#(just to clarify: this isn’t about weight loss or any particular body *IMAGE* thing)

[fitscention]

via Fitscention

#Fitscention

[gaiatheorist]

Eating Disorders.

There’s a piece in The Guardian this morning “GPs are failing people with eating disorders.” Welcome to the twenty-first century, where it is acknowledged that disordered eating blights and takes lives, but there isn’t a cohesive network to prevent lasting damage, and death. There are NHS resources in place to address obesity, which is proven to curtail life, and cause additional expense to the service, but very little at the other end of the spectrum. That focus on obesity, for those vulnerable to disordered eating, may well be part of the problem, for every patient who successfully loses the weight the doctor advises, how many take the message the wrong way? 

That’s not a criticism of the NHS, the service is being pulled apart by the insidious top-down efficiency drives, and it is evident that more people are overweight/obese on presentation to services than are demonstrably suffering from eating disorders. ‘Demonstrably’ is the issue, because the vast majority of people with eating disorders maintain a ‘normal’ weight, I can’t use the word ‘healthy’, because the self-harming crossover into disordered eating is vast, immeasurable. A person with an eating disorder, unless they’re at the very extreme ends of the spectrum, quite often appears ‘normal’, and the physical/mental health links are generally unexplored. There is no funding in the NHS-pot for addressing lower-level mental health issues, and so the cycle perpetuates, until needs become acute. Even at the acute end, provision is limited. People will die, families will be bereaved.

I skimmed another article yesterday, about the reluctance of frontline health staff to TELL people they need to lose weight, which links in neatly to the disordered eating angle. Personally, I have never been advised to lose weight, but, in 40 years of accessing NHS services, even when I have presented with a BMI between 17 and 19, disordered eating has never been broached either. “You could gain another 2st, and still be OK.” around 2005, when I was concerned about a pulsating, palpable ‘lump’ in my abdomen being an ectopic pregnancy. (It was my aorta, I had so little visceral and subcutaneous fat that my aorta was palpable.) Then again in 2016, on admission to hospital for elective surgery, “Have you lost a lot of weight recently, is your appetite OK?”, yes, I have, and no, it isn’t. Curious, that when I presented at my GPs surgery concerned at my inability to maintain weight, my superficial assurances that yes, I was eating, were enough to close down any discussion about mental health, or eating disorders. Occam’s razor again, start with the physical, and, because the NHS is over-stretched, start with the least expensive. I wonder how many people with eating disorders just don’t go back to the GP after a colonoscopy? (Colonoscopy is HORRIBLE.)  

I need to clarify here that my weight-loss wasn’t linked to any eating disorder, but that’s exactly what a person with an eating disorder would say, which is part of the problem. The way I under-disclose how much I smoke, or drink? I suspect a lot of us are guilty of that, we know what we’re supposed to do, so we manipulate the figures a little bit, that, in relatively ‘normal’ mental health. In poor mental health it can be much more opaque and occluded. A person in the grip of an eating disorder will justify and normalise their behaviours, there is much crossover between self-harming and addictive behaviours, and the occlusion is often a major issue. In the initial stages of disordered eating, the person generally feels that they are in control, justifying counting and weighing as normal, it takes time for the health impacts to become apparent, by which time lasting damage may already have been done.

As is ever the way with me, I’m going to skew to Slimming World and such, with the internet reaching all of us, everywhere, and the ‘slim is sexy’ angle. The aesthetic objectification of ‘this’ body-type for women, and ‘that’ body-type for men has a powerful pull for those vulnerable to disordered eating, and the ‘healthy’ or ‘positive’ body-image can be thrown by the wayside in the search for perceived-attractiveness. The you-won’t-do is eclipsing the OK-to-be-me, and, for individuals susceptible to disordered eating, that is very dangerous indeed. You would need to be living under a rock not to know what the recommended BMI-range is, what the guidance on alcohol and fruit-and-vegetables-per-day are, I can’t comment on TV advertising, because I don’t watch much TV, but the internet is awash with weight-loss adverts.

Hello body-image dysmorphia. Now, at the age of 40, I accept that my body is not perfect, but I also acknowledge that a certain degree of maintenance is necessary, this vehicle that transports my thoughts requires fuel and care, or it will fail. This meat-we-don’t-eat, this incrementally failing vessel, for all the scars and tattoos and bits I don’t particularly like, is not my enemy, it is my body, and it’s the only one I have. A person with an eating disorder wouldn’t necessarily view their body that way, I remember describing myself as ‘fat, and flat-chested’ when I was 15, and refusing to accept assurances from others that I was neither. As a society, we need to adjust mindsets, to move out of the ‘attractive’ ideal, and into the ‘healthy’, or more people will suffer and die. The pervasive perpetuation of ‘pretty’ has a lot to answer for, and not just in terms of insecure 15 year old girls.

GPs may well be failing people with eating disorders, but the wider issue is more complex. The aesthetic-objectification feeds into negative thought-patterns, which can, in some individuals, lead to lasting harm, or worse. I accept that some of my tangent-skewed thought-patterns are deviations from the accepted norms, and I don’t claim to be ‘right’ about everything. My nose is wonky, because it has been broken three times, I don’t care, it’s just my nose, I only really use it to balance my spectacles on, and check if the milk is OK. My skin isn’t the honey-gold smooth and perfect landscape that adverts suggest is desirable, I don’t care, I can cover up the vast majority of it with fabric, and it’s sort-of useful for stopping my internal organs from touching slightly-disturbingly-damp seats on public transport. I’m an oddball, and I know it, I don’t buy-in to the “This *whatever* will make you happy!” mentality, because the only factor in anyone’s happiness, really, is their own mental state. You could have all of the puppies, and rainbows, and bunches of flowers, all of the expensive shoes and loving hugs in the world, and still be unhappy, or not-content. 

