Thursday 2 January 2020

Eating disorders: what we can do to help

I turn away in tears, no longer able to watch the near-skeletal figure on the treadmill across the gym pounding out mile after joyless mile.

I am upset not just because of how thin this individual is, and the potentially-fatal strain their body is under, but also because I am aware how much someone is inevitably hurting, emotionally, by the time they reach this point.

Most of all, I am upset because I feel unable to help.

How many of us have been in similar situations, where we’ve encountered someone clearly suffering from an eating disorder, with or without exercise addition or other mental health issues, and felt that we could not intervene?

Is it a lack of expertise that is holding us back? Or the feeling that it is not our place to say something? With denial a major feature of eating disorders, are we simply afraid that the individual will turn down our offer of help?

We can’t force a grown adult to seek treatment against their will. At least not unless they are an immediate harm to themselves or others. But we can certainly offer help.

And while we’re considering whether or not it’s our place to say something, or our responsibility to intervene, we should take a moment to put the taboo of eating disorders aside.

If this was an individual standing on a bridge, ready to jump, I wouldn’t be concerned that my offer of help was untimely or out of place. Nor would I worry that I might make matters worse. I probably wouldn’t even think twice before dialling 999.

If I was a barman and a customer was clearly over-indulging in my goods, to the point that their health and wellbeing were clearly in danger, I would be legally obliged to stop serving them.

Why does the same not apply to those exercising to the point of self-destruction?

Why are eating disorders so different?


Not all eating disorders are visible

And this is just with anorexia that has progressed to the point that it is physically obvious! If we can’t support with these, how can we even consider supporting the large number of individuals who are engaging in destructive eating behaviours that have no obvious physical signs.

Most individuals suffering from Bulamia, for example, maintain a constant weight, but the binging and purging practices which characterise the illness also have severe physical and mental consequences for the individual.

Those with early stage anorexia may also not display any excessive weight loss or physical changes. Particularly in a distance running environment, where thinness is common, the individual’s health may already be severely compromised by the time their illness becomes physically evident.

Changes in mood, feelings and behaviours may be better early warning signs in these cases.

A comprehensive list of warning signs can be found on the website of Beat (the British Eating Disorder Charity).


Intervention is not easy, but it’s unquestionably necessary

Did you know that anorexia nervosa has the highest mortality rate among all mental illnesses and psychiatric disorders? People aged 15-24 years with anorexia have 10 times the risk of dying compared to their age-matched peers. Approximately half of these deaths are sudden cardiac deaths.

In the US, one person dies as the direct result of their eating disorder every 62 minutes! We don’t have similar figures for the UK or Ireland, but death rates are high and sudden death is a real possibility!

Add to that the fact that the earlier an eating disorder is treated, the greater the chance of recovery. Oh, and that many individuals suffering for an eating disorder often do not realise the extent of their destructive behaviour, and the importance of intervening becomes a little bit more obvious.

Many athletes, when sharing their eating disorder stories, will mention a trigger point to them seeking help – often somebody else intervening – or a wish that someone had said something sooner.

Eating disorders are mental illnesses. They very, very rarely improve without professional treatment, and early treatment significantly increases the chance of recovery!

So, while we’re worrying whether now is the best time, or wondering what the right thing to say is, there’s someone who just needs us to say something.


Denial an issue

Denial is a major characteristic of eating disorders. If you suggest to an individual that you think they aren’t eating enough or are too thin, then the chances are that they have an answer for that. They are likely to explain it away.

In a distance running context this is even more likely, where extremely low body weight is not only highly accepted, but often expected.

The general advice when offering support to someone with an eating disorders is to approach in a place which is private, quiet and comfortable for them. Avoid approaching at meal times, or in any other environment in which they may be more uncomfortable or anxious that they normally are.

You should listen and communicate non-judgementally. Ask the individual about how they are feeling, and care about their answers. The Mental Health First Aid (MHFA) manual recommends that you focus on specific behaviours that concern you and the underlying emotional distress they may be feeling, rather than weight, food or appearance.

There is the possibility that your sensitive, non-judgemental approach is brushed off, or treated with defensiveness or even anger. But that doesn’t mean that your conversation has not been worth the effort. The individual may need time before accepting help.

There is even a chance that they are relieved to have the opportunity to talk about their feelings. They may even have been waiting for someone to reach out. It’s just as important to be prepared for a positive response to your offer of help.


First steps

Both Beat and Bodywhys, the Irish Eating Disorders Association, recommend that visiting the GP is the first step on the road to treatment. However, with stretched healthcare resources, it is not without its drawbacks!

B-eat has an excellent resource on their website to prepare individuals for the reluctance to refer they may experience. It has advice and prepared answers to possible misunderstandings they may encounter.

No individual who feels they have an issue should come away from a GP appointment without a referral for a specialist eating disorder assessment. They especially shouldn’t be told that their eating disorder is not yet severe enough.

It is also worth noting that while many dietitians will have some awareness of and training in eating disorders, anorexia and bulimia are mental illnesses, and will not be resolved by dietary intervention alone.


Treatment

Once an individual has been assessed, depending on the stage of the eating disorder and the severity of the weight loss, inpatient treatment may be required.

National Institute for Health and Care Excellence (NICE) guidelines recommend outpatient psychological support involving Cognitive behavioural therapy (CBT), psychotherapy or other appropriate therapy or counselling delivered by an eating-disorder specialist.

For those under 18, family therapy should also be recommended. Exercise may be contraindicated, particularly in the early stages of treatment.

The Beat and Bodywhy helplines both give advice not just for those suffering with an eating disorder, but also for those supporting them. Parents, friends and, potentially, coaches will play an important role in recovery, which may take some time.


In summary

If you know someone who may be suffering from an eating disorder, approach them in an empathetic and non-judgemental way. Yes, it will be a difficult conversation, but it may just be the one that enables them to seek the support that they need.

The Beat and Bodywhys helplines can provide advice on how to raise the issue with an individual, who may or may not respond in a receptive way. But don’t give up hope.

The GP is the first port-of-call on a long road to recovery. No individual should be turned away because they are “not yet thin enough”, or that they are “just going through a phase”.

Early intervention is crucial! With the right support recovery is not only possible, but likely.

If that was me on the treadmill, slogging through my third gym session of the day, I might not fully appreciate the offer of help from a caring, non-judgemental stranger. It might not be what I want. 

But it might just be what I need.

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