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Eating disorders are a greatly misunderstood silent killer

Anorexia has the highest mortality rate of any mental illness, yet prejudice and ignorance persists.

By Wera Hobhouse

Across the UK 1.25 million people have an eating disorder. These include binge eating disorder, bulimia, anorexia, other specified feeding or eating disorder (OSFED) and avoidant or restrictive food intake disorder (ARFID). Despite their high prevalence, eating disorders are frequently misunderstood and viewed as a lifestyle choice. However, left undiagnosed and untreated, they 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. 

We are all aware that the NHS is in crisis, but while we have heard harrowing stories about ambulance and A&E delays, the impact on mental health services has received little attention. NHS figures show that hospital admissions for people with eating disorders in England have risen 84 per cent in the past five years, with more than 24,000 admissions in 2020-21. The Independent has also revealed that more than 8,000 adults with eating disorders are waiting to be seen for therapy, the highest figure recorded since data collection began in 2019; just 30 per cent of adults got treatment within four weeks of a referral.

Our health service is not equipped to deal with eating disorders. There has been very little progress in addressing the epidemic, with no effective national strategy in place. Data from Beat, the eating disorder charity, showed an average delay of three and a half years between someone’s eating disorder symptoms emerging and them accessing treatment. These delays prolong the suffering.

The crisis is further compounded by rigid criteria surrounding sufferers’ weight. I have been horrified by stories of people being told they cannot be treated for an eating disorder because their body mass index (BMI) was not low enough. To imply that someone seeking help for an eating disorder is “not skinny enough” is an act of cruelty. 

It is unacceptable that sufferers may have to reach the point of emergency hospitalisation before they can access care. Without early intervention, a vicious cycle ensues where sufferers may become unable to participate in education or employment. We need urgent action to stop this.

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Healthcare should focus on prevention before cure. Access to the right treatment and support early on is life-changing. Recovery from an eating disorder can take years, and the sooner people get help, the sooner they can get better. This growing epidemic can only be reversed by investing in prevention, early intervention, timely high-quality treatment without discrimination, and research to find new and more effective treatments. Integrating obesity and eating disorder prevention strategies is critical, as contrary to popular beliefs, eating disorders are most common among people with severe obesity.

The government is not taking eating disorders seriously. I was deeply disappointed to learn that it has abandoned its promise to publish a ten-year cross-government mental health and well-being plan for England. This is a callous disregard for the nation’s mental health. Mental health services need to be funded properly. Local authorities are a crucial partner here. More people are seeking mental health support than ever, but in 2022-23, only 13.8 per cent of local health spending is being allocated to mental health (including learning disabilities and dementia), despite mental illness accounting for 21.3 per cent of the total disease burden in England. Councils’ budgets are under severe strain, and the government must ensure they are properly funded.

Nationally, we are not doing enough to tackle eating disorders. NHS mental health services are severely constrained by staff shortages. According to the National Audit Office, between 2021-22, 17,000 staff left the NHS mental health workforce. The government has no real plan to fill these vacancies, meaning longer waiting times, missed targets and dangers to patient safety. I have called for a duty to produce a long-term NHS workforce strategy to be written into law to gain a better understanding of these pressures. 

For those left in the NHS, training on eating disorders is lacking. According to Beat, 20 per cent of medical schools do not include eating disorders at all in their teaching, while those that do provide less than two hours of teaching. This training should be compulsory to spot early signs of eating disorders.

As the chair of the All-Party Parliamentary Group on Eating Disorders, I will use my voice in parliament to challenge the government to do better for eating disorder sufferers. Eating disorders have touched the lives of so many, and I have been pleased to find support from all sides of the House for a debate I have secured to mark Eating Disorders Awareness Week at the end of February.

This year the awareness week’s theme focuses on male sufferers, an often overlooked group in discussion of eating disorders. I look forward to hearing everyone’s contributions and I will also be listening to the minister’s response closely, hoping to hear a commitment to develop a strategy for eating disorders with a clear time frame of implementation. No one should be condemned to a life of illness, nor should anyone be dying of an eating disorder in 2023.

Read more:

Those who die of anorexia don’t always do so surrounded by sympathy and understanding

Laurie Penny on eating disorders: youthful rebellion turning inward, with deadly consequences

For those of us recovering from eating disorders, calorie-labelled menus will be devastating

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