Clare Steedman explains why new evidence-based guidance could bring greater clarity, confidence and equity to occupational therapy practice in eating disorder care.

For occupational therapists working in eating disorder services, there has long been a fundamental gap: no UK-wide evidence-based guidance setting out what occupational therapy should look like across assessment, intervention and evaluation. Clare Steedman and her colleagues are seeking to change that.

Clare and Abigail Cardwell co-lead the Royal College of Occupational Therapists specialist interest group for eating disorders. Through the group’s quarterly meetings, they work with occupational therapists working with adults, children and young people across the UK. A repeated concern emerged, particularly among students and clinicians new to the field: there was no clear reference point explaining the role of an occupational therapist in eating disorder care or what people using services should be able to expect.

The group responded by making the development of guidance a shared priority. Over around 18 months, members researched different stages of the occupational therapy process, reviewed the available evidence and brought their findings together into one document. The result, which Clare will discuss at The Occupational Therapy Show, is intended to provide a common foundation for practice while leaving room for professional judgement and person-centred adaptation.

For Clare, consistency is not simply a professional concern. It is also a question of equity. Without shared guidance, a person’s experience of occupational therapy may vary considerably depending on where they live or which service they access. A clearer national approach could help people understand the support occupational therapists offer, and encourage a fairer, more consistent service across the country.

A shared approach could also strengthen the evidence base. When services use different models, assessments and outcome measures, it becomes difficult to combine data or demonstrate impact at scale. Greater alignment would make it easier to evaluate outcomes, build research and show decision-makers where occupational therapy adds value. In time, Clare believes that stronger evidence could support professional recognition, service development and the case for more occupational therapy posts.
 

Looking beyond food and eating

Eating disorders can affect almost every part of daily life. Clare sees occupational therapy’s particular strength in connecting a person’s psychological and emotional experiences with what is happening in their everyday occupations. This means considering the effect on self-care, productivity, leisure, relationships, routines and the ability to participate in a meaningful life, as well as the influence of the person’s physical and social environment.

“We can understand what is going on in the mind and body, but also see how it is translating into day-to-day life. Occupational therapy can bring those elements together.”

That perspective makes occupational therapists valuable members of multidisciplinary teams. They can work with the thoughts, emotions and experiences that may drive illness while also addressing their practical consequences. Recovery is therefore not considered only in terms of symptoms, but through a person’s capacity to engage, regain independence and rebuild a life that feels purposeful.
 

A foundation for practice rather than a rigid formula

The process of developing the guidance revealed that clinicians already shared many approaches to intervention. The greatest variation was more often found in the conceptual models, assessments and evaluation methods they used. The guidance is designed to bring greater coherence to these areas.

Clare is clear that this does not mean fitting every person into one inflexible model. The aim is to establish an evidence based starting point from which therapists can use their judgement, adapt to individual needs and draw on occupational therapy’s creativity. A common foundation may be especially helpful to newly qualified practitioners, giving them clearer language and structure as they build confidence in a specialist field.

There will be practical challenges. Some clinicians may prefer other models, while pressure on public services can make comprehensive assessment and evaluation difficult. However, Clare argues that consistent use of recognised approaches is important if the profession is to produce meaningful data and communicate its contribution in terms that health organisations and commissioners understand.
 

The importance of trauma informed practice

Clare also emphasises the importance of understanding the relationship between trauma, eating disorders and everyday occupation. Trauma and eating difficulties can be closely interlinked, and both may affect physical, psychological and social functioning. A trauma informed approach helps practitioners remain alert and sensitive to what may sit beneath behaviours such as restricting food or exercising excessively, rather than considering those behaviours in isolation.

Knowledge and experience enable therapists to notice these nuances and explore them safely with the person. For occupational therapists, the central question remains how those experiences are affecting someone’s ability to participate in daily life. That understanding can inform more effective, compassionate and individually relevant support.
 

Relevant learning for every occupational therapist

Many visitors to The Occupational Therapy Show will not work in a specialist eating disorder service, but they may still encounter people affected by eating disorders in mental health, physical health, community, education or other settings. Clare hopes the session will help all practitioners recognise what occupational therapy can contribute and when specialist input or a referral may be beneficial.

Attendees will leave with an evidence-based picture of the occupational therapy role, together with approaches they may be able to apply within their own scope of practice. Even where they do not use the interventions directly, greater awareness can support earlier recognition, better conversations and more appropriate referrals.

“Even if you do not work in this area, there may be something appropriate and helpful that you can take into your own work. If not, you will be better placed to recognise when someone may benefit from a referral.”

For Clare, that continuing curiosity is part of professional responsibility: developing the knowledge needed to offer people the best possible support. The new guidance gives occupational therapists a much-needed reference point - and an opportunity to build a clearer, more equitable and better evidenced future for the profession’s work in eating disorder care.