Eating Disorder Awareness

Wera Hobhouse Excerpts

Tuesday 1st April 2025 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House has considered eating disorder awareness.

It is a pleasure to serve with you in the Chair, Mr Stuart.

Eating disorders are among the most serious and life-threatening of all mental illnesses, but they have been overlooked and underfunded for too long. Because of this, they have one of the largest treatment gaps in modern healthcare, and we must ask why that is. In the face of overwhelming need, why are we still ignoring this crisis, especially as it is a documented fact that recovering from an eating disorder is possible, no matter how long and complex the illness has been?

In the past decade, we have seen an alarming rise in eating disorders—a trend that only worsened during the pandemic. What was already a struggling support system for those affected by eating disorders has collapsed under pressure. Too many people are waiting, too many people are failed and too many people are feeling neglected by the system. The eating disorders all-party parliamentary group, which I chair, recently published its report, “The right to health: People with eating disorders are being failed”, which highlights the increasing neglect we are seeing across eating disorder services—but that is by no means to say that those who are working in eating disorder services are not working their socks off. People with eating disorders are being told that they are not thin enough, that they are too complex, and in some situations are being moved on to palliative care and identified as treatment-resistant. That is why we are pushing for a complete reformation of eating disorder treatment alongside the development of a stand-alone eating disorder strategy.

During Prime Minister’s questions on 19 March, the Prime Minister emphasised the NHS’s goal of bringing eating disorder care closer to home. This is an important goal, but it requires equitable access to intensive community and day treatment, as highlighted in Beat’s report, “There’s no place like home”. Such services can reduce the need for costly hospital admissions and shorten stays for those who need in-patient care. However, Beat’s report shows that only one in six NHS integrated care systems in England currently offer enough intensive community and day patient treatments for both children and adults. Alongside this, it is crucial that we do not focus on only one end of the spectrum. Day services cannot always meet the needs of those with extreme malnutrition, and in-patient care is critical for many people who need high levels of physical, behavioural and psychological support.

The strain on family carers, who often lack medical expertise, must be considered too. In-patient and day patient care must be part of a well-integrated, stepped care system. If those services are not co-ordinated nationally, gaps will form in the care pathway and patients may fall through the cracks. I agree with the Government that if people are treated in a timely manner in the community, there will be less need for costly in-patient care, but before we make any changes, we must ensure that all levels of care are adequately funded and can work in tandem to provide the best possible support.

I recently had the privilege of hearing Nicky Smith share the story of her courageous daughter, who has been in in-patient services for over a decade. Unfortunately, during her long stays, she has not always received the treatment she needs. Her current stay is now in its 21st month. For the last eight months, her team has been trying to find an alternative placement for her complex needs. Sadly, she has been rejected by every service she has applied to and now faces discharge. Nicky and her daughter acknowledge that although some in-patient units are better resourced than others, being in in-patient care has saved Nicky’s daughter’s life and continues to do so. Over the last 12 years, the community eating disorder teams provided limited, inconsistent support. That caused rapid relapse, sometimes in just a few weeks, leading to low body mass index and frequent readmissions, often to inappropriate units such as general hospitals or acute mental health wards. Ultimately, she was readmitted each time to a specialist eating disorder unit, under section 3 of the Mental Health Act 1983. That is the only way she can complete meals without the need for nasogastric feeding.

In addition to being deeply moving, this story drives home the importance of well-resourced specialist eating disorder units. We cannot cut back on those essential services and force those who are unsuited for discharge into community care. Specialist units are essential for keeping people alive, safe and supported, as they work towards recovery and reintegration into everyday life. That must continue, alongside investment in community and day-treatment programmes.

To tackle eating disorders and develop effective treatments we need to understand them fully. Worryingly, the International Alliance of Mental Health Research Funders found that eating disorders accounted for just 1% of the UK’s already severely limited mental health research funding between 2015 and 2019. That is despite people with eating disorders accounting for around 9% of the total number of people with a mental health condition.

