Eating Disorders: Provision of Care

Lord Giddens Excerpts

Tuesday 4th February 2020 Lords Chamber

[Lord Giddens (Lab)]

My Lords, I congratulate the noble Baroness, Lady Parminter, on having secured this debate and introducing it so ably.

I start, somewhat improbably, in China—a part of the world currently in the news for reasons other than what I want to talk about. Only some four decades ago, 40 million people starved to death in the country during Mao’s rule; far greater numbers suffered from pronounced malnutrition. Switch to the present and things look very different indeed. Some 800 million people have been brought out of poverty over that period. Huge urban centres—several far larger than London—have emerged where there was once barren countryside.

I do not know whether noble Lords saw the TV programme on Shenzhen the other night. It was amazing—40 years ago nothing was there but green fields and a river; now, it is a massive high-tech centre, outstripping Silicon Valley. As noble Lords will learn in a moment, I am not in the wrong debate. Nothing like this has ever been accomplished before. Yet not all such change is positive. Some 30% of the population in China today—300 million people—are overweight or obese. An estimated 50 million still suffer from food deprivation, but now as a result of anorexia. A whole spectrum of online “vomit bars” has sprung up in which people encourage each other to vomit after eating.

As China goes, so goes much of the rest the globe. The number of people either overweight or obese in the world now surpasses those who live at near-starvation levels—an amazing, but not wholly positive, turnaround. What a reversal of history this is, and, totally unlike in the past, the vast majority of obese people are not the rich but those in lower income groups. The poor used to be the ones who were undernourished or starved to death. Today, in complete contrast to starvation in the past, anorexia across the world is mostly a pathology of the more affluent.

All this may seem a bit remote from the Question posed by the noble Baroness, Lady Parminter, and indeed from the UK. However, I see it as an essential backdrop. It shows the sheer scale of the issues involved, based on a sort of global reversal of traditional diets and eating habits. It was good to see Health Secretary Matt Hancock taking a similarly macroscopic view in a speech to a recent conference on eating disorders.

The term “eating disorder” is usually reserved for those suffering from anorexia and/or bulimia. Yet the only genetic factor involved in these conditions is dispositional, not causative, which is exactly the same in the case of obesity. The health implications are far-reaching indeed. Two-thirds of adults in the UK are classified as overweight or obese, with a full third in the second of these categories. Anorexia and obesity used to be thought of as two distinct populations; to some degree this is true, since the former is more often linked to high levels of distress and malfunction. However, the incidence of anorexia is much lower. Recent research indicates that those at the more extreme levels of obesity show comparable levels of anxiety, stress and depression to those with anorexia, particularly in the case of female sufferers.

I welcome the Government’s initiatives for raising consciousness in schools about eating disorders and their parallel reforms to provide early treatment within the NHS. More than one report in the Commons has warned about the serious lack of training on eating disorders for doctors. Just as important is ensuring that GPs are up to date with the most recent research in a field that has a strong medical pathology yet is closely embedded in lifestyle.

Since the Minister has strong Oxford connections—and speaking as an academic myself—I should like to ask her views on the avant-garde research into anorectic disorders being carried out by the Department of Psychiatry at Oxford University. The interest of this work is the attempt to link the biological, emotional and somatic processes involved in anorexia. There is a shortage of evidence-based treatments for anorexia and eating disorders more generally. The Oxford Centre for Human Brain Activity—a really interesting research organisation—is working together with psychiatrists and social scientists on this.

We need further long-term studies of eating disorders, in the wide sense in which I am using the term. A study carried out at Harvard University showed that fewer than half of adults in the US achieve recovery from anorexia or bulimia nervosa over the long term. It is good to see that this research explores the links between those apparent opposites—anorexia and obesity—which I am saying are part of a connected syndrome. The common link is a compulsive relationship to food coupled with distorted but powerful body imagery. Some of the underlying neural mechanisms seem to be the same. One piece of research in the US describes anorexia and obesity as—going back to Chinese—the yin and yang of bodily weight control.

“Go on a diet!” That is the common-sense response to obesity. However, both anorexia and obesity stem from the fact that we live in a world where we are all on a diet. For the first time in history, an almost endless array of foods is available on a daily basis. Every day, consciously or not, we have to decide what to eat in relation to how to be. Even noble Lords have to take these decisions since there are so many cafés on site here; I never quite know which one to go to at a particular time.

I have a couple of questions for the Minister in concluding, as one is supposed to. First, what procedures have the Government established to track and assimilate cutting-edge research on the diagnosis and treatment of eating disorders? By that I mean international research, not simply research in this country; as I am trying to stress, this is an amazing global reversal in human beings’ relationship to food and the body, so the research needs to be transnational. Secondly, and in conclusion, will the UK follow the lead of other countries in recognising the need to explore the aetiological parallels between anorexia and obesity?