Eating disorders: we need to be offering help that actually helps and recognises that eating disorders are not about food but feelings.

In seven days, Eating Disorder Awareness Week begins. Like all such initiatives, it provides a welcome opportunity, often with mainstream media interest and coverage, to shine a spotlight on eating disorders and highlight key issues with getting access to the right support and resources.

I work with a lot of clients with eating disorder(s) and focused my Masters research on eating disorders last year. It is a topic which has increased in public consciousness since COVID and the subsequent much-reported increase in referrals to NHS services for those experiencing eating disorder(s) - and the widely-reported significant increases with children presenting at home and school with eating disorders. 

I care passionately about those living with eating disorders and, sadly, no, infuriatingly, hear story after story, week after week of negative experiences that clients of mine have when interacting with NHS and private providers of eating disorder support services. 

In my opinion, it is a national disgrace that in the UK, those who encounter eating disorders - which has the highest mortality rate of any mental health condition - are mostly offered under-funded, under-resourced, short-term, one-size-fits-all, inadequate help. 

They are let down by the system again and again. Sometimes because they cannot access any help - they are deemed not sick enough (often simply by weighing them) - or because they are “treatment resistant”, which translates to being too hard to help in the time the NHS and others have allocated that it takes to recover from an eating disorder. Just let that sink in. You have a mental health condition which has the highest death rate of all mental health conditions and you are not offered help because you are not close enough to death yet, or because you are too close to death.

Time and again, I meet clients who have received medical interventions in hospital which saved their lives. They are given treatment which provides the nutrients and vitamins to prevent death. This is vital work and work which, although can be crude and emotionally painful for the client (or patient as the NHS deems them) is necessary in these moments of crisis. What happens next is where things go off the rails. 

Time and again, I meet clients who have been receiving apparently specialist  “help” for years that has done nothing to help them deal with the underlining causes of their eating disorder(s). In many cases, clients tell me that things got worse for them. Time and again, I meet clients who have received medical intervention, which saves their lives, but in the moment of most need they are refused the necessary complementary therapy, which could help them deal with the root causes of what brought them into hospital in the first place. In these moments, clients tell me they are told they are “cognitively impaired” or “not thinking straight” so they cannot properly engage with therapy. Their brain has been too starved - sometimes literally - to make meaningful use of talking therapies. Their treatment therefore focuses on weight and food only. 

This - my clients often tell me - is the moment they feel most abandoned and let down. They are only ever given time and space to talk about food, calories, physical health and the need to change their eating habits - “you need to eat more”. Believe it or not, this is what many clients of mine are told by senior healthy professionals, as if it was just that simple. 

In one of the cruelest aspects of their experience clients have also told me that having been denied therapy because they are not eating enough, they are then discharged from the service before therapy is offered as they have started eating more and reached a healthy weight. Time therefore to move them out and bring in a person who is in greater (medical) need. In other words, closely to imminent death without intervention. Some clients have told me that they have eaten more - or told their doctors/nurses what they know they want to hear about how they are feeling - simply to get out of hospital because it is so painful or being there was making matters worse for them. 

They are not given the time and space to talk about the reason they needed the eating disorder - the pain, fear, anxiety, trauma and more that the eating disorder was trying to soothe. The eating disorder is there for a reason. This reason(s) needs understanding and addressing.

They are not offered the chance to unpack what has brought them to the place where, for some, eating feels more dangerous than the possibility they are running of having a heart attack. They are not given the opportunity to fully understand why their relationship with food, and often exercise, changed to become damaging and dangerous. 

Instead they are given the formula they must follow of three meals and three snacks a day, with family members (or others) taking on the role of the food police, which creates more anxiety, conflict, trauma and often drives them more into the arms of the eating disorder. 

We need to move away from a one-size-fits-all model. 

We need to listen to those with eating disorder and tailor the support to their individuals needs. 

We need to offer therapy to all those with an eating disorder and give them the time and space to uncover, understand and address the root causes of their eating disorder(s). 

We need to put serious money into eating disorders but also serious thinking into how support is offered and structured. 

We need to recognise that eating disorders are not about food but feelings.

We need to give people the real help they need. 

We need to do better.