Recent funding announcements are even more cause for concern. The Royal College of Psychiatrists found that 24 of the 42 integrated care boards planned real-terms spending cuts to children’s eating disorder services in the current financial year. That would result in real-terms cuts of well over £800,000. Those planned spending cuts come against a background of severely stretched children’s and young people’s eating disorder services: a 13% increase in referrals in the past 12 months; high thresholds to access services, resulting in more young people being in crisis; almost 800 urgent referrals still waiting for treatment at the end of December 2024; and a 30% true vacancy rate for all eating disorder consultant psychiatrist positions across England, as of March 2023. Following those troubling findings, will the Minister assure all of us here and across the country that all ICBs will invest sufficiently in those vital services in 2025-26 and beyond?

As well as providing an increase in funding, we must take a close look at measures to protect children from harmful online eating disorder content. There is growing evidence that social media is linked to an increase in eating disorders among young people. Algorithms are showing harmful content to vulnerable people. Those include posts promoting fasting non-stop for days on end as a healthy lifestyle. There is an online trend of “thinspiration” posts, which glorify unhealthy weight loss. There have also been cases where, even after users have blocked certain accounts, they still see content that promotes eating disorders.

In research conducted by the Center for Countering Digital Hate, a fictional UK-based 13-year-old user watched a video about eating disorders for the first time. Following the video, one in four suggested videos were for harmful eating disorder content. More than half were for content relating to eating disorders or weight loss. Under the Online Safety Act 2023, YouTube will have a responsibility to protect children from primary priority content such as eating disorders. Yet, YouTube still does not appear to be taking that seriously. In fact, algorithms are pushing the content in order to increase engagement.

Harmful content viewed online can push children further into eating disorders that have a drastic effect on their health, wellbeing and life chances. From the evidence I have seen, I am concerned that, even when the provisions of the Online Safety Act 2023 come into force, the actions of those media giants may not change, which truly worries me. Social media is not the cause of eating disorders. Users who post much of this content are unwell and are not doing so maliciously, but social media can lead those who are already suffering further down the path of disordered eating. More needs to be done to hold social media companies accountable to legislation such as the Online Safety Act.

Another issue of grave concern is the need for more accurate recording of eating disorder-related deaths, and a better understanding of the factors contributing to them. As we know, eating disorders are one of the most life-threatening mental illnesses, however, all too often they are not explicitly listed on death certificates, despite being a significant factor in the person’s death. For example, someone suffering from anorexia and severe malnutrition may have their cause of death recorded as organ failure, without any mention of the underlying eating disorder. That is a crucial gap that we must address.

The APPG has heard first hand from people who have experienced the heartbreak of losing a loved one to an eating disorder. One particularly moving example is that of the Laurence Trust, a Northern Irish charity founded by Laurence’s family after his tragic death. Laurence had struggled with bulimia and depression, and eventually suffered a fatal heart attack. His mother Pam shared with the APPG that his death certificate did not list the eating disorder as a contributing factor. Instead, the cause of death was recorded as undetermined. That misclassification not only deprives families of closure, but hinders our understanding of the true scale of eating disorder-related fatalities.

To better prevent such deaths in future, we must ensure that coroners’ reports accurately reflect eating disorders as contributory factors. Only by tackling these deaths can we gain a clearer picture of the impact of eating disorders, and take meaningful steps towards prevention and improved care. Accurate recording will raise awareness and ultimately save lives. It is high time that eating disorders are treated with the seriousness they deserve. We are all well aware of the many different parts of the NHS that require additional funding, but I have simply heard far too many harrowing stories about delays to treatment, inadequate care and premature inpatient discharge. Now is the time for change.

[John Milne (Horsham) (LD)]

In my constituency of Horsham, we had a particularly upsetting case of a constituent whose daughter had significant mental health and behavioural issues that were very difficult to deal with and, as a consequence of those not being dealt with, she also developed an eating disorder. The only place they could send her to that could cope with that combination of factors was in Yorkshire—my constituency is in West Sussex. That was an extraordinary burden on the family. We need provision across the country to deal with the cases that present.

[Wera Hobhouse]

I totally agree. Unfortunately, there is a massive postcode lottery. Services need to improve across the country so that everybody, like my hon. Friend’s constituent, can get the treatment they need as close to home as possible, because carers are so important, and so that families can see their loved ones.

