Eating Disorder Awareness

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.

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.

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.

Order. I remind Members that they should bob if they wish to speak in the debate. I will bring in an informal guide for Members: if everyone speaks for about four minutes, we can hopefully get everybody in.

It is a pleasure to serve under your chairmanship, Mr Stuart. I thank the hon. Member for Bath (Wera Hobhouse) for her fantastic, articulate and passionate speech, and for the work she has done, along with the rest of the all-party parliamentary group, on this very important issue.

According to Beat, at least 1.25 million people in the UK—that is one in 50 people—are living with an eating disorder. As we know, eating disorders are complex health conditions that are often misunderstood or undiagnosed, which often prevents people from reaching out for help. Even when somebody is brave enough to reach out for help, or they reach a crisis point that requires intervention, they often struggle through a complex and underfunded system that does not provide the comprehensive help they need.

As we heard, in January the eating disorders all-party parliamentary group published a stark report that stated that NHS admissions for eating disorders exceeded 30,000 for the first time in 2023-24, that eating disorder services have become worse rather than better over the past few years, and that some NHS trusts are discharging patients with a body mass index of less than 15 and even as low as 11.1. The most recent report from Beat, “There’s No Place Like Home”, found that, worse still, only one in seven NHS areas in the UK provides the recommended level of intense community and day treatment for children, young people and adults, with 6% offering that for children and young people only and 10% offering it for adults only. Those are staggering statistics but, as we know, behind them lie the real human stories, which highlight the inadequacies of the system as it stands and the heartbreak that the individuals and their families go through.

Over the years I have dealt with a number of cases. A few years ago there was a particularly harrowing case of a teenage girl whose weight had dropped so low that she was in a life-threatening crisis a number of times, but nearly every time she needed hospital admission her family were informed that no specialist beds were available. In one instance, she was offered a bed on a general paediatric ward, where staff were not trained in dealing with eating disorders. She was put on a refeeding plan, but because there were no specialist staff, she did not eat anything significant and her weight dropped even further. In another instance she was offered a bed on an adult psychiatric ward, which is a frightening place for any teenager, and in another the family were told that there were simply no beds available and that if they were really worried about her, they should just go straight to A&E.

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.

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.

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.

It is a pleasure to serve under you, Mr Stuart. I pay tribute to the hon. Member for Bath (Wera Hobhouse). When I was elected last year, I cared about eating disorders, but through her work on the APPG I have really come to understand them much more.

I pay tribute to the secretariat, Hope Virgo—it is almost insulting to describe her as the secretariat, because she is such a powerhouse and really cares about this issue. I made the mistake of doubting the ambition of the APPG but, through the hon. Member for Bath and through Hope, we have made fantastic progress. Through them, I was shocked to find out that people are entering palliative care because of eating disorders. That is a disgrace and a sign that the whole system is failing the people—largely young people—facing this disease. I hope the Minister acknowledges that that is unacceptable.

I am a Scottish MP, so I want to talk a bit about Scotland, where the situation is just as stressed as it is in England, but I will end with a slight glimmer of hope. Since I was elected last July, I have met people in Edinburgh South West who face eating disorders. I met a parent whose daughter had waited months for a consultation. They were filled with hope as the date arrived, only to find out that it was just a triaging slot to decide whether she should be referred to formal treatment months later.

I met a parent whose daughter had been admitted to hospital and was released over a few days to see whether she could cope at home. She could not, but when she was taken back after the weekend, she was told that the bed space had gone, and that left the family in absolute crisis.

I am not surprised that there is pressure on admissions. The number of people admitted in Scotland has increased substantially since 2007, and almost doubled during covid, so the system in Scotland is under real pressure. I spoke to the chief executive of my local NHS board about that, and she described the state of eating disorder treatment in the Lothians as at the absolute minimum acceptable level. I think we know what that means for many families.

It is a pleasure to serve under your chairship, Mr Stuart. I thank my hon. Friend the Member for Bath (Wera Hobhouse) for securing this debate and for all her work. It is important that we keep bringing attention to this important issue, because eating disorders continue to claim far too many lives and undermine the wellbeing of countless people.

As we have heard, recent statistics show the severity of the challenge. The proportion of 11 to 16-year-olds with an eating disorder rose from one in 200 in 2017 to five in 200 in 2023. Hospital admissions have doubled in the past decade, and as we know, hospital is not always the most appropriate destination. More alarmingly still, rates among 17 to 19-year-olds surged from one in 100 in 2017 to more than 12 in 100 last year.

