Clegg's EU referendum move raises the pressure on Miliband

The Deputy PM has said it is now a question of "when, not if" a referendum will be held. Does Miliband agree?

Nick Clegg's declaration at PMQs that it is now a question of "when, not if" an EU referendum will be held was a significant advancement on his previous position. The Deputy Prime Minister has long supported the coalition's "referendum lock", under which a vote is triggered whenever there is a transfer of powers to Brussels, but this is the first time that he has suggested that one will be held at some point in the next three-four years.

It remains unclear whether Clegg believes this would be a yes/no referendum on a new treaty or an in/out vote on EU membership. The referendum lock, introduced through the government's European Union Bill, suggests the former but the Lib Dems' 2010 manifesto, which said that an in/out referendum should be held "the next time a British government signs up for fundamental change in the relationship between the UK and the EU", suggests the latter. At PMQs, Clegg misleadingly conflated the two, stating: "That's what we had in our last manifesto and that's what we have now acted on in government by passing legislation together in the coalition just two years ago."

But this ambiguity is less important than the fact that he now believes some kind of referendum is inevitable. One question that follows is how Labour will respond. In an interview in January, Ed Miliband explicitly stated that he would not repeal the coalition's referendum lock ("there is legislation on the books that we don't intend repealing," he said) but has yet to say whether or not he believes a vote will or should be held in the next four years. Clegg's move means it will now be harder for him to avoid answering this question. 

Ed Miliband speaks at the CBI's annual conference on November 19, 2012 in London. Photograph: Getty Images.

George Eaton is political editor of the New Statesman.

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I’m a man with bulimia. But too many like me are unable to address their “hidden” condition

A failure to understand that eating disorders can strike anyone, at any time, can make it harder for people to accept they have a problem and start asking for help.

What was it about George Osborne’s last Spending Review that made me physically sick? Fresh cuts to already-sliced government departments? The latest squeeze on vulnerable housing benefit claimants? The sheer jamminess of the Chancellor’s tax credits u-turn?

Actually, it was a handful of salt and vinegar crisps and a couple of tiny triangle sandwiches, courtesy of the Institute for Fiscal Studies.

It’s now customary for journalists to head to the IFS for what we like to call the “real” Budget. This hour – blissfully free from “long-term economic plans”, with nary a “hard-working family” in sight – is when Britain’s sharpest economists help us cut through the spin.

Less known about the IFS, though, is that they also put on a top-notch spread for assembled hacks. And it was this, rather than the Chancellor’s latest manoeuvrings, that had me on my knees last November.

For about eight years now, I’ve been bulimic. Bulimia is often described as a “battle”, but I’m not a big fan of this term. You don’t feel like much of a hero when you follow a detailed briefing on the distributional effects of Universal Credit with a bout of shoving your fingers down your throat in a Senate House toilet to get rid of a cucumber sarnie.

According to the National Institute for Care Excellence (NICE), just under 1 per cent of the UK population has bulimia nervosa. Using some back-of-a-fag-packet maths that the IFS would no doubt slam me for, I reckon this means that there are more than half a million of us out there making shonky excuses to leave meals or brushing our teeth at strange times. But we’re a shrewd lot – time and again, the people I speak to about the problem characterise it as a “hidden” condition.

Mary George from the eating disorders charity BEAT tells me that while anorexia is actually the rarest of all the eating disorders – accounting for around 10 per cent of all diagnoses – it continues to receive the most attention, in part because its visible consequences “are much more obvious”.

“With bulimia, somebody can stay the same weight and those around them are just not aware of the struggle that they’re having unless they start observing certain behavioural patterns,” George says. “It’s difficult to spot – but it is equally as serious.”

While we bulimics very often don’t look that different, then – meaning we can slip under the radar of GPs – George says that we can rather quietly be doing ourselves some real damage. Getting rid of food, unsurprisingly, deprives the body of vital nutrients – and over the long term that runs some big health risks.

“It can impact on the heart, the cardiovascular system, it can lead to loss of bone density, resulting in osteoporosis,” she says. “Bulimia can also lead to long-term dental problems because of purging and the acidity passing through the mouth, an electrolyte imbalance in the body because of the purging, a reduction in testosterone levels in men, and a loss of sexual interest.”

