eating‑related difficulties. The focus is on safety, understanding, and building confidence at home so recovery can continue between sessions.

What support looks like

Helping the family take an active role: Parents and carers play a key part in supporting their young person to:

• establish regular eating
• reduce bingeing and purging
• manage triggers and high‑risk situations
• build routines that feel safe and predictable

The therapist will guide you step‑by‑step so you feel confident and supported.

Support for the young person: Alongside family sessions, the young person may have individual time with their key worker. This can include:

• learning coping strategies
• managing urges and emotions
• building motivation and self‑confidence
• planning for tricky situations

The focus is always on safety, understanding, and helping the young person feel less alone with the eating disorder.

The Three Phases of Treatment in FT-BN

Phase 1: Understanding the problem and creating safety

This first phase focuses on helping the family understand how bulimia affects the young person and how the cycle of bingeing, purging, and restriction is maintained.
Families are supported to:

• build regular eating routines
• reduce high‑risk patterns
• create a calmer, more predictable environment around food
• understand that the eating disorder is separate from the young person

The aim is to reduce shame and blame, increase safety, and help everyone feel more confident about what they can do at home.

Phase 2: Supporting change and building new patterns

Once things feel more stable, the therapist works with the family to help the young person gradually take more responsibility for their eating and coping.
This phase includes:

• strengthening regular eating
• reducing bingeing and purging behaviours
• helping the young person manage urges, emotions, and triggers
• supporting parents to step in or step back as needed

The focus is on building healthier routines and giving the young person tools to manage difficult moments.

Phase 3: Looking forward and strengthening recovery

The final phase helps the young person and family prepare for life beyond the eating disorder.
Together, you’ll look at:

• confidence and independence
• managing stress, relationships, and school life
• planning for future challenges
• strengthening communication and support within the family

The aim is to help the young person feel ready for the future, with the eating disorder no longer in control.

Most families have weekly or fortnightly sessions, depending on the treatment model. Early sessions often focus on:

• stabilising eating
• understanding risks
• supporting parents/carers to take an active role
• building trust and safety

The pace is steady and structured.

Ongoing physical health monitoring

Because eating disorders affect the body, regular health checks are part of treatment. These may include:

• Weight and height
• Pulse and blood pressure
• Temperature
• Blood tests (if needed)
• The team will always explain what’s being done and why, and will check your child’s comfort.

Support with eating

Depending on the treatment model, you may receive:

• guidance on meal planning
• support around re‑establishing regular eating
• coaching for parents/carers on how to support meals at home
• strategies for managing distress around food

The aim is to reduce risk and help your child’s body and brain begin to recover.

Therapeutic work

Therapy focuses on understanding the eating disorder, building healthier coping strategies, and supporting emotional regulation. This might include:

• Family‑based treatment (FT-AN and FT-BN)
• CBT‑ED
• Dietetic support
• Skills for managing anxiety, perfectionism, or low mood

Therapy is paced carefully so your child isn’t overwhelmed.

Your role as parents or carers

Families are central to recovery. You may be supported to:

• lead on meals and snacks
• create structure and predictability at home
• respond to distress or resistance
• notice early warning signs
• build confidence in supporting recovery

You’re not expected to know everything, the team will coach and guide you.

Safety planning

If there are concerns about physical or emotional safety, the team will work with you to create a clear plan. This might include:

• What to do if symptoms worsen
• When to seek urgent medical help
• How to manage high‑risk situations
• Who to contact between sessions

Safety is always the priority.

Space for questions and emotions

Treatment can bring up big feelings, hope, fear, frustration, relief. The team expects this and will make space for you to talk things through. You can ask for things to be slowed down, repeated, or adapted.

Reviews and adjustments

Treatment isn’t static. The team will regularly review progress with you and your child, adjusting the plan as needed. You’ll always be part of these conversations.

Recovery is a process

Early treatment often feels intense, but it’s designed to create safety and momentum. Over time, as your child stabilises and gains strength, the focus shifts toward independence, identity, and long‑term wellbeing.

Documentation you may receive during eating disorder assessment and treatment.

Care plan

A care plan outlines the agreed goals, interventions, and responsibilities for everyone involved. It usually includes:

• The main aims of treatment
• Who is providing which parts of care
• How often sessions or health checks will happen
• What you and your child can expect between appointments
• Any agreed strategies for safety and support

It’s a living document that gets updated as things change.