In the last year alone, more than 30,000 acute admissions for eating disorders were recorded—that is a vast number. What was already an overstretched and under-resourced support system for those affected by eating disorders has now become a national emergency. Our APPG report sadly proved these systemic failures are costing lives. It is clear we need an urgent and comprehensive overhaul of eating disorder care and treatment in this country to ensure that we do not lose our important inpatient care, and to massively improve community and day treatments. I add to what my hon. Friend the Member for Horsham (John Milne) said, that if eating disorders, or the underlying mental health disorders, are not prevented or cared for early enough, everything becomes so much worse further down the line.

I repeat that we must address the role social media plays in promoting eating disorders and harmful content, especially to young people. We also cannot even begin to understand the depth of this crisis without accurate data regarding eating disorder-related deaths. I hope the Government have heard what I said today, and will act fast and decisively to ensure that eating disorder sufferers finally receive the treatment and care they all deserve. I have been chair and vice-chair of the APPG on eating disorders for the last six years. That is a long, frustrating time to see get worse something that one wants to get better, so I hope that today may be the start of us turning a corner.

[Several hon. Members rose—]

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[Danny Kruger (East Wiltshire) (Con)]

I acknowledge and thank the hon. Member for Bath (Wera Hobhouse) for her long campaign on this topic, for securing this debate and for all that she has done and will probably have to continue to do on this agenda for a while. I entirely endorse the campaign and the things that need to happen that she and the hon. Member for Salford (Rebecca Long Bailey) have outlined.

Eating disorders present an utter tragedy to families and to young people. Last week I met a family in my constituency whose daughter is in the grip of anorexia. We had a long conversation about both the services available and the nature of the illness itself. I asked the simple question, “What is anorexia and where does it come from?” Despite the extent of their experience and all the reading they have done, it was a very difficult question to answer. The answer included that it is like an addiction, or has the qualities of an addiction. There is apparently a genetic component, and a link with autism. As the hon. Member for Bath suggested, there is a clear element of social contagion—her points about social media are extremely important. It strikes me that in many ways anorexia is an illness of modernity. It is a consequence of the pressures that young people and, indeed, older people can face in this very difficult world we live in. That suggests that a multiplicity of responses are appropriate.

I pay tribute not just to colleagues here, on the APPG and across the House who campaign on this issue, but to campaigners from outside Parliament, including Chelsea Roff, Hope Virgo, Agnes Ayton and others, whom I have got to know in the last couple of years. I honour their expertise and commitment.

As the hon. Member for Bath said, and as cannot be pointed out too often, eating disorders, and anorexia in particular, are treatable illnesses. The services are in absolute crisis, as we have heard, but we should never lose sight of the fact that the illnesses are treatable. There is clearly desperate confusion in the NHS between the physical and mental dimensions, particularly when it comes to the extreme acute phase of anorexia. We know it is the most dangerous mental illness in terms of the tragedy of death. There is clearly a lot to do in reconciling the mental and physical sides of our health service.

The hon. Member for Bath and I are on different sides on this, and the Minister and I have been debating it over the last month or so, but I have to acknowledge my concern about the Terminally Ill Adults (End of Life) Bill. Currently, there are patients in our NHS who are diagnosed with eating disorders—anorexia in particular—who are categorised as terminally ill by the system and put on a palliative care pathway, because the system decides that their condition is not in fact treatable. It is scandalous and tragic that people who have a condition that is eminently treatable are categorised as terminally ill.

My great concern is that if we were to pass that Bill, we would end up with people being diagnosed as eligible for an assisted death. It is important to acknowledge that in other countries that have assisted dying laws, our understanding is that, in all those jurisdictions, people with anorexia have qualified for and been given an assisted death. In 100% of the cases that we know about, they passed the capacity test that we would apply here in our country. That is my great concern.

[Wera Hobhouse]

It is important that we stress that an eating disorder is not a terminal illness and therefore should not fall under that legislation. I know that the hon. Gentleman and I agree on that; I think we disagree on his worries about how it would be treated, practically, in the future. An eating disorder is not a terminal illness.

[Danny Kruger]

I am grateful to the hon. Lady, and I entirely agree. It is vital to stress that point, and I am sure the Minister agrees.