Despite those worrying statistics, eating disorders are often viewed through a narrow lens. Conditions such as muscle dysmorphia are increasingly affecting teenagers and are challenging the stereotype of what an eating disorder is. Muscle dysmorphia is a dangerous condition that can lead not only to disordered eating, but in some cases to the use of anabolic steroids or other performance-enhancing substances, as we are increasingly seeing.

Social media platforms play an influential role in shaping perceptions of body image and can sometimes fuel these destructive conditions. We are continually exposed to curated images of supposedly perfect physiques, with posts and videos that can glamorise unhealthy behaviours. Although social media has the potential to serve as a space for positivity and connection, we must recognise that it can also intensify body-related anxieties and push vulnerable individuals towards extreme measures. Rather than letting this content spread unchecked, it is vital to ensure that any material glorifying unhealthy lifestyles, whether that means severe calorie restriction or steroid use, is firmly curtailed, while healthy evidence-based advice is made readily available.

It is a pleasure to serve under your chairmanship, Mr Stuart. I thank the hon. Member for Bath (Wera Hobhouse) for securing this extremely important debate and for the work that she and others have done with the eating disorders all-party parliamentary group.

I have come to this debate to speak up on behalf of the many people who have suffered from eating disorders, both past and present. I confess to having a personal interest, as one of those people is my mum. Like many people who suffer from anorexia, my mum developed the disorder as a teenager; as with many people, it came from being bullied by her peers at school. I do not want to give away my mum’s age—that is something that she would never forgive me for—but hon. Members will appreciate that that was a little while ago, although I believe that it has a huge impact on her even today.

I can only begin to imagine the additional pressure that young people suffer now that abuse and bullying does not end at the school gate, but extends online, with negative comments, memes and unrealistic, sometimes AI-generated body images. It has worsened a great deal since the pandemic. Approximately 1.25 million people have some sort of eating disorder. One in eight 17 to 19-year-olds in England were reported to have had an eating disorder in 2023. Having spoken to a resident in Harlow who wishes to remain anonymous, I know that this is as much an issue in my constituency as it is anywhere else. I urge anyone who is struggling with an eating disorder in Harlow to reach out.

The service lead for eating disorders at the Essex partnership university NHS foundation trust has described eating disorders as typically developing in adolescence and early adulthood, leading to changes in a person’s brain, body and behaviour. He also says that early intervention is essential in reversing these changes and improves the likelihood of a full recovery. More recently, the Royal College of Psychiatrists said that services are struggling with demand. In February this year, the Government said that NHS England were processing an update to the commissioning guidance on eating disorders. Can the Minister tell us what the recent announcements on changes to NHS England will mean for the publication of that guidance?

May I wish you well in your first debate in your new role as Chair, Mr Stuart? It is your first debate, and I am sure you will keep us all in order. You are always in order in the Chamber, so that sets an example. I jest, of course.

I commend the hon. Member for Bath (Wera Hobhouse) for leading today’s debate. She is greatly to be commended for having spoken about the issue in Westminster Hall and the main Chamber for so many years. I am grateful to be able to contribute to the debate; as the DUP health spokesperson, I have dealt with many issues on which people who have been suffering with eating disorders have sought help and support that will benefit them in the long term. As I always do in these debates, I will give some background on the situation in Northern Ireland, which replicates what other Members have said and will say.

Eating disorders present a significant health concern that affects all age groups back home. A study has found that some 16.2% of 11 to 19-year-olds in Northern Ireland met the criteria for a probable eating disorder. We are quite worried about that in Northern Ireland; I certainly am in Strangford, because it is absolutely shocking.

Between April 2022 and March 2023, the charity Beat delivered 603 helpline sessions to individuals aged 18 to 22 in Northern Ireland—a massive 225% increase, which is very worrying. Action Mental Health has revealed that between 50 and 120 people in Northern Ireland develop anorexia every year, and around 107 develop bulimia, which are worrying figures. There are approximately 100 admissions to hospital for eating disorders every year. I know that the Minister does not have responsibility for Northern Ireland, but I add that information because it shows how things are back home. I will give an example of how we have managed to overcome the problem.

There are many risk factors for eating disorders, including genetics, psychology, trauma, abuse and—a large one for young people today—social media, to which the hon. Member for Bath referred. It is important to remember that eating disorders can affect anyone, not just young people and not just women. It has been said that early intervention is essential for improving outcomes and for reducing the duration of the disorder. There is commonly a stigma around eating disorders; more often than not, people suffering with an eating disorder feel extreme shame.