FACE risk assessment

This is a structured tool used to help clinicians understand any risks related to physical health, emotional wellbeing, self‑harm, or other safety concerns. It helps the team:

• identify what needs close monitoring
• plan how to reduce risks
• agree on actions if concerns increase

It’s not a judgement, it’s a safety tool.

Assessment letter

After the initial assessment, families usually receive a summary letter. It typically includes:

• What was discussed
• Key observations or concerns
• Any diagnosis or working formulation
• Recommended next steps
• Information about treatment options

The aim is to ensure everyone has a shared understanding.

Review letters

These are sent after review appointments or care plan meetings. They summarise:

• progress so far
• any changes in risk
• updates to the care plan
• new goals or recommendations

They help keep everyone aligned and informed.

School letters

With consent, the team may write to school to support your child’s needs. These letters might include:

• Attendance or timetable adjustments
• Meal‑time support recommendations
• Guidance on PE or physical activity
• Information about medical monitoring
• How school can communicate concerns

The focus is always on safety and reducing pressure on the young person.

Mental Health Act (MHA) Paperwork

This only applies if a young person is assessed or treated under the Mental Health Act. Paperwork may include:

• Legal documentation explaining the section used
• Rights and safeguards
• Information about appeals or advocacy
• Details of the responsible clinician and care team

Families are guided through this carefully if it becomes relevant.

Meal plans

Meal plans are created by dietitians or clinicians to support nutritional rehabilitation. They may include:

• structure for meals and snacks
• portion guidance
• foods to include regularly
• gradual changes to support weight restoration or stabilisation

They’re tailored to the young person’s needs and reviewed regularly.

Crisis information

This outlines what to do if things worsen between appointments. It may include:

• signs that need urgent attention
• who to contact in working hours
• out‑of‑hours or emergency options
• when to seek medical help
• agreed steps to keep your child safe

It’s designed to reduce panic and give families a clear plan.

Outcome measures

These are questionnaires or tools used to track progress over time. They might explore:

• eating disorder symptoms
• mood and anxiety
• quality of life
• family functioning
• physical health indicators
• They help the team understand what’s improving and what still needs support.

Treatment reviews are indicated every 6 to 8 weeks, starting with an initial review. These reviews are attended by either a facilitating Senior Practitioner or the multidisciplinary team, depending on the needs of the review.

During reviews it is discussed how both the young person or family are experiencing treatment, in addition to any reflections from the care coordinator. The goal of a review is typically to make a suitable plan regarding next steps in treatment, either within the ED team or outside of it, and some reviews are also designed as discharge reviews at the end of treatment.

What is recovery?

Recovery means helping a young person return to physical health, emotional wellbeing, and a life that feels bigger than the eating disorder. It’s not just “eating normally again” – it’s about restoring safety, energy, identity, and freedom.

Recovery usually includes:

• Physical recovery: stable health, restored nutrition, and normal growth
• Psychological recovery: fewer eating‑disorder thoughts and fears
• Social recovery: reconnecting with friends, school, and activities
• Developmental recovery: getting back on track with age‑appropriate milestones

Recovery is a process, not a single moment.

Is recovery linear?

No and that’s okay.

Progress often looks like:

steps forward → pauses → wobbles → more steps forward

A setback doesn’t mean failure. It’s a sign that the young person needs more support, structure, or reassurance.

How can families support recovery?

You play a central role. Recovery is strengthened by:

• consistent meal support
• predictable routines
• clear boundaries around safety
• compassion paired with firmness
• staying connected with the treatment team
• noticing and celebrating small wins

You don’t need to be perfect, just present and persistent.

Myth 1

“Treatment is just about weight gain”

Treatment is designed to support young people to weight restore and renourish the body, however this is only one part of it. Treatment also involves psychological intervention in order to support young people with managing their cognitions and the impact of these on their mental health. In addition we also offer support working with the family to address any unwelcome dynamics that may act as a perpetuating factor, and at the end of treatment relapse prevention work will take place.

