Quality statement 3: First-line psychological treatment for binge eating disorder

Quality statement

People with binge eating disorder participate in a guided self-help programme as first-line psychological treatment.

Rationale

Guided self-help programmes for adults, young people and children with binge eating disorder can improve recovery rates and reduce binge eating frequency. They can also have a long-term impact on physical and psychological health. If guided self-help is unacceptable, contraindicated, or ineffective after 4 weeks, group eating-disorder-focused cognitive behavioural therapy (CBT-ED) can be provided as part of a stepped care approach.

Quality measures

Structure

Evidence of local arrangements to provide a guided self-help programme as first-line psychological treatment for people with binge eating disorder.

Data source: Local data collection, for example, service specifications.

Process

Proportion of people with binge eating disorder who participate in a guided self-help programme as first-line psychological treatment.

Numerator – the number in the denominator who participate in a guided self-help programme as first-line psychological treatment.

Denominator – the number of people diagnosed with binge eating disorder.

Data source: Local data collection, for example, local audit of electronic records. 

Outcomes

a) Binge eating frequency for people with binge eating disorder.

Data source: Local data collection, for example, using the eating disorder examination questionnaire (EDE-Q 6.0).

b) Rate of relapse for people with binge eating disorder.

Data source: Local data collection, for example, using the eating disorder examination questionnaire (EDE-Q 6.0).

What the quality statement means for different audiences

Service providers (such as community providers, primary, secondary and tertiary care and non-NHS units) ensure that they have teams in place to deliver a guided self-help programme as a first-line psychological treatment for people with binge eating disorder, and to monitor the response to treatment. They should also ensure that healthcare professionals have training in delivering these programmes, and have supervision with monitoring of competency.

Healthcare professionals (such as non-specialist support workers) provide support for people using a guided self-help programme for binge eating disorder and monitor the response to treatment. They establish a good therapeutic relationship with the person and, if appropriate, with their family members or carers. They support and encourage the family to help the person to recover by self-monitoring binge eating behaviours and involving them in discussions.

Commissioners (such as clinical commissioning groups, NHS England and local authorities) ensure that they commission services with the capacity and expertise to deliver guided self-help programmes as first-line psychological treatment for people with binge eating disorder, and to monitor treatment response.

People with binge eating disorder take part in self-help programmes as the first psychological treatment. This includes working through a book about binge eating and having short sessions with a healthcare professional to look at progress. Usually there are between 4 and 9 sessions that last about 20 minutes each.

Source guidance

Eating disorders: recognition and treatment (2017) NICE guideline NG69, recommendations 1.4.2 and 1.4.8

Definition of terms used in this quality statement

Guided self-help programme for binge eating

A guided self-help programme for binge eating should:

  • use cognitive behavioural self-help materials

  • focus on adherence to the self-help programme

  • supplement the self-help programme with brief supportive sessions (for example, 4 to 9 sessions lasting 20 minutes each over 16 weeks, running weekly at first)

  • focus exclusively on helping the person follow the programme.

[NICE's guideline on eating disorders, recommendation 1.4.3]

Equality and diversity considerations

Self-help materials should be supplied in a format that suits the person's needs and preferences. They should be accessible to people who do not speak or read English, and should be culturally appropriate, age appropriate and gender appropriate. People should have access to an interpreter or advocate if needed.

For people with additional needs related to a disability, impairment or sensory loss, information should be provided as set out in NHS England's Accessible Information Standard.