That this House has considered Eating Disorders Awareness Week.
It is a pleasure to serve with you in the Chair, Ms Harris. I thank the Backbench Business Committee for granting the debate, and all colleagues across the Chamber who have supported it.
Across the United Kingdom, an estimated 1.25 million people have an eating disorder. That includes binge eating disorder, bulimia, anorexia and other specific feeding or eating disorders—indeed, any disorder that avoids or restricts the intake of food. Left undiagnosed and untreated, eating disorders can be a silent killer. Anorexia has the highest mortality rate of any mental illness, and results from one study have shown that a third of people with binge eating disorder are at risk of suicide.
Increasing awareness and our understanding of the causes of eating disorders are crucial to providing the right care. Eating disorders are still hugely misunderstood. Does the hon. Member agree that Ministers must fund more research on that, because just 1% of mental health research funding is directed to eating disorder studies?
I completely agree. Indeed, the all-party parliamentary group on eating disorders inquiry on research funding found how crucial it is, and in particular that eating disorder research should be ringfenced. Some progress has been made, and the eating disorder charity Beat has made good progress on the issue, but more research needs to be done.
For too long, sufferers have been left feeling trapped and alone. Here in Parliament, we have been raising the alarm for some years about this rising epidemic, which still needs more urgent action from the Government. However, I want to acknowledge the good working relationships the eating disorders APPG has had with various Ministers. I hope that will continue, and that today’s debate helps us to make progress together.
The theme for this year’s Eating Disorders Awareness Week is eating disorders in men. Eating disorders do not discriminate. Many people think that eating disorders affect only women, but at least one person in four affected by an eating disorder is a man, and 89% of men and boys aged 16 to 18 in my county of Somerset worry about how they look. Those experiences are often overlooked.
Toxic stereotypes are pervasive, and half of respondents to a recent survey of men’s experience carried out by Beat did not believe that someone like them would develop an eating disorder. One male sufferer in five has never spoken out about their struggle. That is why the debate is so important. We must encourage men to speak up and get the help they need.
Other rigid perceptions of eating disorders persist. Eating disorders are frequently misunderstood and viewed as a lifestyle choice. Contrary to popular belief, eating disorders are most common among people with severe obesity. Too many people are still being turned away from treatment because their body mass index is too high. To imply that someone seeking help for an eating disorder is not skinny enough is a terrible mistake that can lead to added suffering, and I commend Hope Virgo for her tireless campaign, Dump the Scales, which has made a significant difference.
I thank the hon. Lady for securing this important debate. She will be aware that the variation of eating disorders called T1DE—type 1 diabetes with disordered eating—is a growing problem that affects young men as well as young women. The right hon. Member for Maidenhead (Mrs May) and I have been co-chairing an inquiry into that variation of eating disorders. I will not pre-empt what our report will say, but one thing is clear: professional support, both psychological and physical, is vital to these young people, who could otherwise end up seriously ill if they do not take their insulin—in some cases, it is fatal.
I thank the right hon. Member for his intervention. As I mentioned, eating disorders manifest themselves in different forms. We need to increase our understanding of the different types of eating disorders, and much more specialist treatment needs to be available to cater for people’s different needs. I thank him for mentioning that specific form of eating disorders among people who are suffering from diabetes.
As I mentioned, eating disorders result in years being stolen from young people, and they can take many years to recover from. Some of the figures are just staggering. A third of people with eating disorders recover fully, a third never really recover, and a third get worse. For the third that never really recover, it is a lifetime sentence of a life that is not as good as it could be. That is why early intervention and understanding the symptoms of eating disorders are so crucial. The earlier someone receives intervention for their eating disorder, the more likely they are to make a full recovery. The longer symptoms are left untreated, the more difficult it is for the person to recover.
Healthcare should focus on prevention before cure, and early access to the right treatment and support can be life-changing. Some 75% of SWEDA’s staff and volunteers have lived experience of an eating disorder, which is another aspect of this issue that is so important: we need to hear from more people who have lived experience of an eating disorder. Their speaking up and leaving behind the stigma that is still associated with eating disorders is so important, and I commend everybody who has come forward and talked about their lived experience. I understand how difficult that can be, but we need them to do it. All those working for SWEDA say that they wish they could have accessed help long before they were offered it. That is why such organisations are so important: they offer specialist therapy and support to people with eating disorders and body image issues before they become ill enough to need more intensive treatment.
Order. Members should be aware that I intend to begin calling the Front Benchers at 10.28 am. I call the Chair of the Women and Equalities Committee, Caroline Nokes.
