Eating Disorders Awareness Week

Wera Hobhouse Excerpts

Tuesday 28th February 2023 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House has considered Eating Disorders Awareness Week.

It is a pleasure to serve with you in the Chair, Ms Harris. I thank the Backbench Business Committee for granting the debate, and all colleagues across the Chamber who have supported it.

Across the United Kingdom, an estimated 1.25 million people have an eating disorder. That includes binge eating disorder, bulimia, anorexia and other specific feeding or eating disorders—indeed, any disorder that avoids or restricts the intake of food. Left undiagnosed and untreated, eating disorders can be a silent killer. Anorexia has the highest mortality rate of any mental illness, and results from one study have shown that a third of people with binge eating disorder are at risk of suicide.

[Margaret Ferrier (Rutherglen and Hamilton West) (Ind)]

Increasing awareness and our understanding of the causes of eating disorders are crucial to providing the right care. Eating disorders are still hugely misunderstood. Does the hon. Member agree that Ministers must fund more research on that, because just 1% of mental health research funding is directed to eating disorder studies?

[Wera Hobhouse]

I completely agree. Indeed, the all-party parliamentary group on eating disorders inquiry on research funding found how crucial it is, and in particular that eating disorder research should be ringfenced. Some progress has been made, and the eating disorder charity Beat has made good progress on the issue, but more research needs to be done.

For too long, sufferers have been left feeling trapped and alone. Here in Parliament, we have been raising the alarm for some years about this rising epidemic, which still needs more urgent action from the Government. However, I want to acknowledge the good working relationships the eating disorders APPG has had with various Ministers. I hope that will continue, and that today’s debate helps us to make progress together.

The theme for this year’s Eating Disorders Awareness Week is eating disorders in men. Eating disorders do not discriminate. Many people think that eating disorders affect only women, but at least one person in four affected by an eating disorder is a man, and 89% of men and boys aged 16 to 18 in my county of Somerset worry about how they look. Those experiences are often overlooked.

Toxic stereotypes are pervasive, and half of respondents to a recent survey of men’s experience carried out by Beat did not believe that someone like them would develop an eating disorder. One male sufferer in five has never spoken out about their struggle. That is why the debate is so important. We must encourage men to speak up and get the help they need.

Other rigid perceptions of eating disorders persist. Eating disorders are frequently misunderstood and viewed as a lifestyle choice. Contrary to popular belief, eating disorders are most common among people with severe obesity. Too many people are still being turned away from treatment because their body mass index is too high. To imply that someone seeking help for an eating disorder is not skinny enough is a terrible mistake that can lead to added suffering, and I commend Hope Virgo for her tireless campaign, Dump the Scales, which has made a significant difference.

Owing to those perceptions, people with eating disorders face a postcode lottery in trying to access specialist treatment. Beat has found large inconsistencies in the availability of treatment for binge eating disorders. Only 12 of the 51 providers in England that responded to Beat’s freedom of information request offered all three services for binge eating disorders recommended by the National Institute for Health and Care Excellence.

In some areas, treatment for people with bulimia is being rationed according to the frequency of binging and purging episodes. In others, treatment is simply not available. The Somerset and Wessex Eating Disorders Association, also known as SWEDA, has seen a 150% increase in people seeking help for eating disorders compared with pre-pandemic figures. Its children’s service has been overwhelmed with young people and their parents desperately trying to get support.

Eating disorders can take years to recover from, and many children and young people need to continue their treatment into adulthood. Young people miss out on so many educational and social opportunities. These years are stolen from them, and that is not to mention the potentially irreversible effect on their physical health. Again, this affects girls and boys, men and women—eating disorders do not discriminate.

