Backbench business

Stephen Metcalfe Excerpts

Thursday 14th February 2013 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Osborne. I pay tribute to the Backbench Business Committee for granting this three-hour debate. I know that the Committee had to negotiate with the Liaison Committee so that we could hold the debate during eating disorders awareness week. This debate is therefore timely as well as important. Others in the House clearly agree, as can be seen by the number of hon. Members present. I know how difficult it is to commit to this slot on a Thursday afternoon, particularly when serious issues such as violence against women are being debated in the main Chamber. I am conscious that several Members are trying to perform the parliamentary feat of being in two places at once.

Eating disorders have not been debated in the House since 2007, a considerable time ago, yet over the course of the past few weeks I have become aware of several hon. Members and members of staff with family connections to those with eating disorders. Just this afternoon, I received an e-mail from an hon. Member’s chief of staff, who told me the moving and difficult story of his wife’s experience with an eating disorder. I pay particular tribute to my hon. Friends the Members for Enfield, Southgate (Mr Burrowes), and for Wells (Tessa Munt), and the hon. Member for North Tyneside (Mrs Glindon), who applied with me for this debate and have significant knowledge of and interest in eating disorders.

Some 1.6 million people in this country have been or are currently known to be affected by eating disorders. That is a massive number, equivalent to nearly 2,500 in every parliamentary constituency. However, the number of unknown sufferers is also of significant concern. The true number of those who suffer is not fully understood owing to the paucity of data relating to those who are not in the system. The Department of Health acknowledges that unreported cases of eating disorders are a huge problem, and the true figure could be higher than 4 million, which is 6.5% of the UK population, or about 7,000 people per constituency.

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

Those statistics are staggering. As someone relatively new to the issue, I was not aware that the numbers were quite so large. How many of those people are men, and are there data identifying the proportion of sufferers who are men of whatever age, and the proportion who are young men?

--- Later in debate ---

[Caroline Nokes]

The hon. Gentleman is absolutely bang on. Many parents of sufferers have commented to me that they feel their GPs do not understand enough, and nor do schools and colleges. I will cover all the points that he raised later.

The fastest increase in eating disorders has been among young men. As well as facing the mental health problems typically associated with female sufferers, they are coming under more pressure than ever before to conform to a stereotype of the body beautiful. Imagery in magazines and advertising plays a significant role.

Of particular concern is the prevalence of eating disorders among gay and bisexual men, who are twice as likely to be sufferers as heterosexual men. I understand that eating disorders in gay and bisexual men are even more linked to concerns about body image than in heterosexual male or female sufferers. Although males account for only 11% of the total of those with eating disorders, the percentage is increasing, and we should be conscious of that. In the 10 years up to 2011, the number of hospital admissions for men suffering from an eating disorder rose by 67%. Furthermore, there is evidence that undiagnosed disorders are even more commonplace among men than among women. The scale of the hidden problem could be immense.

It is not only the young who are afflicted, although there is certainly a trend towards eating disorders manifesting at an earlier age than ever before. I was particularly moved by my contact with a woman whose daughter started suffering from anorexia nervosa at 10 years old but was not diagnosed for years, as her GP and other medical practitioners thought that she was too young to have the condition. Eating disorders are also being diagnosed much later; some sufferers present in their 50s and 60s, and there is evidence that increasing numbers of sufferers manage their conditions not just over the average of seven years, but for decades. An increasing number of people in their 30s and 40s have lived with their eating disorder for more than 20 years.

“Eating disorder” is a term used to describe a wide variety of conditions, some well known and others far less so. Obviously, the best known and most recognisable is anorexia nervosa, in which a sufferer intentionally deprives themselves of food and has a body weight at least 15% below the recommended minimum. People with anorexia have an extremely distorted view of their own body and a fear of gaining weight. However, anorexia is but one condition among several. Eating disorders also include bulimia, which in many cases is harder to detect, as sufferers may maintain a normal-looking weight. However, it is achieved through bingeing, purging and fasting, and like anorexia it can cause long-term damage.

