Eating Disorders

John Howell Excerpts

Tuesday 16th October 2018 Westminster Hall

[Wera Hobhouse]

Across the board, and particularly when it comes to public health, prevention is so much better than picking up the pieces afterwards. We can save so much money if we do something early rather than only intervening when somebody is already in crisis. That is particularly true for mental health, and the challenge here is that eating disorders are still not very well understood.

[John Howell (Henley) (Con)]

I have a personal interest in this subject. A close member of my family suffered from bulimia. What we found most important was the support provided by the family network. That, above anything else that could be provided, was what carried the family member through to a positive conclusion.

[Wera Hobhouse]

Anybody who has had a close family member in such a situation will understand the hon. Gentleman’s point, but families are often pretty helpless too, if they do not really understand what can be done and how they can help their family member to get out of the problem. It is a form of addiction, and like with any other addiction, family members are co-sufferers. They want to help but do not really understand the deep-seated problems. Family members are important, but we need the professionals and their understanding to help families get through together. The hon. Gentleman is absolutely right that families are incredibly important.

Eating disorders define large periods of people’s lives. How can we shorten that time? We need people to be okay with saying, “I’m not okay.” We need to tackle the stigma around eating disorders, and the message needs to get through to a lot of people. More than 1 million people in the UK have an eating disorder; three quarters are women and one quarter are men. That is a very large number, plus there are the friends and family who suffer with them. So many people with conditions such as anorexia and bulimia blame themselves. It is not their fault and we need to make sure that they know that.

When I announced on Twitter that I was holding this debate, I received a wave of emotional responses and personal stories. Yesterday, a local doctor dropped into my office a book that she had written, which described her fight with eating disorders since the age of 13. That shows how early it can start.

I also got an email from a young woman called Lorna, who experienced serious anorexia while studying in my constituency in Bath. This is what she told me:

“I ended up with an initial diagnosis of anxiety and depression, and was started on antidepressants. I suspended my studies and worked as a carer in my local village, living at home with my mum and brother. People I’d known all my life began commenting on the weight I’d lost, and telling me how good I looked. This is when my anorexia began to take full hold.

I stopped eating completely, lying to my mum and saying I’d eaten at work, began over-exercising compulsively, and remember pacing the corridors at work to burn extra calories. I became obsessed. I weighed myself up to 12 times a day.

My mum was terrified, and didn’t know what to do. Eventually she came with me to my GP and I told him everything. I told him I was petrified of putting on weight, exercising excessively and skipping nearly every meal. His response was ‘Oh, that’ll be your antidepressants.’ He took me off a high dose, there and then. Cold turkey.

Each time...I told him how out of control I felt with my eating. He’d force me onto the scales, shaking and crying, and then tell me my BMI was ‘healthy’ and I didn’t meet the diagnostic criteria. I was devastated. I had opened up and was denied help. I never got diagnosed with anorexia, despite going from a size 16 to a size 8 in less than a year.

I went through the monthly humiliation of being dragged onto scales and told I wasn’t thin enough to be helped yet. And not having that formal diagnosis is hard. When I tell people I was anorexic, they never quite believe me, as even doctors didn’t. I think they always assume I was being dramatic, or ‘it wasn’t that bad then’. Today, I am weight-restored, although struggle with now being overweight.

It took me 3 years to recover. 3 years of misery and obsession. I was dangerously unwell, but not sick enough to get an ounce of support.”

When I read that story, I am amazed by how brave Lorna is. She was brave to ask for treatment and even braver to put her trust into the medical system a second time, even after she did not receive the treatment that she really needed. She was very brave to tell her story. Lorna has gone on to campaign for proper treatment for eating disorders. She is here in the Chamber, and I want to thank her personally for letting me share her story—Lorna, thank you. I am so sorry that you had to go through such an awful experience. I know your words will help others, and I desperately hope that together we can improve the treatment and care of those with eating disorders and end the stigma for good.

We cannot ignore the medical failings in Lorna’s story. We need to use them and the figures that prove that Lorna’s experience is not an isolated case. First, we need to break the stereotype that all people with eating disorders are underweight. Hope Virgo’s campaign to “Dump the Scales” was also a response to being told that she was not thin enough to receive support. She is calling on the Government properly to implement the eating disorder guidance delivered by clinicians, a call that I strongly echo along with over 60,000 signatories to her petition. To judge an eating disorder simply by BMI is not good enough; rather, we need to look at the trend and rapidity of weight loss and the story that sufferers tell.

We know that the Department of Health and Social Care knows this is an issue. We know that if we fail to take action, people not only suffer but, in some cases, lose their lives. When questioned on waiting times, the Minister often says that the Government do have targets, but he ignores the fact—or he does not tell us—that there is none for adult services. On average, adults wait twice as long as people under the age of 19. The Government must do everything to remove barriers to treatment. In particular, young adults are incredibly vulnerable. At our autumn conference, the Lib Dems called for the Government to ensure that all young people can access young people’s mental health services up to the age of 25, because from the age of 18 many young adults move out of home, go into further education or start their first job, all of which can be stressful when they no longer have support from home. We must also introduce waiting times for adults to ensure that they receive help as quickly as possible.