Myth 2

“It is the parent’s fault when an eating disorder develops”

There is no evidence to suggest families are to blame for the development of an eating disorder. However there is a strong evidence base that family involvement in treatment gives young people the best chance of recovery, and improves treatment outcomes.

Myth 3

“Eating disorders only affect girls/women”

Anyone can develop an eating disorder regardless of gender. Statistics show that 10 to 20% of those with an eating disorder are male, however statistics may be inaccurate due to the likelihood that many eating disorders go undetected.

Do my parents or carers have to be involved in my care and treatment?

There is no clear answer here, because we work with children and young people, we usually involve parents or carers in treatment and would always advise that this as the best option in most cases. Research shows that family involvement is one of the most effective ways to support recovery from an eating disorder.

Parents and carers can help with:

• supporting meals at home
• keeping you safe
• encouraging recovery
• understanding what you’re going through

However, we also respect your right to privacy. We will talk with you about what information is shared and make sure your views are heard.  If you are older (for example 16 or 17), you may be able to consent to treatment yourself. We will always discuss this with you and explain your options clearly.

Can I decline treatment?

We understand that starting treatment for an eating disorder can feel frightening or overwhelming. You may not always feel ready to accept help.

In most situations, treatment is offered with your agreement. We will always try to:

• explain why treatment is recommended
• listen to your views and concerns
• work at a pace that feels manageable
• involve you in decisions about your care

However, eating disorders can sometimes seriously affect your physical health. If we are very worried about your safety or medical risk, we have a duty to protect you. In rare situations, treatment may need to continue even if you do not agree, particularly if your health is at immediate risk.

If this ever becomes a concern, we will explain clearly what is happening and why.  We will always make sure you and your family understand the process.

Our goal is always to work with you, not against you.

If you are physically stable and the risk is low, then yes you can decline to be involved with our service.  Should this be the case we will hand your care over to your GP for further support and review.

What is a care plan?

Your care plan is a shared plan that explains:

• what you are struggling with
• what your goals are
• what support we will provide
• what you and your family can do to help
• What to do if things get worse

Having a care plan helps everyone stay on the same page. It makes sure your treatment is safe, clear, and focused on what matters most to you.  Eating disorders can affect both your physical and mental health, so your care plan may include things like therapy sessions, physical health monitoring (such as weight and blood tests), and family support.

You will be involved in creating your care plan, and we will review it regularly together.

What is nasogastric feeding?

Nasogastric feeding (often called NG feeding) is a way of giving your body nutrition if you are unable to eat enough by mouth to stay medically safe.

It involves:

• A thin, soft tube being passed gently through the nose
• the tube going down into the stomach
• liquid nutrition being given through the tube

NG feeding is usually considered when:

• weight loss is severe
• your heart rate, blood pressure, or blood tests are unsafe
• eating by mouth is not possible or not enough

It can feel worrying, but it is a medical treatment used to protect your body. In many cases, it is temporary and stops once you are able to meet your nutritional needs safely through eating an oral meal plan.

Why do I need a multivitamin?

Eating disorders can reduce the variety and amount of nutrients your body receives. Even if you are eating some foods, you may not be getting all the vitamins and minerals your body needs.

A multivitamin helps to:

• support your heart and other organs
• protect your bones
• support your immune system
• prevent vitamin deficiencies (such as low iron, vitamin D, or B vitamins)

It does not cause weight gain and is not a substitute for food. It is simply a way of helping your body stay as safe and as supported as possible while you work on recovery.

If you have any questions about medication or supplements, please ask your care team or your GP, we are always happy to explain.

Can I be held under the service past my 18th birthday?

CYPMHS (Children and Young Persons Mental Health Services) usually support young people up to the age of 18.

As you approach your 18th birthday, we will plan ahead with you. If you still need support, we may:

• transition you to an Adult Eating Disorder Service
• refer you to Adult Mental Health Services
• work with other appropriate services

Sometimes, if it is clinically appropriate and agreed by the service, you may remain under CYPMHS briefly beyond your 18th birthday to ensure a smooth transition. This is decided on an individual basis.

Our priority is to make sure you continue to receive the right support at the right time.

Will I get fat?

This is a very common and understandable fear.

When you begin eating more regularly, your body may change. If you have lost weight, your body will need to restore weight to a healthy range. That is not the same as “getting fat”, it is your body repairing itself.