I am content-enough, and I would like more people to be so. There is no ‘truth universally acknowledged’ that human beings HAVE TO support each other, but, in these testing times, wouldn’t that be better? A GP, or a nurse, or whoever, can’t possibly screen for everything all at once, they’re line-of-best-fit on whatever their management says they should be targeting, it isn’t that they DON’T care, it’s quite often that they don’t have the time to. Additional support services are fatigued and fragmented, there is very little in the way of early intervention for eating disorders, where the negative behaviours could be addressed before they become harmfully embedded. We need to step up, all of us.

I can’t remember how long ago it was that I attended ‘Child Protection- Schools on the Front Line’ training, probably five or six years ago at least, but that was a telling indicator of how that particular area of expertise was being farmed out. The trend has continued, with services folding and not being replaced, not just in respect of children, although children and young people are my particular ‘niche’.  We are all ‘On the Front Line’, as adults with compassion towards each other. Eating disorders are immeasurably complex, there will be as many reasons for developing disordered eating as there are individuals suffering in the grip of them. We, as a society, need to dismantle the myths around eating disorders, and step in, to help. Very few people are comfortable talking about it, which feeds the ‘hidden’ element, and increases the burden of shame on the individual suffering. That’s not OK.

Enmeshed in the myriad reasons and causes is the ‘attention seeking’ myth, which is one of the most uncomfortable angles to explore. To my mind, adults competing for that Slimming World basket of other people’s cupboard-clearance are as guilty of ‘attention seeking’, but that behaviour has become normalised. A person in the grip of an eating disorder is rarely consciously ‘seeking’ attention, although there may well be an unacknowledged need for attention to resolve the initial cause of the disorder. As with many other negative behaviour patterns, and mental health disorders, an eating disorder can be a symptom, rather than the whole of the issue.

It is ‘self-inflicted’. It is. In the 1990s, the ‘lad-ettes’ were drinking themselves unconscious, and comparing hangovers as a badge of honour, it has taken 20 years or more to arrest that self-injurious behaviour, but nature abhors a vacuum, and another tends to slip in. To dismiss someone suffering from poor mental health as self-indulgent is utterly abhorrent, and perpetuates non-disclosure.

“But you look fine!” Catch-22, between the dysmorphia-distortion, and the you-won’t-do ideologies, a person with an eating disorder doesn’t FEEL fine, and continues to attempt to control their weight, often, but not always, because it is the only thing they feel they can control. Again, a person with an eating disorder, unless extreme, will quite frequently fall within the ‘normal’ weight-range. They won’t accept assurances, because their self-image is skewed. In my personal opinion, compliments based on appearance can be harmful for individuals with eating disorders, but, again, it’s normalised, and that’s an enormous unpicking-task. Please, give compliments, but tangible, specific ones, praise someone’s work, their thought-process, their bloody blouse if you want, but this “You look fine to me.” when someone comments they want to lose a couple of stones isn’t helpful.

“You need to eat more pies.” That’s a completely personal one, and was said to me by other adults, in more than one way during a period of my life when I was incredibly underweight. For me, that was offensive, that another adult could be so dismissive and flippant about the fact that, if I didn’t dress carefully, every single one of my ribs was visible. For a person with an eating disorder, that could be terrifying, it’s not uncommon for food-phobias to develop, fears that certain types of food will cause choking, or vomiting, throw in The Daily Mail’s cancer-list, and incredibly restrictive eating patterns can develop. The restrictive eating, and obsessive behaviours lead to genuine physical health issues, we all know about the osteoporosis risks, but people with eating disorders are at risk of a plethora of other issues while-ever their needs are not addressed.  

Eating disorders are less about food than feelings. Every fraught parent demanding their child clear their plate means well, but it’s not really about the food, and in some circumstances, the force-feeding accentuates the emotional turmoil, although the intention is not to cause harm. The journalist Mark Austin made that point perfectly clear, an intelligent, rational man, who had, at one point, become so frustrated with his own daughter, he’d told her “Go on, starve yourself to death.” The feelings, the emotional state of a person in the grip of an eating disorder appear rational to them, it is a mental health issue as well as a physical one.

Time to talk, and time to change. There are more and more unaddressed mental health needs, because there are less and less available services. We all need to step in, and fill the gaps in whatever way we can. The conversations are uncomfortable, if it was easy, nobody would have a problem, but shying away from having the conversations embeds the shame and occlusion. The shame leads to non-disclosure until the issues are incredibly entrenched, and not every over-stretched health professional can join the dots on the vague presenting symptoms. If I turned up at my GP surgery next week, and complained of tiredness, aching joints, disrupted sleep, headaches, mood-swings, hair-loss, and all the rest of the ‘stress’ symptoms I’m currently exhibiting, I’m fairly confident that diet wouldn’t even be mentioned. I’d likely be either offered SSRI medication, or sent for blood tests. (SSRI medication causes weight-gain in some people, and they stop taking it.) 

Contentious, isn’t it? We’re socially conditioned not to comment if someone has gained weight, becoming increasingly obsessed with losing weight, and eating disorders are going unaddressed because they’re so poorly-understood amongst the general population. More awareness is needed, in order that the issues can be addressed at an earlier level, where intervention would be less costly, both in monetary terms, and in terms of acute-care facilities being so geographically sparse that families are massively disrupted. It isn’t the ‘weight’ that kills people with eating disorders, it’s the wait.

#EatingDisorders NHS TimeToTalk BEAT Guardian