It is a pleasure to serve under your chairmanship, Ms Harris. I congratulate the hon. Member for Bath (Wera Hobhouse) on having secured this important debate and thank the Backbench Business Committee for having agreed to it.
I will not repeat the statistics, because the hon. Member for Bath covered them brilliantly. She highlighted the scale of the problem and the fact that it is growing more among young men; of course, Eating Disorders Awareness Week 2023 particularly highlights the challenge for young men. I will focus on some constituency cases that I have come across recently, and on some areas where we can do better to raise awareness in order to start to tackle the root causes, thereby hopefully helping future generations of young people.
I say young people, and we all know that eating disorders are most likely to impact on 17-year-old girls, but the stark reality is that they can endure into much later life. I remember meeting groups of women in this place who were well into their 40s and still suffering from eating disorders. That is not to paint too negative a picture, because we know that people can recover from eating disorders. With the right support and, crucially, early intervention, eating disorders can be tackled successfully. However, we also know that more and more people are suffering from eating disorders in this country today and that covid exacerbated that. Being locked down in our own homes, confronted with image after image on social media, undoubtedly contributed to the problem.
Social media algorithms will serve to those with eating disorders more and more content that encourages harmful and dangerous behaviours. That is particularly worrying for younger and adolescent sufferers. Does the right hon. Member agree that platforms cannot be allowed to continue to profit from that via advertisements, and that the Online Safety Bill provides the perfect opportunity to address that?
That was exactly what I was going to ask the Minister: can we please make sure that the online safety legislation is used as a tool to oblige social media platforms to clean up their acts when it comes to profiting from legal but undoubtedly extremely harmful forms of advertising to people who are already suffering from very serious medical conditions? When it comes to eating disorders—specifically anorexia nervosa, which is the most lethal mental health condition there is—we have to make sure that we do not trivialising or dismiss them, regarding them as something that happens only to young girls and they get over it. The stark reality is that eating disorders kill more people than any other psychiatric illness.
We have seen from the evidence provided to all Members by the Royal College of Psychiatrists the increase in incidence, but we also know that waiting times are up hugely. I return to my initial point: early intervention is crucial. When somebody with an eating disorder asks for help, that is the time to give it to them, not 12, 24 or even more weeks later. We know there is a huge challenge with transfers from children’s to adult services. Too often, sufferers will fall through the cracks and be forced to go back to the beginning of a waiting list.
I want to highlight the case of one of my constituents— I will not give her name—who is currently suffering from a severe eating disorder and has been for years. She had been in children’s services for years but recently turned 18, which brought with it the challenge of finding her appropriate support. She is currently in an adult mental health bed in a secure ward. The stark reality is that she and two other girls in the area covered by the Southern Health NHS Foundation Trust were competing for the one bed available at Leigh House, which is the Hampshire-based specialist support unit for eating disorders. There we have it: an 18-year-old in an adult secure mental health unit, and a real challenge among clinicians to decide whether they will try to treat the physical symptoms of the eating disorder or the mental health conditions, and whether a mental health condition should take precedence over the physical problems.
I am delighted to participate once again in this debate in Eating Disorders Awareness Week.
An eating disorder is a cruel and distressing illness both for those who live with the disorder and for their families, who are so often at a loss as to how best to support their loved one who is experiencing the illness. As we have heard, an eating disorder can affect anyone, regardless of gender, age, ethnicity or social background, and the impact of this serious mental illness, affecting 1.25 million people across the UK, is profound. The causes are complex, and there is no quick fix to resolve this condition. There is no doubt that, as we have heard, the gap between the onset of the illness and the start of treatment is simply too long. While family members shrink into the grip of the illness before the eyes of loved ones, families are left feeling helpless to understand what is happening and how best to provide the support that is so obviously needed.
One innovation, or new measure, that has not helped the charities and those on the frontline seeking to support people living with this condition or in danger of developing an eating disorder is calorie information on menus, which has become mandatory in England. Although we all understand the good intentions behind it, I believe it is a misguided measure. The eating disorder charity Beat is urging the Scottish Government not to follow suit on that, for very understandable reasons.
My first knowledge of the issue of eating disorders was through the story of Karen Carpenter, who died at the age of 32 in 1983 because of illness related to her eating disorder, and then Lena Zavaroni, a Scottish singer and entertainer who died in 1999 at the age of 35 because of issues surrounding her long battle with anorexia. Both those young, beautiful and very talented women spent almost all of their short lives battling with this condition, and they ultimately lost their lives to it.