From my research for this debate and my conversations with many sufferers of eating disorders, I have learned of many other conditions: binge eating; compulsive overeating; food neophobia, an extreme fear of trying new food; and compulsive over-exercising. A year ago, I met a young man who ran up to 30 miles every day. There is also selective eating: sufferers eat only an extremely limited range of foods.

Bulimia is a disorder linked closely to low self-esteem, emotional problems and stress. The sufferer may think constantly about calories, dieting and ways of getting rid of food that they have eaten. It is actually more common than anorexia, but it is more hidden, because people with bulimia usually maintain an average or just-above-average weight. Bulimia can go unnoticed for a long time while sufferers feel incredibly ill and unhappy.

Those with bulimia become involved in a cycle of eating large amounts of food and making themselves sick, cutting down or starving for a few days, or trying to find other ways to make up for the food that they have eaten. It can cause them to become so hungry that they eat large amounts of food because their bodies crave nourishment. Some people do not vomit, but instead take laxatives, which are especially dangerous. Just because bulimia does not cause the extreme weight loss of anorexia does not mean that it is less serious. Sufferers need help and support, as the side effects and consequences can be serious. I appreciate that I have given a very rapid description of some eating disorders, for which I apologise, but I am sure that other Members will wish to discuss some of them in more detail.

I do not wish to generalise, and I apologise if my next remark causes any offence, but in many instances, due to the extreme control with which sufferers approach their food consumption, eating disorders are a type of addiction. However, unlike addictions to alcohol or narcotics, a fixation with how one controls one’s calorie intake must be faced and addressed every day of a sufferer or recovered sufferer’s life. They cannot simply remove food from their lives in the way that others might develop strategies to avoid alcohol, for instance. They must eat to live. For sufferers, by necessity, that battle will occur three times a day for the rest of their lives.

Eating disorders are not trivial conditions. Anorexia kills about 20% of sufferers, and 40% never recover. It is the single biggest killer of all mental illnesses. It has been dismissed for too long as a problem of teenage girls who just need to get a grip on their eating patterns. That is far from the truth. Eating disorders are serious, potentially fatal, mental illnesses, which, even long after a sufferer has recovered, can have long-term implications for their health. The impact on fertility is well known, but there are many other serious implications. Abnormal heart rhythms are commonplace, even in teenagers with eating disorders. In fact, heart damage is the most common cause of hospitalisation for those suffering from eating disorders, but the kidneys and liver are also badly affected, and reduction in bone density leading to osteoporosis can happen in sufferers, even before there has been any physical manifestation of a problem.

As chair of the all-party group on body image, I have been privileged to work with a number of leading charities supporting those suffering from eating disorders and their families. I pay particular tribute, during eating disorders awareness week, to Beat; many of its members are in the Public Gallery. I also pay tribute to Anorexia and Bulimia Care and the Succeed Foundation. I vividly recall hearing the moving stories of ABC members at a reception hosted by my hon. Friend the Member for Wells a few months ago. These charities all do fantastic work with sufferers and their families, and to ensure that the wider community—Members of Parliament, the medical profession, schools, colleges and universities—have a better understanding of the signs of eating disorders, and how to help those in the grip of such a disorder and those who may be at risk. They also work with the media to ensure that they understand the importance of the portrayal of responsible images on advertising and in editorials.

[Stephen Metcalfe]

My hon. Friend is making a powerful, moving speech. These issues have been discussed and debated before, but there seems never to have been any progress in addressing the issues and tackling the problems. Why does she think no progress has been made in the past 10, 20 or 30 years? These things were known about, yet there seems to have been no move forward.

[Caroline Nokes]

That is a difficult question. Later, I may even suggest that we are moving backwards. Unfortunately, these are hidden conditions that the media and others have chosen, occasionally, to trivialise. They are not trivial and they need much higher priority.

