Almost nine years ago to the day, I was standing on a set of scales in my GP’s surgery, waiting to be told if my weight had stabilised or dropped.
I remember thinking that not weighing myself regularly was something that separated me from people with eating disorders, and I wondered if my GP was thinking the same. I ate sweets and chocolate, and I didn’t obsess over calories. Nor did I think I was fat when I was clearly underweight; a lot of people with eating disorders fail to recognise when their weight loss has gone too far – I knew I was too thin.
A lack of research and an imbibing of popular assumptions had led me to believe that people with eating disorders belonged to one of two camps: bulimia and anorexia. Since my behaviour did not fit neatly into either of these, I presumed I didn’t have an eating disorder.
I did, of course. Though it was hardly surprising that I didn’t feel able to attend support groups out of fear that I wouldn’t be as extreme in my actions – or as thin – as other attendees. Equally unsurprising was my failure to concede that I needed a doctor’s support. Yet my mum noticed my weight loss, food restriction and fear of gaining weight, and urged me to see a GP to ensure that my health didn’t deteriorate. This I did – but with the knowledge that my BMI wasn’t far enough below that of a healthy person (PDF) to warrant either inpatient or outpatient treatment. The most my doctor could do was monitor my situation and recommend a meeting with a counsellor (who, it transpired, was only available on the days I was at work).
For many people with an eating disorder, a visit to a local GP can be the first step on the path to recovery. Yet for a growing number of people, a GP may be the only healthcare professional they meet. According to recent reports, growing caseloads have necessitated that people with severe anorexia (as opposed to moderate or mild anorexia, as was my diagnosis) (PDF) be prioritised by specialist services, meaning those whose lives are not in immediate danger may have to wait years for – or simply be denied – specialist treatment.
Following a few years of maintenance and relapse, I am now fully recovered and I count arming myself with knowledge, the people I met through volunteering for charities, and the bold risks I took with food among the tools that helped me get better. However, key changes must be made to ensure that those whose diagnosis is not severe enough for specialist services can still find support.
Since GPs are often the first port of call, simply validating someone’s experience can help them accept that they have an eating disorder. For many, a fear of not being taken seriously on the basis of weight and appearance (put crudely: a fear of not being thin enough) can be enough to discourage them from seeking help, a point made more salient when we consider that only 10% of people with an eating disorder are actually underweight.
It is therefore up to the GP to foster a culture of acceptance, and not use somebody’s weight or shape as a guide to the severity of their illness. My GP was empathetic, but one or two things she said made me feel like I shouldn’t seek support for an eating disorder. When I complained about severe fatigue, for example, she gave me a muscle-strength test they “usually used for anorexics”, a statement implying that I didn’t belong to a more worthy and needful set of patients.
I also got the classic advice that “Your body is like a car: it needs fuel in order to work”. People with eating disorders are aware of this and struggle with the dissonance it can cause on a daily basis. Likewise, phrases like “You need to eat to live” and “Don’t let your weight drop any lower this week.” imply an element of choice and display a lack of understanding for the deeply entrenched schemas that lie behind a patient’s struggles.
Further to this, there needs to be a greater availability of regular community support groups, marketed in a way that highlights the fact that you don’t have to be of a certain weight to attend. Unless the group is affiliated to a specialist service, a diagnosis prior to attending the group shouldn’t be necessary.
Eating disorder charity Beat has a list of services across the UK (for both people with eating disorders and those supporting them) that includes self-help groups. Is also has a helpline and online support facilities. For university students who are struggling with an eating disorder, Student Minds coordinates a network of peer-led self-help groups in most universities as well as workshops for people who are living with or supporting someone with an eating disorder.
Finally, when specialist services are not an option, GPs should make sure to recommend organisations that support and educate friends and family members. Eating disorders can be perpetuated by family dynamics and parenting styles; as a response to this, the Maudsley Method was designed by Prof Janet Treasure to help family members support loved ones. Eating Disorders and Carers (based in London ) and Yorkshire Eating Disorders (in the north-east) both offer workshops and presentations for people supporting someone with an eating disorder. Similar groups can be found via the Beat website.
When it comes to eating disorders, there is no blueprint or timescale for recovery. Nor is there a working definition of recovery that means the same thing to everyone. Healthcare professionals – particularly GPs – need to validate the experiences of every patient, regardless of their weight, remembering that it takes courage to admit to, and request support for, an eating disorder. A shortage of services ought not to result in a flat-out denial of help; I sought out knowledge and peer support, but patients’ resourcefulness must be complemented by robust professional guidance.
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