Is it not also important that we look at athletes? We have heard that a lot of eating disorders are combined with over-exercising. It is important that we look at those highly successful and high-performing people, who are in danger of developing an eating disorder.
Indeed. We have talked about the overlap and common ground between eating disorders and obsessive behaviour. That territory certainly includes issues such as athletes who are very conscious of body image and how to maintain it.
We have heard that eating disorders are often incorrectly, and perhaps almost exclusively, associated with young women. Stereotypes around the disorder mean that often men who are living with this condition can be deterred from seeking the help that they need. They can also have their difficulties and struggles misdiagnosed. That is why this year’s Eating Disorders Awareness Week theme is eating disorders in men. In fact, one in four people with eating disorders are men, and it is important that we raise awareness around that so that people understand this is not restricted to women.
Even though men are in the minority of those affected, an important issue, and one that I too struggle with in my gender, is that many males, and young males, fail to get help, and fail to admit and acknowledge their problems. That is not the case in every other walk of life—if the car is not working, we take it to the garage; if the television is not working, we get the TV repair man—but we sometimes struggle to get males to understand that if help is needed, they should seek help and get it.
Other health statistics show that men are notoriously poor at asking for the help they need, which is why they often have undiagnosed conditions. The creation of a gender stereotype around eating disorders makes it all the more difficult to break the barriers if young men develop this condition or are in danger of developing it. We need to be aware of that.
I am glad that the Scottish Government have made available support to the eating disorder charity Beat, to help to provide additional support and services across Scotland for those who are affected by this cruel illness. All medical courses in Scottish universities are discussing with Beat how to deliver, or are already providing, further training on this complex condition, of which we need to continue to develop our understanding.
Those living with the condition and their families have seen this illness tighten its grip on individuals and families who were already struggling with it during the covid pandemic. Many of those affected were left to the mercy of the awful online forums, which advise those living with the condition on how best to avoid food without family members noticing. In preparation for this debate I checked, and those online forums still exist. They are still operating and advising people how to fool their families into believing that they are eating when they are not—that is simply appalling. It is absolutely disgraceful that such sites can be hosted with apparent impunity, effectively promoting self-harm, which can and often does lead to death. When the Minister responds, I really hope she will address that.
This is a very serious condition. We work to try to remove any websites that host hate speech or incite hatred of any kind; these forums are equally dangerous, in my view, and they ought not to continue. They have been in operation, to my knowledge, for at least 20 years. There seems to have been no progress in tackling them. The takeaway for me today is that the Minister should at least tackle that element of the problem, while we all work together to try to improve treatment and diagnosis for those affected.
Order. I have to impose a five-minute limit on speeches.
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Owing to those perceptions, people with eating disorders face a postcode lottery in trying to access specialist treatment. Beat has found large inconsistencies in the availability of treatment for binge eating disorders. Only 12 of the 51 providers in England that responded to Beat’s freedom of information request offered all three services for binge eating disorders recommended by the National Institute for Health and Care Excellence.
In some areas, treatment for people with bulimia is being rationed according to the frequency of binging and purging episodes. In others, treatment is simply not available. The Somerset and Wessex Eating Disorders Association, also known as SWEDA, has seen a 150% increase in people seeking help for eating disorders compared with pre-pandemic figures. Its children’s service has been overwhelmed with young people and their parents desperately trying to get support.
Eating disorders can take years to recover from, and many children and young people need to continue their treatment into adulthood. Young people miss out on so many educational and social opportunities. These years are stolen from them, and that is not to mention the potentially irreversible effect on their physical health. Again, this affects girls and boys, men and women—eating disorders do not discriminate.
However, those organisations cannot cope on their own. Waiting times for eating disorder patients are out of control, and waiting lists for children’s eating disorder services have doubled since March 2020. From 2021 to 2022, only 61% of urgent cases started treatment within a week—well below the current NICE standard of 95%. I hope the Minister will be able to respond to that. For adults, there are not even targets in place. The Independent has revealed that more than 80,000 adults with eating disorders are waiting to be seen for therapy—a record number—while just 30% of adults got treatment within four weeks of their referral. Again, I hope that the Minister will refer to adult eating disorder services, where we do not have any waiting list targets or targets for support. It is very important that adult services get the same support as children’s services, where we have made progress because there are targets.