--- Later in debate ---

[Caroline Nokes]

I have been struck by the number of times that relatives of sufferers have contacted me to make the point that their family member was slow to get a diagnosis, or to say that the GP dismissed the eating disorder as nothing more than a teenager being a bit fussy about their food. It is critical to raise awareness, not only among the wider community and the media, but among our general practitioners, because we need these disorders to be identified earlier so that damage to growing bodies, in the instance of young people, does not become permanent.

[Stephen Metcalfe]

As well as the medical profession being aware of these conditions and the first signs, should not parents have some knowledge of the indications, so that they can help their children earlier, before the condition gets too serious?

[Caroline Nokes]

One of the messages that I have received from parents is that they already feel enormous guilt, in some instances completely unjustifiably. They feel shame for what is going on with their child, and as if they are somehow to blame. They are not, and I find that in the majority of cases, parents were the fastest to identify the condition. They instinctively knew that something was wrong with their child, even though they might not have been able to put their finger on what exactly it was. I have heard some terrible tales from parents, which I will come on to—I assure you, Mrs Osborne, I am getting towards the end—about the responsibility and burden placed on them. I have even heard about parents who have been told that it is their fault. It simply is not.

We do not fully understand what causes eating disorders; it is complicated. All the parents I have spoken to have done the most fantastic job in supporting their children. As one sufferer’s mother said to me on the phone just yesterday, there is nothing that she would not have sacrificed to get her daughter the help that she needed. Had the mother been able to buy private health care, she would have sold her house to do it, so desperate was she for her daughter to get well.

I know how long sufferers have had to wait to gain admission to April House—something that has been emphasised to me incredibly strongly—and the picture from around the country is that the average wait from diagnosis to treatment in a specialist unit can be as long as nine months. For sufferers, that is simply far too long. As we move from primary care trusts to clinical commissioning groups, it is imperative that awareness of the scale of the problem is uppermost in the minds of GPs, who will be responsible for commissioning the relevant services.

I have mentioned briefly one significant theme, but I would like to mention it again. It is a message that has come from the parents about the impact on families. The effects are many and varied, and certainly include huge feelings of guilt and despair, and lack of comprehension of why this has happened to their child, or why an individual might choose to deprive themselves of the necessary nutrition to lead a healthy life.

--- Later in debate ---

[Stephen Metcalfe (South Basildon and East Thurrock) (Con)]

It is very generous of you to call me, Mr Walker, because I had not intended to speak in the debate. I am not sure I will detain Members long, because I am not sure what I am going to say.

Twenty-four hours ago, the debate was not on my horizon at all, but in discussion with colleagues yesterday, I was very taken by some of the numbers that were bandied around. Today, having heard the opening speech by my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes), I felt compelled to say something in the debate. I come relatively new to this issue. I have sat here listening to powerful, passionate and informed speeches, and mine will be nothing like that. However, I hope it will give an insight into the epiphany I have had over the past 24 hours.

The numbers have been referred to many times this afternoon, but what strikes me is that although 2,500 people in my constituency may suffer from an eating disorder, not one has contacted me, either before the debate or in the two and a half years I have been a Member of Parliament. I hope that is because the services they receive from the primary care trust and the mental health trust are exemplary, but I would be surprised if that was the case. I therefore encourage constituents who are struggling to access the services they need to contact me.

I was also struck by the fact that 1.6 million people nationwide have been identified as suffering from an eating disorder, but that number could be as high as 4.2 million, because we count only those who have presented and who are seeking treatment. Another thing that struck me was that a quarter of those people could be men.

As I said, I came new to this subject. Following my discussions yesterday evening, I eventually went home. My children—I am fortunate to have two, who are 22 and 20—were up. Our television is currently broken, so one of our pastimes is talking to each other, which is a novel experience, I have to admit. We got talking about what I had been discussing—this afternoon’s debate and my intention to come along and perhaps make an intervention to highlight the fact that a quarter of those suffering from an eating disorder may be men.