[Sir George Howarth (Knowsley) (Lab)]

I thank the hon. Lady for securing this important debate. She will be aware that the variation of eating disorders called T1DE—type 1 diabetes with disordered eating—is a growing problem that affects young men as well as young women. The right hon. Member for Maidenhead (Mrs May) and I have been co-chairing an inquiry into that variation of eating disorders. I will not pre-empt what our report will say, but one thing is clear: professional support, both psychological and physical, is vital to these young people, who could otherwise end up seriously ill if they do not take their insulin—in some cases, it is fatal.

[Wera Hobhouse]

I thank the right hon. Member for his intervention. As I mentioned, eating disorders manifest themselves in different forms. We need to increase our understanding of the different types of eating disorders, and much more specialist treatment needs to be available to cater for people’s different needs. I thank him for mentioning that specific form of eating disorders among people who are suffering from diabetes.

As I mentioned, eating disorders result in years being stolen from young people, and they can take many years to recover from. Some of the figures are just staggering. A third of people with eating disorders recover fully, a third never really recover, and a third get worse. For the third that never really recover, it is a lifetime sentence of a life that is not as good as it could be. That is why early intervention and understanding the symptoms of eating disorders are so crucial. The earlier someone receives intervention for their eating disorder, the more likely they are to make a full recovery. The longer symptoms are left untreated, the more difficult it is for the person to recover.

Healthcare should focus on prevention before cure, and early access to the right treatment and support can be life-changing. Some 75% of SWEDA’s staff and volunteers have lived experience of an eating disorder, which is another aspect of this issue that is so important: we need to hear from more people who have lived experience of an eating disorder. Their speaking up and leaving behind the stigma that is still associated with eating disorders is so important, and I commend everybody who has come forward and talked about their lived experience. I understand how difficult that can be, but we need them to do it. All those working for SWEDA say that they wish they could have accessed help long before they were offered it. That is why such organisations are so important: they offer specialist therapy and support to people with eating disorders and body image issues before they become ill enough to need more intensive treatment.

However, those organisations cannot cope on their own. Waiting times for eating disorder patients are out of control, and waiting lists for children’s eating disorder services have doubled since March 2020. From 2021 to 2022, only 61% of urgent cases started treatment within a week—well below the current NICE standard of 95%. I hope the Minister will be able to respond to that. For adults, there are not even targets in place. The Independent has revealed that more than 80,000 adults with eating disorders are waiting to be seen for therapy—a record number—while just 30% of adults got treatment within four weeks of their referral. Again, I hope that the Minister will refer to adult eating disorder services, where we do not have any waiting list targets or targets for support. It is very important that adult services get the same support as children’s services, where we have made progress because there are targets.

Data from the eating disorder charity Beat showed an average delay of three and a half years between someone’s eating disorder symptoms emerging and their accessing treatment. That is simply not good enough. Targets are crucial if we are to tackle this epidemic. An access and waiting time standard for adults would provoke significant extra funding and focus. If we want to encourage people to seek help, we need to give them a guarantee that they will be seen.

Having clear standards can facilitate service improvements. Standards introduced in 2015 for waiting times for children and young people’s eating disorder services have been crucial in driving service improvements. However, similar standards have been lacking in adult services. Shockingly, sufferers are reaching the point of emergency hospitalisation before they can access care. Again, that is not good enough. It also costs a lot more money if we reach people only at that crisis point.

Clinicians have reported a significant increase in the proportion of young people first presenting when they are already severely ill. NHS figures show that hospital admissions for people with eating disorders in England have risen by 84% in the past five years. For children and young people, there was a 35% increase in the past year alone—and among men and young boys, hospital admissions have risen by 128%. There is an increasingly alarming picture that eating disorders in men and boys are being overlooked and not treated early enough. That is why today’s debate is so important.

Tragically, people are losing their lives. Take the terribly sad death of Zara Taylor after two years of struggling to get the right treatment for her eating disorder. An investigation by the Health Service Journal found that at least 19 lives were lost to eating disorders in England over the past five years. At least 15 of those were deemed avoidable and resulted in coroners issuing formal prevention of future deaths reports. Coroners described patients’ safety risks being missed or poorly managed because of limited knowledge of eating disorders among doctors and health professionals, and delays in accessing appropriate treatment. That is why it is so important to have more research into eating disorders, and focus on the more specialist and rare forms of eating disorders. Those same failings were among the key issues identified five years ago by the Parliamentary and Health Service Ombudsman in its report “Ignoring the Alarms”. Surely, we need to do more and to do better.