Data from the eating disorder charity Beat showed an average delay of three and a half years between someone’s eating disorder symptoms emerging and their accessing treatment. That is simply not good enough. Targets are crucial if we are to tackle this epidemic. An access and waiting time standard for adults would provoke significant extra funding and focus. If we want to encourage people to seek help, we need to give them a guarantee that they will be seen.
Having clear standards can facilitate service improvements. Standards introduced in 2015 for waiting times for children and young people’s eating disorder services have been crucial in driving service improvements. However, similar standards have been lacking in adult services. Shockingly, sufferers are reaching the point of emergency hospitalisation before they can access care. Again, that is not good enough. It also costs a lot more money if we reach people only at that crisis point.
Clinicians have reported a significant increase in the proportion of young people first presenting when they are already severely ill. NHS figures show that hospital admissions for people with eating disorders in England have risen by 84% in the past five years. For children and young people, there was a 35% increase in the past year alone—and among men and young boys, hospital admissions have risen by 128%. There is an increasingly alarming picture that eating disorders in men and boys are being overlooked and not treated early enough. That is why today’s debate is so important.
Tragically, people are losing their lives. Take the terribly sad death of Zara Taylor after two years of struggling to get the right treatment for her eating disorder. An investigation by the Health Service Journal found that at least 19 lives were lost to eating disorders in England over the past five years. At least 15 of those were deemed avoidable and resulted in coroners issuing formal prevention of future deaths reports. Coroners described patients’ safety risks being missed or poorly managed because of limited knowledge of eating disorders among doctors and health professionals, and delays in accessing appropriate treatment. That is why it is so important to have more research into eating disorders, and focus on the more specialist and rare forms of eating disorders. Those same failings were among the key issues identified five years ago by the Parliamentary and Health Service Ombudsman in its report “Ignoring the Alarms”. Surely, we need to do more and to do better.
I was disappointed that the Government decided against publishing a 10-year cross-Government mental health and wellbeing plan for England. Instead, they have developed and published a major conditions strategy that would include mental health alongside other groups of conditions, including cancers, cardiovascular disease and dementia. That is not helpful. Compared with physical health, mental health has been a Cinderella service; for years, we have been asking for parity. If everything is put together again, we run the risk of losing special attention to mental health.
Can the Government not see that for targeted and varied issues we need targeted and varied strategies? I point them to Hope Virgo’s eating disorder manifesto, which calls on the Government to implement an evidence-based national eating disorder strategy, with a plan outlining how they will tackle the huge rise in people affected by eating disorders.
I want to single out Hope Virgo for her tireless campaign. She has made such progress in helping us to understand what it is to suffer an eating disorder and access services. She has continually engaged with us and Government in order to achieve improvements. She has done fantastically well. The strategy that she calls for should integrate obesity and eating disorder prevention plans, given the overlapping factors between the two. The Government should also look at reforming treatment approaches. I hope they are looking seriously at Hope Virgo’s manifesto and strategy.
A recent University of Oxford study found that using the integrated CBT-E—enhanced cognitive behaviour therapy—approach over the current in-patient approach reduced readmission rates for people with anorexia by 70% over a year. That means that we need to treat this as a mental health condition first and foremost, and to treat people’s physical health as a result of the mental health issues. If we do not tackle the mental health issues, we will not cure the physical problems.
The strategy should also include better training. According to Beat, 20% of medical schools do not include eating disorders in their teaching at all, while those that do provide less than two hours on the topic. Training should be compulsory in order to spot early signs of eating disorders. Many participants in a 2021 Beat survey reported having a negative experience when they first sought help from a GP. There are many brilliant practitioners in the NHS delivering excellent care, but I want every doctor to complete their training with the knowledge and skills to best support people with eating disorders.
The crisis in the NHS has decimated mental health services. Staff shortages are growing. According to the National Audit Office, between 2021 and 2022, 17,000 staff left the NHS mental health workforce. The Royal College of Psychiatrists 2021 workforce census shows that since 2017 there has been a 30% increase in the number of vacant or unfilled consultant posts in England. That is not good enough. How we can encourage specialists into services is a big question that the Government need to answer.
Eating disorder psychiatry has one of the highest numbers of vacancies, with just 28 full-time consultants. We need significant investment in staff retention. The RCP’s members report high workloads and poor work-life balance. NHS trusts should be supported to meet important improvement targets for retention. I hope that the Government will keep their commitment to publish an NHS workforce plan and that they will bring that forward early, along with adequate investment.