I agree with the hon. Lady and the hon. Member for Salford that we need a complete reformation of the system—I will not repeat the points of the campaign, which I endorse. I am deeply concerned about the prospect of cuts to eating disorder services. It is a great shame that the proportion of NHS spending on mental health is declining. That is very significant.

I pay tribute to the sufferers—these amazing people who battle through this awful illness. They are mostly girls but also young men—I know a young man who is still in the grip of the condition. And I pay tribute to their families. I emphasise, as I am sure the hon. Member for Bath would, given her experience, that there is hope. We must not give up on these young people. We must absolutely provide the services that are needed. We need to get our systems and our society right.

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[Perran Moon (Camborne and Redruth) (Lab)]

Meur ras, Mr Stuart; thank you for your chairship. I thank the hon. Member for Bath (Wera Hobhouse) for securing this important debate. I declare an interest: I am also a member of the eating disorder APPG.

As has been mentioned, recent data suggests that one in eight 17 to 19-year-olds in England have an eating disorder—a massive increase from fewer than 1% in 2017. On average, young people are now waiting for almost three and a half years to get treatment.

My relationship with anorexia began nine years ago. It is a story that I am sure resonates with many thousands of other parents the length and breadth of Britain; frankly, it is a massive part of why I became an MP. My story began when I took a phone call from a teacher at my daughter’s school. She asked me to come and collect her, as she had passed out, having not eaten breakfast or dinner.

Over the next few months and years, my daughter, whose relationship with food had already become terribly distorted, unbeknown to me, was clutched by anorexia. Its claws dug deeper and deeper into her as she slipped into a desperately poorly state. She became too unwell for school, and the pressure of her exams was like a ton of bricks on her as the anorexia gave her a cruel outlet for the control—something that sits behind so much of this—that she sought in her life.

As parents, our most solemn undertaking is to protect and nurture our children. Against this terrible illness, I was utterly useless. As my daughter’s illness took hold, I became more and more angry: first with her, then with others, and then with the system. It was only years later that I had to have it explained to me that that anger was actually driven by fear. I was impotent to support my daughter. Worse still, I was incapable of finding anyone else who could provide her with the care that she so desperately needed.

Here is the killer blow. The only way she could qualify for lifesaving support was if she became critically ill—so ill that she was staring death in the face. Imagine sitting at the kitchen table for hours, watching your emaciated child looking terrified at a small plate of food in front of her and hoping that she does not eat it, so she becomes so ill that she qualifies for the support that she needs. Those truly shameful thoughts are etched on my conscience and visit me every single day. They have left an indelible stain on my soul. For having those terrible thoughts, to my daughter, wherever she is, if she sees this speech, I want to say, “I’m sorry, my lamb.”

[Wera Hobhouse]

I congratulate the hon. Member on being so brave in talking about his own experience. I, too, have a daughter who suffered from an eating disorder; she was not quite as ill as he describes his daughter being, but I am still visited by those hours—though they were many years ago—when I was gripped by fear and anxiety. It is only by sharing these stories that we can ultimately bring all this to light, so again I thank him for being brave enough to share that.

[Perran Moon]

I thank the hon. Member. How could a system be so warped as to make a parent feel that way about their own child—the thing they love most, more than anything else in the world? Measuring the criticality of eating disorders through BMI is a medieval evaluation, hopelessly inadequate to the needs of the sufferer. Proper psychological assessments must be undertaken at the earliest identification of a problem, with a package of appropriate measures applied thereafter, dependent on the severity of the case.

My daughter spent two periods of six months in hospital. She recovered her health and is today working in the NHS in mental health services as a senior assistant psychologist, using her own painful experience to offer others the care and support she never had. Under-investment has left mental health services stretched beyond capacity, and young people like my daughter become desperately unwell while sitting on waiting lists, with the cost of their recovery, both emotionally and financially, spiralling by the day.

I know the Department of Health is taking the issue incredibly seriously, but we must prioritise a rapid overhaul of the system to offer hope to young people and their families. This Government must prioritise investment into mental health and eating disorder services. Today, I ask the Minister to say to all the families going through that hellish tornado of pain, to all those angry dads, tearful mums and terrified children, “Hang in there. We will come for you. We know your pain and we will act swiftly to help you to relieve it.”