I was disappointed that the Government decided against publishing a 10-year cross-Government mental health and wellbeing plan for England. Instead, they have developed and published a major conditions strategy that would include mental health alongside other groups of conditions, including cancers, cardiovascular disease and dementia. That is not helpful. Compared with physical health, mental health has been a Cinderella service; for years, we have been asking for parity. If everything is put together again, we run the risk of losing special attention to mental health.

Can the Government not see that for targeted and varied issues we need targeted and varied strategies? I point them to Hope Virgo’s eating disorder manifesto, which calls on the Government to implement an evidence-based national eating disorder strategy, with a plan outlining how they will tackle the huge rise in people affected by eating disorders.

I want to single out Hope Virgo for her tireless campaign. She has made such progress in helping us to understand what it is to suffer an eating disorder and access services. She has continually engaged with us and Government in order to achieve improvements. She has done fantastically well. The strategy that she calls for should integrate obesity and eating disorder prevention plans, given the overlapping factors between the two. The Government should also look at reforming treatment approaches. I hope they are looking seriously at Hope Virgo’s manifesto and strategy.

A recent University of Oxford study found that using the integrated CBT-E—enhanced cognitive behaviour therapy—approach over the current in-patient approach reduced readmission rates for people with anorexia by 70% over a year. That means that we need to treat this as a mental health condition first and foremost, and to treat people’s physical health as a result of the mental health issues. If we do not tackle the mental health issues, we will not cure the physical problems.

The strategy should also include better training. According to Beat, 20% of medical schools do not include eating disorders in their teaching at all, while those that do provide less than two hours on the topic. Training should be compulsory in order to spot early signs of eating disorders. Many participants in a 2021 Beat survey reported having a negative experience when they first sought help from a GP. There are many brilliant practitioners in the NHS delivering excellent care, but I want every doctor to complete their training with the knowledge and skills to best support people with eating disorders.

The crisis in the NHS has decimated mental health services. Staff shortages are growing. According to the National Audit Office, between 2021 and 2022, 17,000 staff left the NHS mental health workforce. The Royal College of Psychiatrists 2021 workforce census shows that since 2017 there has been a 30% increase in the number of vacant or unfilled consultant posts in England. That is not good enough. How we can encourage specialists into services is a big question that the Government need to answer.

Eating disorder psychiatry has one of the highest numbers of vacancies, with just 28 full-time consultants. We need significant investment in staff retention. The RCP’s members report high workloads and poor work-life balance. NHS trusts should be supported to meet important improvement targets for retention. I hope that the Government will keep their commitment to publish an NHS workforce plan and that they will bring that forward early, along with adequate investment.

Mental health services need proper funding. This financial year, only 13.8% of local health spending has been allocated to mental health services, although mental illness accounts for 21.3% of the total disease burden in England. The money spent on young people’s eating disorder services has not kept up with the number of young people who need treatment. I support the NHS Confederation’s call for £12 million of additional funding to be made available over the next year to get children and young people’s eating disorder services back on track.

The funding that is provided needs to reach frontline services. An inquiry by the APPG on eating disorders, which I am proud to chair, found that 90% of the additional NHS funding given to clinical commissioning groups for children’s services did not reach the services to which it was pledged. We wrote to CCGs at the time, and the answers that we received were not satisfactory. The Government must ensure that their funding pledges are not empty words and that money is getting where it is needed. A one-off boost for children’s mental health services is not enough. Soaring demand for underfunded services will lead to children missing out on care.

