Eating Disorders Awareness Week 2023 – Food for thought
2 March 2023
DPhil Health behaviours
28 of February to 5 of March is Eating Disorders Awareness week. Elena Tsompanaki, a registered dietitian and DPhil student in Primary Care in the Health Behaviours team explains why awareness is important in eating disorders.
“Eating Disorders” is an umbrella term to describe a range of mental illnesses affecting one’s relationship with eating and their body image. Diagnosis of an eating disorder is done using the relevant criteria of the Diagnostic and Statistical Manual of Mental Disorders (DSM) (https://www.psychiatry.org/psychiatrists/practice/dsm), and it has to be done by a specialist following a structured interview with the person suspected to have an eating disorder.
Symptoms displayed by a person with an eating disorder involve limiting the amount of food eaten or eating large portions of food all at once and/or compensatory behaviours like using laxatives, inducing vomiting, or excessive exercise. Risk factors in developing an eating disorder include biological, psychological, and sociocultural issues. People often develop eating disorders in response to trauma and/or bullying as a result of body image dissatisfaction, behavioural inflexibility, or genetic reasons. Often, food is just the tip of the iceberg.
Some healthcare professionals and members of the public believe that eating disorders stereotypically affect mostly teenage girls. However, it’s important to note that they affect people of all ages, genders, ethnicities, and sociodemographic backgrounds. One of the most common misconceptions around eating disorders is that people with an eating disorder are very thin. This could be true for some people with anorexia nervosa, but eating disorders equally affect people with weight within the normal range for body mass index (BMI) and certainly people living in larger bodies.
Weight stigma is even present in the eating disorder services available; people are heavily prioritised on the basis of their BMI. This is of course reasonable for someone who has a very low weight, as this may lead to serious complications, but the actual weight is only a snapshot of the severity of the disease. It is always important to consider the behaviours one is utilising to reduce their body weight, how risky they are for health (e.g., using excessive amounts of laxatives or other medication to burn calories), what is the trend and rate of weight loss, if any, as the clinical impairment the person is experiencing due to the eating disorder.
Unfortunately, there is not much room for that in the utterly overwhelmed eating disorder services in England, especially post Covid-19.
It is not only clinical care that is affected; research in eating disorders is notoriously underfunded. An enquiry into eating disorder research funding in the UK compiled by BEAT (https://beat.contentfiles.net/media/documents/APPG_Research_Funding_inquiry_report.pdf ), the leading eating disorders charity in the UK, found that only 1% of UK mental health research funding went to eating disorders. This is disproportionate to the people affected by eating disorders, which is around 9% of people living with a mental health condition. This is further contributing to the notion that eating disorders are rare or even “self-inflicted” conditions.
Clinically diagnosed eating disorders are one side of a wide spectrum of eating behaviours; there is also sub-clinical disorder eating, which is not considered “clinically enough” for a diagnosis but is important to be aware of, as it can eventually progress to a clinical eating disorder that could significantly impair the person experiencing it.
In the case of people living with overweight/obesity where disordered eating is behind an attempt to achieve a healthier weight, things can get more complicated. What should be prioritised? Losing weight or improving one’s relationship with their eating and body? Some people find it helpful to focus on improving their relationship with food, no matter the weight, whereas others want to work on both simultaneously. Some people choose to work on their mental health, which then could result to improvement in eating behaviours and often weight loss. But to choose a plan of action, one needs to be aware that their relationship with food is sub-optimal. However, when thin bodies are glorified and larger bodies experience bullying and are accused of laziness and gluttony disguised as health concerns, anything except for losing weight feels absurd.
In recent years, there is a field in research where obesity and disordered eating meet; and this is the field I am interested in.
It still feels a little niche, since most researchers are either only interested in obesity research while others only in the management of eating disorders. But, as with disordered eating, this is also an interesting spectrum. Some healthcare professionals working in eating disorders consider dieting as the source of all evil, whereas some researchers in obesity keep busy thinking which type of weight loss programme is the most effective in helping people with obesity lose weight for good.
My opinion is that we need probably something somewhere in the middle. But it’s not for me to decide! As a researcher, my priority is to produce good quality evidence on whether we can offer people with disordered eating certain rigid weight management programmes safely. As a clinician, my priority is to use this evidence to help a patient make an informed decision about their health, whether that is choosing to work on their mental health and ditch dieting, or that is choosing to lose weight as a means to improve their mental health. But either way, it all starts with awareness of the problem.
Tips for healthcare professionals working in primary care:
- Eating disorders affect people of all ages, genders, ethnicities, backgrounds and body sizes.
- An easy way to screen for eating disorders in the community is the SCOFF questionnaire (turn into link https://www.psychtools.info/scoff/)
- Further resources and information on eating disorders can be found at the BEAT charity webpage (https://www.beateatingdisorders.org.uk/)