Mental health services need proper funding. This financial year, only 13.8% of local health spending has been allocated to mental health services, although mental illness accounts for 21.3% of the total disease burden in England. The money spent on young people’s eating disorder services has not kept up with the number of young people who need treatment. I support the NHS Confederation’s call for £12 million of additional funding to be made available over the next year to get children and young people’s eating disorder services back on track.
The funding that is provided needs to reach frontline services. An inquiry by the APPG on eating disorders, which I am proud to chair, found that 90% of the additional NHS funding given to clinical commissioning groups for children’s services did not reach the services to which it was pledged. We wrote to CCGs at the time, and the answers that we received were not satisfactory. The Government must ensure that their funding pledges are not empty words and that money is getting where it is needed. A one-off boost for children’s mental health services is not enough. Soaring demand for underfunded services will lead to children missing out on care.
We are all aware that the NHS is in crisis. We hear harrowing stories about ambulance and A&E delays, but the impact on mental health services has received little attention. I hope that today’s debate will make a difference and that we will hear more about the crisis in mental health service provision.
The Liberal Democrats firmly believe that physical and mental health should be treated equally in the NHS. Eating disorders are an epidemic. The sooner we realise that, the sooner we can treat them with the attention they deserve. No one should be condemned to a life of illness, nor should anyone be dying from an eating disorder in 2023.
I then heard from the trust that my constituent was having to be transferred every single day to be force fed with a tube because staff in the mental health unit were not able and did not want to do that. I believe that at just 18 someone is still a child. We know that with eating disorder sufferers development is often slower and young people are more childlike. Yet they are effectively forced to live in an adult mental health ward while suffering from a severe eating disorder and needing specialist help. Furthermore, training is crucial and support for staff who treat people with eating disorders is equally so. It is incredibly gruelling and, in no uncertain terms, a hideous process to have to force feed someone. We cannot imagine the impact that has on staff.
On social media content and algorithms, what does the Minister believe we can do to better protect young people? What can we do to give them the tools they need to be more resilient and to understand, when they are being pushed social media content, what is good and what is not—what is harmful and what is less harmful? I am proud to have stood repeatedly in this Chamber and called for personal, social, health and economic education to be a mandatory part of the curriculum, and proud that a Conservative Government have achieved that, but we also need to ensure that teachers are better equipped to teach PSHE, and I repeat my call for it to be mandatory up to the age of 18. It is not good enough to say that young people have to stay in education—school or college—or training until they are 18 but not to equip them with crucial life skills between 16 and 18. I get that the good colleges will do that, but many will not, so I ask the Minister to work with her colleagues in the Department for Education to ensure that the highest possible quality PSHE is delivered by teachers who feel and, indeed, are equipped to deliver it.
I want to talk briefly about stigma. I am conscious that this Eating Disorders Awareness Week we are highlighting eating disorders in boys and men. Stigma is still a huge challenge and it is undoubtedly worse for men and boys. When we look at the statistics, we see that one in five does not ever even say to anybody else that they think they might be suffering from an eating disorder. How on earth can someone get help if they cannot even talk about it?
It is incredibly difficult for young men to find their way in the world. They are under massive pressures through body dysmorphia or through the images they see, which are wholly unrealistic and unachievable. There are fitness apps on which the proponents will be taking significant amounts of steroids to achieve a physique that is, to be frank, virtually impossible for the ordinary person—the ordinary man—to achieve, and we know that over-exercising is every bit as much a part of eating disorders as not consuming calories. I am particularly aware that we need to find mechanisms to support young men, through the education system, so that they recognise the challenges around over-exercising, the dangers of steroid abuse and, frankly, the wholly unrealistic male body image that is being promoted to them.
I visited April House in Southampton, a specialist over-18 eating disorder unit, years ago now. That is to my shame: I should go back and say hello again. What was striking was that in a room of women, there was one man, and his particular problem was running. Every single day, he was running a marathon, and he could not rest mentally unless he had run those 26 miles every single day. Let us all just imagine what that was doing to his body and how incredibly weak and damaged he was by it. If we do nothing else today, let us encourage more men to speak up, encourage people to be braver, and ensure that we speak with a united voice from this Chamber. This is not a party political issue; it is absolutely a cross-party issue that we have to do more to support eating disorder sufferers.
Those are two very high-profile examples of deaths from eating disorder. Many people will have heard their stories and about their struggles. Sadly, it is the case that, for anyone who develops this condition, the mortality rate is frighteningly high: it is the highest mortality rate of any mental illness. As we have heard today, eating disorder does not come alone; it is accompanied by other mental health conditions such as depression, self-harm and obsessive behaviour.