Watching someone you love struggle with an eating disorder is one of the most painful and bewildering experiences a family can go through. You may find yourself walking on eggshells, second-guessing every word, and feeling utterly helpless as the person in front of you seems to slip further away. When the situation begins to feel out of control — when meals become battlegrounds, when you notice the physical changes, when fear keeps you awake at night — it is natural to wonder whether what you are doing is enough.
You are not alone in that feeling. And you are right to ask questions, because recognising the moment when professional, hospital-level care becomes necessary can quite literally save a life.
The shared starting point: outpatient care first, hospital when necessary
Both French and British guidelines emphasise that the recommended first approach is to manage anorexia nervosa in an outpatient setting, except in cases of physical or psychiatric emergency. Hospital admission is not a punishment or a last resort — it is a specific medical tool for specific situations. The decision to admit is never based on a single criterion alone, but on the combination of factors and how they are evolving over time.
The French HAS criteria: three families of risk
The Haute Autorité de Santé published its reference guidelines on anorexia nervosa in partnership with the AFDAS-TCA (the national association for eating disorder). These criteria fall into three broad categories: physical (somatic), psychiatric, and environmental — and they apply differently depending on whether the patient is a child/adolescent or an adult.
Physical warning signs include : rapid, significant weight loss, low blood sugar (hypoglycaemia), signs of kidney strain, dangerous body temperature (hypothermia or hyperthermia), very low blood pressure, an abnormally slow heart rate, or severe electrolyte disturbances such as low potassium. A very low BMI is often the first criterion considered, but it is far from the only one. Needing to be fed by a nasogastric tube is another one.
Psychiatric warning signs include a serious and immediate suicide risk — including a recent attempt, a clear plan, or repeated self-harm. Anorexia nervosa carries one of the highest mortality rates of any psychiatric illness. Other psychiatric factors include severe anxiety, substance abuse, or compulsive excessive exercise.
Environmental warning signs include situations where the family or carers are unable to provide adequate support at home, where the home environment itself contributes to the illness, or where previous outpatient treatment has clearly failed. The HAS stresses that these contextual factors matter: a patient living alone, or in a highly stressful environment, may need hospitalisation even if their physical indicators are not yet extreme.
The British guidelines: NICE and MEED
In the United Kingdom, two key documents guide clinical decisions. The NICE guideline on eating disorders (NG69, most recently reviewed in 2024–2025) and the Medical Emergencies in Eating Disorders guidance (MEED), published in 2022 by the Royal College of Psychiatrists, which replaced the older MARSIPAN guidelines.
NICE is explicit that clinicians should not use a single measure such as BMI or duration of illness to determine whether to offer treatment, and should not use an absolute weight or BMI threshold when deciding whether to admit someone to inpatient care. This is a crucial point for families to know: your loved one does not have to reach a certain number on the scales before they are entitled to hospital-level care.
Inpatient admission is recommended when someone's physical health is severely compromised and medical stabilisation or refeeding cannot safely happen in an outpatient setting. Specific factors include the rate of weight loss (for example, more than 1 kg per week), the need to actively monitor heart rhythm (such as a very slow heart rate below 40 beats per minute), blood tests, and other physical parameters that are in a concerning range.
Whether parents or carers of children and young people can support them and keep them from significant harm under day-patient care is also explicitly taken into account.
The MEED guidance introduced a traffic-light risk framework — green, amber and red — designed to help clinicians assess impending risk to life across physical, nutritional, and psychiatric dimensions. This framework covers 11 risk areas and includes specific adjustments for age and gender when applied to children and young people. Red means hospitalisation is urgent; amber signals serious concern requiring close monitoring and likely escalation.
What this means for families
Doctors on both sides of the Channel are guided by the same underlying principle: act before the crisis becomes irreversible. If you are worried that your loved one is deteriorating — physically or mentally — you do not need to wait until they collapse. You can ask their GP or treating clinician to formally assess whether hospitalisation criteria are met.
Keep a record of what you observe at home: weight changes, physical symptoms, mood, eating behaviour, sleep, exercise. This information helps clinicians make better decisions, especially since patients with anorexia often minimise or conceal how unwell they feel.
Most importantly, know that seeking hospital care is an act of love, not defeat. The guidelines exist precisely to ensure that people get the right level of care at the right moment — and families who understand them are better placed to make that happen.
Sources: Haute Autorité de Santé (HAS), Anorexie mentale : prise en charge (2010, reference guidelines); NICE Guideline NG69, Eating Disorders: Recognition and Treatment (2017, updated 2024–2025); Royal College of Psychiatrists, Medical Emergencies in Eating Disorders (MEED), CR233 (2022).