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[The Minister for Care (Stephen Kinnock)]

It is a pleasure to serve under your maiden chairship today, Mr Stuart. I am extremely grateful to the hon. Member for Bath (Wera Hobhouse) for securing the debate and raising this important topic. I know that, as a Member of this House and chair of the APPG on eating disorders, she has been a doughty champion for those living with eating disorders, their families and supporters. I am also grateful to other hon. Members for their valuable contributions, many of which were deeply personal and profoundly moving. I pay tribute to hon. Members for making those contributions.

I share the desire of the hon. Member for Bath to improve the lives of people affected by an eating disorder. Raising awareness of eating disorders and improving treatment services is a key priority for the Government, and a vital part of our work to improve mental health services. We know that living with an eating disorder can be utterly devastating, not just for those battling the condition but their loved ones and those who witness their struggle. We know that eating disorders can affect people of any age, gender, ethnicity or background. However, we also know that recovery is possible, and access to the right treatment and support can be lifechanging, as we have heard today.

Although record investment and progress has improved access to eating disorder services, the reality is clear: demand has surged, especially since the pandemic, outpacing the growth in capacity. We must do more to ensure that everyone who needs support can get it without delay.

[Wera Hobhouse]

The Minister is making a powerful point. Demand is surging, yet it seems that investment from ICBs is going to fall. How can that be possible, and how is it morally acceptable?

[Stephen Kinnock]

National funding has increased over the years, as the hon. Lady will know. The question is whether that funding channels through to ICBs. The Government’s view is that ICBs are best placed to make decisions as close as possible to the communities that they serve and to target and, if necessary, reallocate funding accordingly. As a Government, we are constantly trying to get the balance right between setting frameworks and targets and ensuring that those are being met, while also ensuring that ICBs are not being micromanaged from the centre. We do not think it is right that people sitting in Whitehall or Westminster micromanage what is going on at a local level. We are absolutely clear that every ICB must meet its targets, while also being clear that it is up to the ICB to take decisions as close as possible to the communities that they serve.

Sadly, we have seen the prevalence of eating disorders in children and young people sharply increase since 2017. In 2023, NHS England published follow-up results to its survey on the mental health of children and young people. The report found that the prevalence of eating disorders in 17 to 19-year-olds rose from 0.8% in 2017 to 12.5% in 2023. Unfortunately, we are also seeing the prevalence of eating disorders rising among adults. The 2019 health survey for England showed that 16% of adults over 16 screened positive for a possible eating disorder. The figures do not mean that the individual had a confirmed eating disorder, but they present a worrying situation that we must address by continuing to promote both awareness and early intervention.

The surge in demand has inevitably made meeting our waiting time targets more challenging. However, our services and clinicians, backed by new funding, are supporting more people than ever before. These services are changing and saving lives. As hon. Members will know, we have kept in place the access and waiting time standard for children and young people who are referred with eating disorder issues. This sets a 95% target for children with urgent cases to begin treatment within one week, and for children with routine cases to start treatment within four weeks.

Figures released last month show that although the number of referrals and demand for services has begun to stabilise during the past year, the number of children entering treatment reached a record high of 2,954 last quarter. This shows that the extra funding is enabling services to begin to meet the extra pressures caused by the pandemic. Similarly, the number of children entering treatment within the target time has reached a record high. Of the 2,954 children entering treatment last quarter, 2,414 were able to access that treatment within the one-week urgent target or the four-week routine target—a rate 81.7%. That is the highest figure recorded since NHS England began collecting that data in 2021.

However, we recognise that there is still far more to be done to ensure that patients with eating disorders can access treatment at the right time. The hon. Member for Bath rightly focused the debate on the importance of awareness. Raising awareness of eating disorders is the first step towards early intervention to prevent the devastating impacts that eating disorders can have on people’s lives. To support this, NHS England is currently refreshing guidance on children and young people’s eating disorders.

The refreshed guidance will highlight the importance of awareness and early recognition of eating disorders in schools, colleges, primary care and broader children and young people’s mental health services. A number of colleagues asked when that guidance will be published; my officials are working hard with specialists on that, and it will be published later this year.