Early in recovery, you might notice:

• bloating
• feeling fuller more quickly
• temporary changes in weight
• water retention

These changes are common and usually settle as your body adjusts.

Eating disorder thoughts can make normal, healthy weight restoration feel scary or “wrong.” Treatment helps you learn to tell the difference between eating disorder fears and what your body actually needs.  The aim of treatment is health, strength, and freedom, not forcing you into an unhealthy size.

Why is treatment hard?

Eating disorders often feel like they are helping you cope. They may give a sense of control, numb difficult feelings, or reduce anxiety in the short term.

Treatment asks you to:

• eat when the eating disorder says not to
• reduce behaviours that feel “safe”
• face fears around weight and shape
• experience feelings you may have been avoiding

That can feel uncomfortable, emotional, and exhausting.  Recovery is hard because you are doing something brave: challenging an illness that has taken up a lot of space in your life.

It is also important to know:

• feeling worse before feeling better can be normal
• motivation can go up and down
• you do not have to feel ready all the time
• progress is not always linear

You are not failing if you are finding it difficult. It means you are working against something powerful, and that takes strength.

What is a supplement ?

A supplement is a nutritional drink (milkshake or juice) but can at times be in the form of a yogurt or ice–cream, that provides energy, protein, vitamins, and minerals.

Supplements may be used when:

• you are not able to eat enough food to meet your bodies requirements
• weight gain is needed for medical safety
• your body needs extra nutrition to recover

Supplements are a medical support tool to help your body heal.  Sometimes supplements are used short-term alongside meals. As eating improves, they are usually reduced and stopped.

Can I still learn to drive while in treatment?

This depends on your physical and mental health.  Eating disorders can affect:

• concentration
• reaction times
• energy levels
• blood pressure
• risk of fainting

If you are feeling dizzy, faint, very weak, or medically unstable, it may not be safe to drive or have driving lessons.  If your physical health is stable and your team is not concerned about risk (for example, fainting episodes), you may be able to continue learning.

We may ask about symptoms like blackouts or dizziness and we may also review your medical stability before advising to give us a clear idea of physical health.  To have a full clear picture we may also liaise with your GP if needed.

Safety: yours and others’  is always the most important factor. If you are unsure, please ask your care team before booking lessons

Can I fly abroad while in treatment?

It depends on your health and where you are in treatment.

Flying can pose extra risks if:

• your weight is very low
• your heart rate or blood pressure are unstable
• you are at risk of fainting
• you require frequent physical monitoring
• you need supervised meals

Changes in routine, time zones, and meal patterns can also make recovery more challenging.  However, If you are medically stable and doing well in treatment, travel may be possible. We will consider:

• how long you will be away
• whether you will miss important appointments
• whether you can access medical care if needed
• who will support you with meals

Always discuss travel plans with your care team before booking. In some cases, we may advise postponing travel until your health is safer.  Our goal is not to stop you living your life, it’s to make sure you can do so safely.

It is also important to check with your insurance company as to whether you will be covered if you did need medical input abroad.  You may need a letter from your care team to support you flying.  We can not stop you from flying abroad we can only advise, going against medical advise may be a decision for you and your family to make if we do not feel it is safe for you to travel.

What does my weight need to be?

There isn’t one single “right” number. A healthy weight is different for everyone. It depends on many factors including  your height,  age,  sex,  stage of puberty, Your growth pattern before the eating disorder and your physical health.

For children and young people who are still growing, we often use growth charts. These show how your weight compares to others of the same age and height, and help us understand what is healthy for your body.

What is a “target weight range”?

Rather than aiming for one exact number, we usually talk about a target weight range. This is a range that supports your heart and other organs, allows normal growth and development, it will help your concentration and energy return and support hormone health (including periods if applicable).  It will also support the reduction of eating disorder thought.

The target weight range is based on medical evidence and your individual growth history and not on your appearance. The range also allows for natural fluctuations in weight that everyone experiences.

Why can’t I go to school or college?

We know how important school, college, and seeing friends are. Being asked to reduce or pause attendance can feel frustrating or unfair.