I was surprised by my children’s responses, and I am going to refer to them. I have texted my children to apologise to them in advance, in case I embarrass them. I was shocked because both of them talked about friends and acquaintances who had suffered from eating disorders. What took me aback most, however, was that they both admitted that they had probably had an encounter with some form of eating disorder. For the record, that has not manifested itself in anything particularly serious, and they both see what the pattern was at the time, but it could have been serious, and that is why I felt compelled to speak.

I want to say a little about what my children said, and about what I think the reasons behind what they said were. My son, Tom, is 22. He is a fitness trainer and he runs a gym. He is a health fanatic: he is very fit, he is always at the gym and he plays rugby football. He recognised some time ago that he was getting to the point where, however much exercise he took, he still felt there was too much fat on him. He was deliberately avoiding food and certain other things to try to slim down. There is not an ounce of fat on him, and he does not need to do that. He knows that now, but at the time, for whatever reason, he felt he had to change his body shape.

My daughter, who is 20, is incredibly slim. She suffered the reverse problem from my son: people would accuse her of perhaps having an eating disorder, when she did not think she had one. The problem was that that gave her cause for concern and made her ask whether she perhaps did have an eating disorder. As it happens, she does not; she is fine—she is just a slim girl. Both my children therefore felt under pressure because of the way other people saw them, or because of their perception of the way other people saw them.

I know the reasons behind eating disorders are complex, and we have heard about them, but the thing that concerns me most is the idea of body image, of perfection and of trying to be something that we cannot be. We know the numbers: only 5% of us could ever get close to the perfect image we see in the press and the media. The rest of us are struggling to conform to that or just to be comfortable in ourselves. That is one of the main drivers of this issue. Those who get past their brush with an eating disorder may do so because they see through that. However, if there are other pressures in people’s lives—pressures relating to relationships, family breakdown, the future, money and education—they might trigger the body image issues that push people towards having a fully-fledged eating disorder.

The other thing that surprised me is that eating disorders are on both sides of the gender divide, and they affect old and young alike—there is pressure on not just the young, but all of us. However, I want to focus most on young men such as my son, who perhaps felt under pressure to change his image.

There is the statistic that gay men are twice as likely as straight men to suffer from an eating disorder, and I can see how that could well be true. However, when we hear that the proportion of men, including young men, suffering from eating disorders could be between 11% and 25%, how can we have any confidence that those figures are accurate, given that one is more than double the other? We do not know how widespread this problem is. Gay men may be more prone to coming forward to seek help, and straight men may not seek help. I do not know, and I suspect we will not know until we do more research. However, we do know that there has been a 68% increase in 10 years in the number of men presenting with an eating disorder, and the number is still rising. We therefore need to take action.

One remark that struck me earlier was from my hon. Friend the Member for Enfield, Southgate (Mr Burrowes), who said that if we are not aware of a family member, a friend or a constituent with an eating disorder, we are out of touch. Well, I have to say that I probably was out of touch. I feel less out of touch now, and I am grateful to my hon. Friends for putting me back in touch, but that, I think, is one of the issues, and I referred to this earlier in an intervention. I am not sure that, as a parent, I fully understood some of the tell-tale, early-warning signs, and I do not know how we get that information across to parents, especially parents of boys.

We have to help parents accept that these problems are not their fault, and they need not to feel the guilt that is perhaps associated with this issue. They can then signpost those who are suffering towards help at an earlier stage, rather than hiding the issue from themselves because it does not fit with the way they view their family set-up.

We also need to educate young men. We need to say that eating disorders are serious and affect not only young women, but young men. If young men do not seek help, that can have ramifications for the rest of their lives. We therefore need to help them deal with any stigma that might be associated with that.

The problem, which is obviously serious, has only come to my knowledge in any great detail in the past 24 hours. The condition affects all parts of society and all ages, and crosses social divides. I hope that through debates such as this one, and awareness week, and the information that I have been provided with, we can push the agenda a little further onward, so that we can help those who are in desperate suffering, many of whom suffer in silence. I am grateful to my hon. Friend the Member for Romsey and Southampton North for obtaining the debate, and I am grateful for the opportunity to speak, and to become more informed about an important issue.