The existing mental health support teams, supplemented by the specialist mental health professionals that we will be providing access to in every school in England, will support school staff to raise awareness and identify children and young people showing potential early signs of an eating disorder. Through these interventions, children and young people can be given early support and help to address problems before they escalate.

Community-based early support hubs for children and young people aged 11 to 25 also play a key role in providing early support for young people’s mental health and wellbeing. Early support hubs provide open-access drop-in mental health services that assist children and young people with a range of issues, such as eating disorders, at an early stage without the need for a referral or doctor’s appointment.

I am pleased to say that this year, thousands more young people will receive support with their mental health, thanks to £7 million of new funding for 24 existing community-based early support hubs to expand their current offer. That funding will deliver 10,000 more interventions such as group sessions, counselling therapies and specialist support over the next 12 months. Looking forward, we are also committed to rolling out open-access young futures hubs in communities. This national network is expected to bring local services together and deliver support for young people facing mental health challenges, including support for those with eating disorders.

We should also be concerned about the widespread availability of harmful online material that promotes eating disorders, suicide and self-harm, which can easily be accessed by people who may be vulnerable. We have been clear that the Government’s priority is the effective implementation of the Online Safety Act, so that those who use social media, especially children, can benefit from its wide-reaching protections as soon as possible. Our focus is on keeping young people safe while they benefit from the latest technology. By the summer, robust new protections for children will be enforced through the Act to protect them from harmful content and ensure that they have an age-appropriate experience online.

It is right to focus on awareness and early intervention, but we know that some people simply need access to high-quality treatment in order to get better. A key priority of this Government is therefore to expand community-based services to treat eating disorders, so that people can be treated earlier and closer to home. NHS England is working to increase the capacity of community-based eating disorder services. By improving care in the community, the NHS can improve outcomes and recovery, reduce rates of relapse, prevent children’s eating disorders continuing into adulthood and, if admission is required as a last resort, reduce the length of time that people have to stay in hospital.

I am pleased to say that funding for children and young people’s eating disorder services has increased, rising from £46.7 million in 2017-18 to a planned £101 million in 2024-25. With this extra funding, we can focus on enhancing the capacity of community eating disorder teams across the country. We are also committed to providing an extra 8,500 new mental health workers across child and adult mental health services to cut waiting times and ensure that people can access treatment and support earlier. Through the 10-year health plan, this Government will overhaul the NHS and ensure that those with mental health needs, including those living with eating disorders, are given the support that they need.

I share the concern of the hon. Member for Bath about accurate recording of deaths to understand the extent to which eating disorders and other factors have caused or contributed to deaths. This matter is being explored with the national medical examiner for England and Wales, the Office for National Statistics and the Coroners’ Society of England and Wales.

Hon. Members also raised concerns about BMI. It is not right that any individual is being refused treatment based on their weight or BMI alone. National guidance from the National Institute for Health and Care Excellence is clear that single measures such as BMI or duration of illness should not be used to determine whether to offer treatment for an eating disorder. I am ready to receive any representations from colleagues who have evidence that that is happening, and I would be happy to raise that with the appropriate channels.

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[Wera Hobhouse]

First, thank you Mr Stuart for chairing your first Westminster Hall debate so well; you kept us in order and on time. I thank all Members for their wide-ranging, thoughtful and moving contributions. Sharing our stories can raise awareness, but it takes a lot of courage. As we have heard, eating disorders do not discriminate on the basis of age, gender or background. Although they disproportionately affect young women, it is important that we keep an eye on young men—we heard very good contributions on that.

Eating disorders are a national emergency—I reiterate that even after hearing the Minister’s response. Although some things might be improving, as I said at the beginning, I have been here for six years and, on the whole, things have got worse, not better.

We have heard about the Minister’s sharp elbows, and we have heard that there is hope. This debate is an annual event, and I hope that next year I am able to come here and say that the situation has got better, not worse. We owe it to all sufferers. As my hon. Friend the Member for Chichester (Jess Brown-Fuller) said, it is a moral outrage that we have continued to let the situation deteriorate. It has to get better. Next year, I want to be able to say that we have made real progress. The APPG and I want to work with the Government to make the situation better. Campaigners are there to help; we need to work together. I hope that it does not get worse for another year.

Question put and agreed to. 

Resolved,

That this House has considered eating disorder awareness.