My blood ran cold as George told me about those effects. Yet, in the rare instances it is discussed publicly, bulimia can still be seen as a poor relation to anorexia – even a bit of a comedy eating disorder.

Conservative MP Caroline Nokes – who chairs the all-party parliamentary group on body image – tells me that while understanding of eating disorders more broadly has improved in the last few years, there is still “a great deal of ignorance” about bulimia – and an ongoing perception that it’s only a problem for “middle-class teenage girls”.

“When [former Deputy Prime Minister] John Prescott revealed that he had suffered from bulimia, there was almost sort of a collective question mark hanging in the air,” Nokes says. “People were joking, ‘Well, how can he be bulimic, look at the size of him?’ They were making really cruel, hideous jokes about him.”

It’s important to stress that most of those diagnosed with eating disorders are women – NICE figures show a female to male ratio of around 3:1. But there’s also been a sharp, 63 per cent increase in the number of men being diagnosed with eating disorders in the past five years (not necessarily a bad thing – it could mean more of us are seeking help). And research has shown that men are more likely to get bulimia than any other kind of eating disorder.

So it turns out I’m part of a growing group. Like me, Sam Thomas had bulimia as a young man, and in 2009 decided to set up a charity called Men Get Eating Disorders Too, offering advice and support tailored specifically to men, who he believed were still not provided for. Seven years on, he tells me he’s still trying to challenge the view that eating disorders are confined to just one set of people.

“One of the key messages that we try to get across all the time is that eating disorders have no gender,” he says. “They’re very inclusive in that respect – incorporating not just men and women, but trans people too, who often get forgotten about in these sort of debates. Eating disorders are indiscriminate.”

There are all sorts of reasons somebody can get an eating disorder – a traumatic life event, stress, broader psychiatric problems – and Mary George from BEAT tells me “high achievers” and “perfectionists” are particularly at risk.

Nokes meanwhile points out that men are also increasingly getting a taste of the kind of “impossible-to-obtain” body ideals that women have had to put up with since time immemorial.

Yet despite more pressure on men to worry about the way they look, Nokes says there is still an assumption that we’re not really meant to talk about this stuff.

“There’s a view that if a man reveals something like that he’s fair game to be ridiculed – and that’s just so wrong,” she says. “From visits I’ve made to eating disorder units, what has really struck me is that the men that I have met have had conditions that are every bit as severe as the women in there. And yet they have somehow been expected to be tougher about it.”

But research published a couple of years ago in the British Medical Journal, based on extended interviews with male eating disorder sufferers, makes it clear why those misconceptions can be such a problem.

In it, the authors warn that the “culturally prevalent view that eating disorders largely affect teenage girls” meant many of the people they spoke to “only recognised their behaviours and experiences as possible symptoms of an ED after a protracted delay, mitigating possibilities of early intervention and improved prognosis”.

In other words, a failure to understand that eating disorders can strike anyone, at any time, can actually make it harder for people to accept they have a problem and start asking for help.

The IFS incident was arguably my illness at its most daft – an absurd situation that prompted me to realise that something that had become a weary part of my daily routine was now taking control of my life in a big way.

In many respects, though, I’m one of the lucky ones, tentatively wriggling out of bulimia’s clutches with the help of some open-minded friends who’ve been keeping an eye on me and gently reminding me that it’s alright to sometimes have a donut.

I have no doubt, however, that talking about an eating disorder like mine would have been ten times harder if I had been, say, a working-class teenager, or a City trader whose career depended on never showing weakness, as opposed to a hummus-munching trade journalist in a steady job.

But, as Sam Thomas says, nobody suffering from bulimia – or any other eating disorder – should be left feeling like they’re not entitled to seek help.

“Without stating the bleeding obvious, it’s just important to know this is an issue that other people have experienced, right across the world,” he says. “You’re not the only one. You’re not an alien. You’re not a freak of nature. Get help when you are ready to – talk to somebody you can trust. It may not be that you just pick up the phone and call the GP. But that isolation and secrecy that an eating disorder can often thrive on? You can break that link.”

Matt Foster is deputy editor of Civil Service World and a former assistant news editor at PoliticsHome.