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Frequently Asked Questions about Eating Disorders
Where can I access NHS treatment near me?
Can eating disorders be prevented?
Can people get better from eating disorders?
What is BMI?
What are "Pro-Ana" and " Pro-Mia" Websites?
What is Orthorexia?
Where can I access NHS eating disorders treatment near me?
For children and teenagers aged up to 18, your local NHS Child and Adolescent Mental Health Service should be able to help. Please discuss this with your GP.
For adults aged 18+ community-based treatment should be available in the Primary Care Trust area where your GP is based. A GP or consultant referral is required.
Manchester North, Central and South: Manchester Eating Disorders Programme, Gaskell House, Swinton Road 0161 277 1120
Stockport: Oakwood House NWCED, contact us by clicking here
Tameside: Ask your GP to contact Effective Use of Resources, Mossley Health Centre on 01457 850 522
Salford: Willows Eating Disorders Service, Lord Street, 0161 212 4341
Bolton: Breightmet Health Centre 01204 463 979
Wigan and Leigh: Accessed via Willows Eating Disorder Service, Salford, 0161 212 4341
Trafford: accessed via PCT commissioning, Alex Cotton 0161 873 6057
Bury, Rochdale and Oldham: speak with your GP
Macclesfield: Jocelyn Solly House, Victoria Road 01625 505 621
Derbyshire: Bridgefoot, Belper
Leicester: Brandon Unit, Leicester General Hospital 0116 225 6180
Liverpool and Sefton: William House, Rathbone Hospital 0151 471 7751
Chorley: Euxton Lane 01772 647072
Nelson: Pendle House, Leeds Road 01282 657 999
Can eating disorders be prevented?
The simple answer is, no, given the inevitable occurrence of vulnerability factors and triggers for all eating disorders in our culture. But sensible prevention measures include:
- raising children and adolescents in environments that promote healthy acceptance of normal body image and a non-dieting approach to healthy eating
- teaching young people to question and reject images of unrealistically thin people such as those used in advertising , television and cinema
- teaching young people to question the "healthy" message used to market "diet" foods (such as non-fat or artificially sweetened foods, diet brands and so on)
- helping children and young people to value positively adaptive personality traits and talents in themselves and others rather than appearance or weight
- encouraging young people to get involved in non-competitive socially engaging activities and community citizenship
Can people get better from eating disorders?
The simple answer is, yes, recovery is possible and about half of all people who get treatment eventually become fully free of eating disorder symptoms. Those who recover generally regain full physical and emotional functioning. About a third of those who receive treatment improve overall but may continue to experience some symptoms or will have periodic lapses into eating disordered behaviour. About a fifth of those who receive treatment will unfortunately get worse or develop a chronic eating disorder. A small proportion, primarily those with anorexia, will eventually die of complications from starvation, purging or suicide.
There is sparse research on what happens to people who don't get treatment. Due to inadequate treatment provision in the UK, plus the tendency for some individuals with eating disorders to avoid treatment, a larger proportion of those with eating disorders never access treatment that those who do. There is a suggestion that some people who don't receive treatment improve by themselves or with the help of their families, but there is an "invisible" population of people with eating disorders that little is known about, but who inevitably suffer debilitating effects on their health and social functioning.
Research does show us that specialist care teams tend to be more effective in treating eating disorders than generalist care teams. However, no particular method or theory of treatment appears to be superior. The three main factors influencing positive outcomes in eating disorders treatment are:
1) the eating disorder is detected within a year or two of onset and good quality, timely treatment is accessed.
2) the person with eating disorder possesses motivation to recover.
3) the person with eating disorder belongs to a supportive familial or social network.
What is BMI?
Body Mass Index is a simple way for health professionals to measure a person's weight in proportion to their height. The formula is: (weight in kilograms) divided by (height in meters squared), or kg/m2. These days electronic BMI calculators are often built into bathroom scales, and handy online BMI calculators are easy to find with Google
Normal weight is considered to fall with the range of BMI 19 - 25. Underweight individuals are likely to experience increasing symptoms of anorexia the further their BMI falls beneath 19. If weight falls below BMI 17.5 a formal diagnosis of anorexia may be made although people can suffer all the symptoms of anorexia at higher weights depending on their weight when weight loss commenced.