We are all aware that the NHS is in crisis. We hear harrowing stories about ambulance and A&E delays, but the impact on mental health services has received little attention. I hope that today’s debate will make a difference and that we will hear more about the crisis in mental health service provision.

The Liberal Democrats firmly believe that physical and mental health should be treated equally in the NHS. Eating disorders are an epidemic. The sooner we realise that, the sooner we can treat them with the attention they deserve. No one should be condemned to a life of illness, nor should anyone be dying from an eating disorder in 2023.

[Several hon. Members rose—]

--- Later in debate ---

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I am delighted to participate once again in this debate in Eating Disorders Awareness Week.

An eating disorder is a cruel and distressing illness both for those who live with the disorder and for their families, who are so often at a loss as to how best to support their loved one who is experiencing the illness. As we have heard, an eating disorder can affect anyone, regardless of gender, age, ethnicity or social background, and the impact of this serious mental illness, affecting 1.25 million people across the UK, is profound. The causes are complex, and there is no quick fix to resolve this condition. There is no doubt that, as we have heard, the gap between the onset of the illness and the start of treatment is simply too long. While family members shrink into the grip of the illness before the eyes of loved ones, families are left feeling helpless to understand what is happening and how best to provide the support that is so obviously needed.

One innovation, or new measure, that has not helped the charities and those on the frontline seeking to support people living with this condition or in danger of developing an eating disorder is calorie information on menus, which has become mandatory in England. Although we all understand the good intentions behind it, I believe it is a misguided measure. The eating disorder charity Beat is urging the Scottish Government not to follow suit on that, for very understandable reasons.

My first knowledge of the issue of eating disorders was through the story of Karen Carpenter, who died at the age of 32 in 1983 because of illness related to her eating disorder, and then Lena Zavaroni, a Scottish singer and entertainer who died in 1999 at the age of 35 because of issues surrounding her long battle with anorexia. Both those young, beautiful and very talented women spent almost all of their short lives battling with this condition, and they ultimately lost their lives to it.

Those are two very high-profile examples of deaths from eating disorder. Many people will have heard their stories and about their struggles. Sadly, it is the case that, for anyone who develops this condition, the mortality rate is frighteningly high: it is the highest mortality rate of any mental illness. As we have heard today, eating disorder does not come alone; it is accompanied by other mental health conditions such as depression, self-harm and obsessive behaviour.

[Wera Hobhouse]

Is it not also important that we look at athletes? We have heard that a lot of eating disorders are combined with over-exercising. It is important that we look at those highly successful and high-performing people, who are in danger of developing an eating disorder.

[Patricia Gibson]

Indeed. We have talked about the overlap and common ground between eating disorders and obsessive behaviour. That territory certainly includes issues such as athletes who are very conscious of body image and how to maintain it.

We have heard that eating disorders are often incorrectly, and perhaps almost exclusively, associated with young women. Stereotypes around the disorder mean that often men who are living with this condition can be deterred from seeking the help that they need. They can also have their difficulties and struggles misdiagnosed. That is why this year’s Eating Disorders Awareness Week theme is eating disorders in men. In fact, one in four people with eating disorders are men, and it is important that we raise awareness around that so that people understand this is not restricted to women.

--- Later in debate ---

[Dr Rosena Allin-Khan (Tooting) (Lab)]

What a pleasure it is to close for the Opposition with you in the Chair, Ms Harris. I thank the hon. Member for Bath (Wera Hobhouse) for bringing forward this debate; I am honoured to be part of it again. It is a shame that we have to be here every year talking about this issue, but it is a testament to how seriously we take it. We will be here until we see the issue resolved.

This is normally the point at which I mention a few comments from Labour Members and say, “Didn’t they do well?”, but every single contribution and intervention was valuable. I learned new things on a topic that I thought I already knew very well. I hope that this debate will not just be filled with words about what needs to change, but that there will be something tangible—some action—at the end.

