Eating Disorders Awareness Week takes place 1–7 March 2021. This year, eating disorder charity Beat is focusing on binge eating disorder (BED). This involves a person experiencing a loss of control and overeating on a regular basis.

BED is one of many types of eating disorder, and the symptoms of one can overlap with another. Research suggests that eating disorders are not about food. Treatments therefore focus on tackling the thoughts and feelings underlying the disordered behaviour.

Binge eating disorder

People with BED may eat an unusually large amount of food in a short period of time, often when they are not hungry and to the point of significant discomfort. To qualify for diagnosis in the UK, binges must occur on average twice a week over a six-month period. Those suffering from BED often report feeling that they have no control over their eating.

According to Beat, more people live with BED than anorexia nervosa or bulimia nervosa. It can affect anyone at any age and it can be life threatening. One in six people who have suffered from BED have attempted suicide. Despite this, it remains a relatively hidden disorder, poorly understood by the general population. Many experience high levels of shame associated with binges, feeling that they lack willpower and restraint. Perhaps because of this, Beat says that only one in four people suffering from BED ever receive treatment.

Anorexia nervosa

Perhaps the most widely recognised eating disorder among the general public, anorexia nervosa is marked by severe restriction of calorie intake, an intense fear of gaining weight, and significant importance placed on body shape and weight in self-evaluation. Warning signs of anorexia can include dramatic and rapid weight loss, a refusal to eat certain foods, dressing in layers of clothing to keep warm, and an intense desire to burn off calories.

Like all eating disorders, anorexia is a dangerous illness. It carries the highest mortality rate of any mental illness. Physical complications can include muscle and bone problems, such as osteoporosis; damage to the brain leading to seizures and memory issues; and heart problems including heart failure.

Bulimia nervosa

Those suffering from bulimia nervosa are caught in a cycle of eating large amounts of food, and then compensating by vomiting, taking laxatives, fasting, or exercising excessively. It is in this ‘purging’ that bulimia differs from binge eating disorder, although the two disorders do share some symptoms.

People with bulimia tend to maintain a healthy weight, making it easier for them to hide their disorder from others. They may appear preoccupied with food, and display secretive behaviour or discomfort when eating in front of others. The cycle can dominate a person’s daily life and lead to difficulties with relationships and social situations. Physical complications from frequent vomiting include damage to the teeth, low blood pressure and irregular heartbeat, and kidney failure.

Who is most at risk from eating disorders?

Eating disorders affect all kinds of people. Around 75% of those with an eating disorder in the UK are female. Causes, triggers and risk factors are complex, and often vary from patient to patient. However, researchers have found that certain characteristics increase the risk of developing an eating disorder. These include:

  • having a close relative with an eating disorder;
  • having perfectionist tendencies and displaying inflexible behaviour;
  • a history of anxiety disorder;
  • an experience of historical trauma, often in childhood; and
  • high levels of body image dissatisfaction.

What treatment is available?

Eating disorder treatment services are available from the NHS for both children and young people and adults. The National Institute for Health and Care Excellence (NICE) has published guidelines setting out separate treatment options for BED, anorexia, and bulimia.

The majority of patients will access some form of outpatient treatment, such as cognitive behavioural therapy or guided self-help. Seriously ill patients may be admitted to a specialist eating disorder inpatient ward, where they undergo a strict regime of regulated meal and snack times, therapy, and skills classes. NICE provides guidance on criteria for admitting patients to inpatient treatment. Severely underweight patients admitted may be at increased risk of refeeding syndrome, a potentially fatal condition caused by the reintroduction of electrolytes to the body.

Problems accessing treatment

On 15 December 2012, 19-year-old Averil Hart died from severe anorexia. Averil’s father, Nic Hart, complained to the Parliamentary and Health Service Ombudsman (PHSO) about failures in the eating disorder care his daughter received at four different NHS organisations. In its subsequent 2017 report, the PHSO found that Averil’s death would have been avoided if the NHS trusts involved had cared for her appropriately. As part of the wider recommendations in the report, the PHSO called for reviews into:

  • the training for all junior doctors on eating disorders;
  • why adult services appear to fall short compared with services for children and adolescents; and
  • how current education and training can address the gaps in knowledge among non-specialists around how to treat eating disorders.

In 2019, eating disorder charity Beat published a report arguing that a ‘postcode lottery’ existed for NHS eating disorder treatment in England, with patients in some areas experiencing much longer waiting times than others. It supported the findings of the PHSO on the difference in provision between adult services and services for children and adolescents.

Long waiting times can have serious consequences for those suffering with an eating disorder. These include patients making themselves more ill in an attempt to access treatment sooner, and harmful doubts about whether a patient is really ‘deserving’ of treatment at all. Beat have called for the introduction of an ‘access and waiting time standard’ for adult community eating disorder services, as exists for child and adolescent services. Beat states that the introduction of a standard would:

be a major step forward towards an NHS where all adults with an eating disorder can benefit from timely access to evidence-based treatment.

The proposal was supported by several MPs in the House of Commons in a debate to mark Eating Disorders Awareness Week 2020. Speaking for the Government, Nadine Dorries said that improving eating disorder services is a key priority, and that it remained committed to developing a waiting times standard for adults by the end of 2020. At the time of writing this has yet to be published. In answer to an oral question on 19 January 2021, health minister Lord Bethell said:

Eating disorders are serious, life-threatening conditions, and we are committed to ensuring that people have access to the right support when they need it. We are growing our investment in community healthcare for adults year on year, with almost £1 billion extra by 2023, with specific funding to transform adult eating disorder care.

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Cover image by Beat: The UK’s Eating Disorder Charity.