Sometimes we recommend time away from education because:

• your physical health is not safe (for example, low weight, dizziness, fainting, heart concerns)
• you need supervised meals during the day
• you feel too exhausted to concentrate
• anxiety around food or body image is making school overwhelming

Recovery requires energy, both physical and mental. If your body is undernourished, it is harder to think clearly, concentrate, and manage stress.

This is usually temporary. The goal is always to help you return to education safely. We work with families and schools to create a gradual plan when you are ready. Your health comes first, education can continue once your body and brain are better supported

What is weight for height?

Weight for height is one way we check whether your body weight is within a healthy range for your height, age, and sex.  For children and young people who are still growing, we often use growth charts. These charts compare your measurements to others of the same age and sex to see how your body is developing over time.  You may hear your care team talking about weight for height and centiles.

Weight for height helps us to:

• understand medical risk
• track progress in recovery
• identify if your body is getting the nutrition that it needs to function at the highest level

It is however only one part of the clinical picture. We also look at:

• heart rate and blood pressure
• blood tests
• energy levels
• mood and concentration

The goal is not to focus on numbers, but to make sure your body is safe and supported while you recover.

Why do I have an eating disorder?

Eating disorders are complex illnesses. They are not your fault.  There isn’t usually one single cause and often the time on onset is unknown. They often develop because of a combination of factors, such as genetics (some people are more vulnerable), personality traits (for example, perfectionism, high sensitivity, need for control), Difficult life experiences (sometimes referred to as trauma), anxiety, low mood, or other mental health difficulties and or social or cultural pressures.

For many young people, the eating disorder may have started as a way of coping, for example, managing difficult emotions or situations. Over time, the eating disorder can develop, and it can take on a life of its own and become hard to stop.  You may be unaware that it is developing which makes it hard to recognise before its fully embedded.

What matters most is not blaming yourself but understanding that recovery is possible with the right support.

How long is treatment for?

Treatment length varies from person to person. It can depend on many factors like your physical health, how long you’ve been unwell for, the type of eating disorder and the recommended treatment programme.

Some young people work with us for several months. Others may need support for a year or longer.  Treatment is usually more frequent at the beginning and gradually reduces as you become safer both physically and psychologically and more confident in recovery.  We review progress regularly with you and your family and would be working towards discharge from day one of treatment. The goal is to support you for as long as you need  but not longer than is necessary.

Why do I need a meal plan?

A meal plan is a structured guide for eating regularly and consistently throughout the day. It ensures that your body has a steady supply of energy. Eating disorders can disrupt hunger cues, portion sizes, and food variety which may result in you not feeling hungry and feeling like you want to eat. A meal plan can give you permission to eat.  It can also provide structure when you may not be able to think or plan clearly in the moment.

A meal plan can also help  to:

• restore weight safely (if needed)
• stabilise blood sugar and energy levels
• reduce binge–restrict cycles
• reduce anxiety around “what” and “how much” to eat
• support your brain to think more clearly

The meal plan is not permanent. As your body and brain recover, you will gradually move towards more flexibility.

Can my appointments be over teams/online?

Sometimes, yes. We may offer online (virtual) appointments depending on your clinical needs.  We will look at what is required in treatment and tailor care to meet your wishes where possible.  We will need to looks at whether physical health monitoring is required and the risk level of not seeing you face to face.  Sometimes we will offer both a variation of face-to-face appointments and virtual appointments so that we are still able to review physical health needs and risk but also work with what works best for you and your family.

Your care team will discuss with you what is clinically safe and most helpful.

Reliable resources and websites for families

Beat ED: the UK’s leading eating disorder charity. Offers

• helplines, webchat, and email support
• parent and carer guides
• online support groups
• help finder directory for local services
• printable resources and awareness materials

Visit the Eating disorder support hub for families and friends (formerly POD)

First Steps ED: A charity offering support for individuals and families, including:

• 1 to 1 support
• Carer workshops
• Online resources
• Peer support

Visit the First Steps ED website

Anorexia and other eating disorders: How to help your child eat well and be well by Eva Musby: A compassionate, practical guide written by a parent.
Covers meal support, communication, managing distress, and staying steady during crises. Very accessible and widely recommended by clinicians.

Skills‑based caring for a loved one with an eating disorder by Janet Treasure, Grainne Smith and Anna Crane: Offers communication tools, motivational strategies, and ways to reduce conflict and shame.