Across the UK, as many as 1.25 million people are living with an eating disorder. That is a staggering number, if we actually think about what that means. We have heard about the considerably high mortality rates; anorexia claims the most lives of any mental illness. With timely and appropriate treatment, people can go on to live healthy and fulfilling lives, so how many of those deaths are avoidable? That is the truth that we have to face.

I welcome the fact that we have opportunities in this place to mark Eating Disorders Awareness Week, but we have to do so much more all year long to challenge the stereotypes and assumptions that so many people still hold about eating disorders. It is so important to remember that eating disorders can manifest themselves in a variety of ways—through people eating too much or too little, or even restricting what they eat. To echo what has been said, we must never forget that eating disorders can affect people of any age, gender, ethnicity and socioeconomic background.

We have heard that one in four people with eating disorders is a man. It is staggering that it is still so difficult for boys and men to come forward and talk about their issues with eating. In my work in A&E, I see younger and younger people—especially boys—talking about their struggles with food and body image. They often cite social media and peer pressure as the source of those struggles.

I always like to thank the charity Beat for its incredible work. It works so hard to combat the negative stereotypes and misleading perceptions of eating disorders, which are sadly all too common. As was said eloquently today, people experiencing an eating disorder can often find themselves in mental health hospitals. To pick up on the point made by my hon. Friend the Member for Sheffield, Hallam (Olivia Blake), about the use of restraint, I have written to the Minister on that topic. I look forward to having a meeting about it, and to seeing the end of the inappropriate use of restraint. Mental health in-patient settings must be a place of safety, where patients and their loved ones can expect to be treated with dignity and professionalism. However, that is clearly not always the case.

For the families of those with eating disorders, the situation is crippling. They have an all-encompassing fear of the unknown when it comes to what their loved one will eat that day. They are concerned that they may have to give up their job, or even not care as much for their other children because they are obsessed with what one child is eating. They know that the child could lose their life at any moment.

It has been agonising to listen to the recent reports of the death of 19 eating disorder patients in in-patient settings; serious concerns were raised about their care. Lives should not be needlessly lost because of poor care and a lack of understanding of eating disorders. My heart goes out to their friends and families. Far too many families—not just the families of those with eating disorders—have lost loved ones in mental health hospitals. How many more people will lose their life before the Government get a grip on safety in in-patient settings? We need a Government who will get serious about mental health and eating disorders. As we have said time and again, access to proper treatment can be life-changing. Prevention is important, and early intervention provides the best chance for recovery. Think of those families who have lost loved ones, knowing that it could have been prevented, and that we in this place have not yet done enough to save these lives.

Targets on accessing treatment are being routinely missed. In 2016, a clear standard was set that 95% of children and young people experiencing the most urgent eating disorder cases should receive treatment within one week. Since then, however—I accept that the Minister has not been in post that entire time—the Government have missed the target; I hope the situation will improve. Disappointingly, only 60% of urgent cases were seen within one week last year. That means that four in 10 children and young people were not seen at the point of desperation. Children and young people are being left on lengthy waiting lists, unable to access support. Meanwhile, their families are helpless, and are trying their best to support their children without vital help from mental health professionals.

[Wera Hobhouse]

Does the hon. Lady realise the mental health impact on those who see a sufferer suffering and not getting the intervention they need? Families see what is happening to their loved one. They are waiting with them, and their mental health is deteriorating at the same time.

[Dr Allin-Khan]

Without a shadow of a doubt, not investing in a person with a mental health need often has a knock-on impact on four, five or six members of the family. Ultimately, we then need to use more mental health resources to serve their needs as well. It makes no economic sense, and no moral sense either, so I thank the hon. Member for her intervention.

The strain that an eating disorder places on an entire family is immense. As I say, parents often have to stop working to care for their child around the clock. How can the Government continue to fail young people with mental health needs? This cannot go on. For how long do the Government think it is acceptable for young people to be stuck on waiting lists for mental health treatment? Eating disorder psychiatry and child and adolescent psychiatry are two of the three psychiatric sub-specialties with the highest consultant vacancy rates. Where is the Government’s workforce plan? Patients are suffering.