BMI must not be the sole criterion for making clinical decisions on the intensity of treatment required. A thorough assessment of all features of the eating disorder and related symptoms must be conducted, covering medical, dietetic, psychiatric and social circumstances. One person may maintain a very low BMI while remaining medically and psychiatrically stable. Other person may have a less alarming BMI but be losing weight rapidly, or have chaotic patterns of binge eating and purging, or suffer medical consequences of starvation or purging, or have a concurrent psychiatric illness such as depression, anxiety, OCD or post traumatic stress which puts them at risk.
What are "Pro-Ana" and " Pro-Mia" Websites?
Pro-ana/pro-mia websites welcome individuals who have an eating disorder or may be at risk of developing one. Their primary goal is to promote extreme weight loss. These websites are recognized as having detrimental effects on the health, body image and self esteem of vulnerable individuals. Pro-ana/mia sites tend to come and go, being removed or frozen due to their abusive and manipulative content.
Pro-ana/mia sites promote methods of maintaining unhealthy eating patterns and unnaturally low body weight by any means possible. They fail to highlight the negative effects on physical and psychological wellbeing. They exploit the competitiveness inherent in anorexia and bulimia while also promoting the notion of a "pro-ana community" that the (potentially socially isolated) viewer can belong to. They seem to be written by those who have first-hand experience of eating disorders, so vulnerable girls may feel these sites are a rare source of understanding and unconditional positive regard.
Some sites give information on unlicensed diet pills, appetite suppressants and weight loss drugs and how to obtain them. Others use shocking photos of semi-naked skeletal girls and women to promote their message. Some give glamorized accounts of the purported dietary and exercise regimes of thin celebrities such as Victoria Beckham or Angelina Jolie. These emphasize fasting and encourage an exceedingly low calorie intake which omits essential food groups. Some include rigorous exercise plans that ignore the effect on the body and mind of hard exercising on a dangerously low calorie intake.
Many pro-ana/mia sites display pages devoted to "pep talks" or "thin-spiration," including misleading statements that display the hallmarks of the cognitive distortion typical in anorexia and bulimia that generate feelings of disgust and self-deprecation surrounding eating. "Thin-spiration" may adopt an aggressive and personalized approach, with statements such as "if you eat now and throw away what you are working for I will hate you." These statements reflect and magnify the self-directed hostility felt by people with eating disorders, so the website actually represents the authoritarian, cruel "voice" that many people with eating disorders experience as telling them not to eat. These sites may also warn readers to expect days of feeling extremely hungry and/or poorly, urging them to believe they are closer to their goal if they become sick with symptoms of malnutrition.
What can be done about pro-ana/mia sites? Pro-ana/mia sites cannot be banned or criminalized, but the Royal College of Psychiatrists in a position paper published in 2009 (http://www.rcpsych.ac.uk/pressparliament/pressreleases2009/proanawebsites.aspx) have recommended that the media avoid making headlines out of these sites and not sensationalize eating disorders in general. They have also recommended that parents receive information about these sites from their children's schools; and that alternative, helpful sources of advice and support be recommended to people at risk of eating disorders such as that provided by B-EAT, the UK eating disorders charity.
What is Orthorexia?
“Orthorexia” is not a clinical diagnostic term. It was coined by U.S. physician Steven Bratman to describe an anxious preoccupation with healthy eating. Bratman describes how the preoccupation develops rather innocently as a desire to improve health and/or overcome illness. Main characteristics of orthorexia include planning meals more than 24 hours in advance; only eating at home to control food; low self-esteem; perfectionism; being self-critical; feeling guilty when eating ‘incorrect’ food; looking down upon individuals whom they feel do not eat the ‘right’ foods; feeling pleasure from the idea of how healthy the food is more than actually eating it; obsessive focus on ‘better’ quality food leading to decreased social activities; and overall decreased quality of life. People with this preoccupation may avoid foods which have artificial colours, flavours, preservatives, fat, sugar or salt, animal or dairy products and pesticides etc. Orthorexia (as described) bears similarities to anorexia, however where people with anorexia will pursue weight loss and weight control at all costs, people with orthorexia focus on the quality of food and attempt to achieve purity in terms of general health. However, the extreme pursuit of a “healthy” diet can lead in some cases to malnutrition due to misguided beliefs.