Health: Anorexia

Countess of Mar Excerpts

Monday 25th February 2013 Lords Chamber

[The Countess of Mar]

My Lords, I, too, am grateful to the noble Lord, Lord Giddens, for introducing this topic for debate tonight. The simple definition of anorexia is a “lack or loss of appetite for food”. Too often, we hear of awful cases of anorexia nervosa. I will leave the discussion on that and on bulimia nervosa to other noble Lords. The noble Lord, Lord Alderdice, has given us a very good grounding in them.

Numerous medical conditions give rise to the loss or lack of appetite for food. I think immediately of the many people with CFS/ME who are too exhausted to chew and swallow food and must be tube fed, either nasally or by a tube connected directly to their stomach. I think, too, of young girls who have had a bad reaction to the human papilloma virus—HPV—vaccine and who suffer fatigue, feverishness and an acute loss of appetite, with the accompanying weight loss. Some other conditions, including viral infections, hormonal imbalances, neurodegenerative diseases and brain tumours, have in their initial stages been labelled as CFS/ME because they present with the extreme fatigue, pain, digestive problems and other symptoms associated with that condition.

From the reports that I have had, there are many people with genuine intolerances to foods and drugs whose symptoms are profound after eating. The symptoms, which may be diverse, are a reflection of a disturbance of the autonomic nervous system and may include nausea, vomiting, bloating, abdominal distension and diarrhoea. Because they occur after meals, these people try to ascertain which foods cause their problems and they assume a restricted diet. This can occur after, for example, gastro-intestinal infection or HPV vaccination. These people, instead of being respected, as all patients should for their observations of themselves, often find themselves castigated. They are wrongly diagnosed as being anorexic, forced into psychiatric facilities and made to eat those foods that they know have provoked their symptoms. Historically, the same fate befell people with coeliac disease until the 1940s, when researchers realised that their symptoms of diarrhoea and malabsorption were caused by wheat, which was accepted by the medical profession. Interestingly, during the war, they were given bananas instead of bread.

I am particularly concerned that young people, mostly girls, are wrongly being diagnosed with anorexia nervosa. Too frequently, their parents are accused of causing their child’s illness and care proceedings are initiated. Several youngsters have been obliged by social services to be confined in mental health units and are subjected to harsh “treatment” before their medical consultants realise that they do not have the condition. In other cases, the young person is blamed for failing to co-operate and not wanting to get well. I am sure that their prognosis would be much better if they were treated with more compassion.

The mother of one young girl wrote:

“After the HPV vaccine she lost three stones in three months. When admitted to hospital the professionals’ first concern was that she was anorexic or bulimic. I even tried to say that she normally loves her food and she actually eats more than normal. Before vaccination her attitude to food was positive. (Her worst nightmare was someone stealing the fridge). Whilst in hospital she was shadowed by a nurse 24 hours a day for seven days to check if she was really eating or making herself sick. The final conclusion was that she doesn’t suffer either from anorexia or bulimia”.

This child and her mother have now been abandoned to the nightmare of CFS/ME. She continued:

“After this diagnosis was made we were pretty much left on our own as there is no ME specialist covering our locality”.

Another mother wrote:

“After … vaccination and since becoming unwell her appetite has fluctuated massively. Some days she eats very little, other days she eats constantly. She suffers constant nausea and vomiting and has to eat what she feels will keep down, which isn’t the healthy choices she would have made. Eating disorders have been mentioned because she often vomits after eating but that is far from the truth. She still has a healthy attitude to food but her body is too broken to make it possible for her always to eat healthily”.

Another mother whose daughter suffered badly from CFS/ME wrote:

“She did not have the energy to eat food and sadly did not get the help she required. So when food is not eaten they assume she does not want to eat. They do not face the reality that she has not got the energy to eat. Therefore they put her into a psychiatric unit for eating disorders”.

I know that this young lady was discharged several months after being admitted in a worse condition than before she was admitted.

I cannot stress enough the importance of getting the diagnosis right, of listening carefully to the patient, of taking a proper history, and of ensuring that the right treatment is given early. Young lives can be ruined, family relationships destroyed and huge amounts of taxpayers’ money wasted when this is not done. I ask the noble Lord the Minister what measures are in place to ensure that these awful histories that I have been hearing for years are no longer repeated.