After more than a decade of Tory mismanagement, patients are being failed, waiting lists are soaring and services are struggling to cope. I do not like to make eating disorders a political football—they are not—but the truth has to be told: the Government have failed thus far on their commitment. If they cannot get a grip and improve services, Labour will. We stand ready with a bold plan to recruit 8,500 additional staff in order to provide mental health treatment within a month for all who need it. Labour will put prevention and early intervention at the forefront of our approach to mental health. We will place a mental health specialist in every school, and we will place an open-access mental health hub for young people in every single community. The Government can no longer continue to neglect mental health services.

--- Later in debate ---

[Maria Caulfield]

Absolutely; I will look out for the results of those trials. I am keen that we use evidence-based medicine, and if something has proven to be effective in clinical research, it absolutely needs to be rolled out. An hon. Member touched on the lack of research into eating disorders. The National Institute for Health and Care Research does have funding available, so I would encourage clinicians, researchers and charities that want to undertake research into eating disorders to apply for funding for those trials. We need more research into eating disorders, particularly around men and high-risk groups, such as diabetics.

[Wera Hobhouse]

Will the Minister respond to the concern raised that Government money had been made available but did not reach the frontline, as a freedom of information request by Beat showed? How do the Government intend to tackle that and ensure that money reaches frontline services?

[Maria Caulfield]

The Government have made huge amounts of funding available, for both mental health and eating disorders. More funding than ever before has gone into those services, but that funding needs to reach the frontline. That speaks to my point about local commissioners: where funding is given to a particular area, commissioners are supposed to use that money to commission services at a local level. If that is not happening in some parts of the country, then I am happy to meet with those commissioners and Members of Parliament to find out why.

We want to ensure that funding is going to the frontline to make the difference that we need it to. We are the first Government to prioritise mental health, and the first to set targets for eating disorder referrals. We are the first Government to set a standard of recruiting 27,000 additional mental health workers. We have started to roll out mental health teams in our schools, and when I spoke to the Royal College of Psychiatrists yesterday, for the first time it said that it had filled all its training posts in the last year.

We are making significant progress, but patients need to feel that. That is the next step. I am happy to work with the hon. Member for Bath and the APPG on eating disorders to make sure that is happening on the ground, because, as someone said, it is great to talk about it, but we need to see the impact for patients.

I hope that reassures right hon. and hon. Members about how seriously we take this issue. I look forward to working with everyone across the House to make eating disorders a bigger priority for clinical work. Good progress has been made, but there is a lot more to do.

[Wera Hobhouse]

It has been a real pleasure to listen to all the contributions today; I thank everyone who contributed to the debate. It was wide-ranging, reflecting the wide-ranging issues associated with eating disorders, from body image and social media to access to services, waiting times and the need for early intervention and diagnosis, as well as the need for research funding and more specialists in the field.

This is a cross-party effort to eradicate the epidemic of eating disorders. The good news is that eating disorders can be treated and full recovery is possible, but we need to do a lot more to make that happen. We need to increase our knowledge about the many different types of eating disorder. We need many more specialists and specialist services, and mental health and physical health services need to be integrated, as has been made clear today. Eating disorders are a mental health condition, as well as a physical health condition. If the two are not treated together, then we are failing patients.

Eating disorders do not discriminate; we must encourage everybody to come forward to seek help, especially boys and men. That was the main topic of the debate. Early diagnosis and treatment can make a life-saving difference. As we have heard many times, men do not like to come forward or talk about physical problems, but it is important for men of all ages to come forward and seek help.

I thank everybody who contributed, particularly those tireless campaigners, including Hope Virgo, who has been mentioned several times, and the eating disorder charity Beat. Without their tireless efforts, awareness of eating disorders and treatment would not be what it is today.

Question put and agreed to.

Resolved,

That this House has considered Eating Disorders Awareness Week.