The Minister is likely to mention that in 2015 the Government allocated £30 million of extra resources per year for five years to improve the NHS treatment of eating disorders for teenagers. However, in some cases that is not reaching the frontline, because the funding is not ring-fenced and can be diverted to other priorities.

--- Later in debate ---

[Matt Warman (Boston and Skegness) (Con)]

I thank you, Sir Roger, and congratulate the hon. Member for Bath (Wera Hobhouse) on securing this important debate. She began, rightly, by saying that eating disorders are about so much more than stigma. It is right that we focus on treatment, because eating disorders—as all of us in the room know—are conditions that are often dismissed initially as girls trying to look like celebrities. They often end with a third of sufferers recovering, but a third of sufferers live with them for the rest of their lives and a third do not make it at all. Those figures are truly shocking and would be shocking for any condition, whether mental or physical.

The stigma arising from eating disorders is not solely about looking slim. It is about the pervasive effect of that eating disorder. It is a condition that quickly stops people being able to function in the way that they would wish to function. It a condition that stops people leaving the house. People end up being stigmatised because they are not behaving as they would like to, not able to fulfil a function within society and, often, not even able to work or go out. The stigma arises because of the condition, and it is the condition on which, clearly, we should focus.

I commend the work that charities such as Beat have done to raise awareness of eating disorders and to ensure that people are not stigmatised; that GPs in particular do not greet people who show up suggesting that they are worried about their attitude to food by saying that it is not a problem and that they might just allow themselves to go away and get better. We need to focus on NHS training but also to acknowledge, as my hon. Friend the Member for Angus (Kirstene Hair) did, that there has been some progress in England, if not sufficient in Scotland yet. However, this is not a party political matter.

We have seen not only some positive work by the NHS and charities, but some of the damaging effects of social media, as the hon. Member for Strangford (Jim Shannon) said. Social media presents a huge opportunity to promote the positive body image that we would all like to see of what being healthy in the 21st century looks like. In reality, at this stage on this front social media does far more harm than good. It is far too easy to scratch the surface of the internet to find images that reinforce deeply negative perceptions of body image, reinforcing behaviours that are profoundly harmful. If social media companies can do a huge amount to take down child abuse images and other images that we as a society decide are profoundly harmful, it is reasonable to ask what more could be done automatically or more rapidly to take down images that all too often end up with people losing or taking their own life.

[John Howell]

My hon. Friend is making a powerful point about social media, but perhaps he needs to go one stage further, to look at the role of the advertising industry and the images that it puts forward, which encourage young people to achieve a fantasy position for themselves and their body image.

[Matt Warman]

I absolutely agree with my hon. Friend and, in fact, that was the point that I was coming on to make next. Clearly, not only do some sites encourage profoundly self-harming behaviour, but the advertising industry puts forward exactly that pervasive image to which he referred. We should look to regulators and Government for action to tackle that in a sensible way that promotes a genuinely healthy lifestyle without promoting unhealthy or unreasonable expectations, but we should not pretend that it is anything other than very difficult. Tackling such issues should not bleed over into not being positive about people who struggle with their weight, who would often like to see a more positive image of people who are larger. None of us wants to see an advertising regulator that ends up prescribing an ideal weight, although we need to prescribe a greater sense of health.

I agree absolutely with what the hon. Member for Bath said about no sensible and properly trained doctor in the modern NHS using BMI alone to assess whether a person has an eating disorder. However, too often it does become the single defining characteristic. Too many doctors have not been provided with all the tools and do not have the services to which they might refer their patients. Too often BMI becomes the measurement of last resort, and it is right for the NHS to seek to tackle that and for this House to do all we can to encourage the Minister and the NHS itself.

The hon. Lady mentioned family therapy. My understanding is that family therapy, in particular for young people and adolescents, is the only clinically proven therapy. It has been shown to make a real difference. It is incredibly intensive in resources and in the pressure on the family and patient, but it works. We should do more to reduce the stigma—to come back to the point of the debate—so that families accept that they might have someone in their midst who needs help not just from the NHS but from them—their family and friends.

As the hon. Lady said, however, it remains the case that eating disorders do not stop when someone is 17 or 18. In all too many cases, triggered by stress, they can emerge or return when a patient gets older. With that in mind, we should commend the work of places such as the Maudsley, which have tried to push family therapy beyond the point where everyone is expected to live at home and to say, for example, that the university setting could be a kind of family that encourages people to get better. What happens when people are older? As I said at the start of my speech, there are of course a number of functioning older adults who need all the help with which we can provide them, and that is about more than antidepressants.

If the Government could do two things, the first would be to encourage social media companies to look more closely at what can be done to tackle those images that go beyond the kind of advertising that my hon. Friend the Member for Henley (John Howell) said we need to look at and go way into a territory that is not healthy for anyone. My second ask, when it comes to funding research and spending some of that £1.4 billion that we are allocating to eating disorders over the coming years, is for the extension of family therapy—the one method that we know works. With the help of science and innovation, we should be looking at whether we can go further with that therapy. The stigma around the condition is a hugely important issue, but we must focus on tackling the illness itself.