If you have concerns about a possible eating disorder you are not alone. A BBC report recently identified that hospital admissions for eating disorders have risen 37% across all age groups over the last two years. Alarming as this figure is, it does not identify the underlying cause of the increasing admission rates. The one thing we do know for certain is receiving early diagnosis will significantly improve the speed of recovery and reduce the need for hospital admissions. In this article, we outline what you can do if you are concerned about whether you have a potential eating disorder and how to seek help.
Has the uncertainty around this pandemic led to an increase in eating disorders?
Whilst specific research correlating Covid-19 and eating disorder incidence is limited, we have certainly seen a rise in demand for eating disorder treatment in 2020. Eating disorder charity, BEAT, saw a 73% rise in enquiries during this period.
The pandemic has also stopped many aspects of an individual’s psychosocial wellbeing. Often having a structure, healthy social life and plenty of extracurricular hobbies helped improve their wellbeing and acted as an important coping mechanism for anyone recovering with an eating disorder. Unfortunately, many of these positive influences were removed during COVID-19 restrictions resulting in individuals feeling more anxious, isolated and unable to manage.
Common eating disorders are known as anorexia, bulimia, avoidant/restrictive food intake disorder (ARFID), binge Eating Disorder, and other specified feeding or eating disorder (OSFED) There are also many other types such as T1ED (diabulimia) which your mental health professional would assess and diagnose accordingly.
How do I know if I have an eating disorder?
As we have seen there are many different types of eating disorders. Having an eating disorder is a complex and severe mental illness. If you have an eating disorder you use disordered eating behaviours as a way to cope with difficult situations or feelings. Often this type of behaviour can include limiting the amount of food eaten, eating very large quantities of food at once, getting rid of the food eaten through unhealthy means (e.g., making themselves sick, misusing laxatives, fasting, or excessive exercise), or a combination of these behaviours.
The first step to identify a potential diagnosis for an eating disorder using this NHS SCOFF eating questionnaire
Please note, if this questionnaire comes back inconclusive and you still believe you have a problem it would be advisable to seek out a specialist eating disorder professional. Often, it is worth seeking both mental health support and nutritional support to ensure you meet your nutritional needs and address the unhealthy patterns you may be experiencing.
The questionnaire identified a possible eating disorder, what should I do?
It is widely recognised that the sooner you seek treatment the better the outcome. The first point of call will be to go to your local GP. If you feel uncomfortable talking about your eating disorder BEAT has created lots of helpful resources to hand to your GP. Depending on the outcome of your appointment you would then be referred to your local NHS eating disorder service.
How do I find my local eating disorder service?
Your GP will usually refer you, but you can find your local eating disorder support by visiting your local NHS website.
I have been referred but there is a long waiting list, what should I do?
Unfortunately, in some areas, the NHS services have become overwhelmed with demand and often you may be unsure of where to turn to for advice. To find private support BEAT has a help finder section.
What professional should I choose?
The next step is to ensure that you see the right professional for your current situation. There are many professionals out there and you need to ensure that you find a qualified provider.
The best advice is to seek support early but also find the right support for your needs and your situation. Often due to longer than average waiting lists, it may be that private support is needed in the interim until the NHS services become available. However, if you do choose a private professional make sure they are clinically trained. If you are seeking private eating disorder support, it is wise to ensure you receive the right care for your circumstances. You should expect a level of professional medical screening before commencing any eating disorder therapy.
Often qualified nutrition professionals will assess your BMI or weight for height, your risk of refeeding and your current medical status. If you are clinically at-risk you will need to be supported by a wider health team who can monitor your blood pressure, blood tests and further routine medical tests.
What weight would I be considered high risk?
It depends on your age. If you are a child or teenager, you are assessed using your weight for height which is determined based on a calculation based on the average you would expect for your age. If this ratio is below 80% then you are deemed higher risk.
In adults generally, a BMI lower than 17.5kg/m2 indicates low body weight and high-risk groups would be < 16 kg/m2. Risk profiling is not just based on weight and you will need medical screening by your GP to determine other risk factors.
Meal plans
Meal plans should be given by eating disorder dietitians or registered nutritionists with clinical training only. Before you commence any form of meal plan or recovery plan your professional will need to ensure it is safe to do so. If you haven’t eaten for 3-4 days or have significantly lost a lot of weight you need to be assessed by a clinical professional for refeeding syndrome risk. If you are safe to commence it is important to follow a plan with a supervised eating disorder professional. Your nutrition professional will review and ensure you are meeting your nutritional needs and the reintroduction of a meal plan has structure and ensures any weight gain is at a safe and managed level.
How can my family support me?
Often it is a very difficult time to witness a family member experience an eating disorder and often family members can feel overwhelmed with how to support them. Family-based therapy has shown to be effective. The advice can be given to help develop an appropriate support structure to use to help your loved one through things. Often, sometimes it can feel that what you may be doing to help may actually be counterintuitive to their eating disordered thoughts. Focusing on eating big meals or the calories in food can also not be helpful. Language plays an integral role and often having a therapist can really help both the individuals and the family learn new coping techniques.
Lastly, please remember to seek support and advice early on. Choose the best and qualified professional based on your situation. All experts should screen and risk profile you before starting treatment, if this doesn’t occur please take that as a red flag for the care you may receive.
Charlotte Turner RNutr founded the Health Nutritionist and runs a Nutrition and psychology clinic alongside her MDT team. If you are looking for support and would like to know how we can help you through your eating disorder please contact us in the first instance for advice. We also have additional support on eating disorders on our eating disorder page.
Additional Helpful resources:
BEAT is the UK's leading charity supporting those affected by eating disorders and campaigning on their behalf. They have chatrooms, downloadable resources and a help finder to find support in your area.
BEAT also have an eating disorder and coronavirus a support hub for advice during this unsettling time.
Young Minds is the UK’s leading charity committed to improving the emotional wellbeing and mental health of children and young people. Driven by their experiences, their campaign, research and influence policy and practice.
The MindEd website is a free e-learning resource designed to help adults to identify and understand children and young people with mental health issues.
The Royal College of Psychiatrists aims to improve the outcomes of people with mental illness, and the mental health of individuals, their families and communities.