11 minute read
FOOD FOR THOUGHT
Interviews by Jo Henwood, Sophie Brown and Jackie Rankin.
Heart failure, infertility, permanent memory loss, early death. We look at the stark reality of eating disorders in children. And we talk to the experts doing things differently to save young lives.
Dr Ashish Kumar does not mince his words when he describes how an eating disorder can affect a young person’s life.
“If you leave it too long before seeking treatment the brain shrinks, the heart shrinks. If a girl’s period stops then there can be permanent damage to bone growth causing malformation and lifelong pain. If the periods don’t return quickly, she can be left infertile. If brain function is not restored the person can be left with reduced intelligence and emotional functions. We need to reach these young people early to reverse it quickly and get them better very soon.”
As consultant psychiatrist leading Mersey Care’s eating disorder service for young people, Dr Kumar and his team work with young people aged eight to 18 and their families.
They are saving lives using an evidence based approach that centres around early identification of an eating disorder and intervention with proven therapies. A unique blend of psychological therapies and other vital physical health support is offered to patients and families by a diverse team of dieticians, doctors, therapists, and nurses.
Consultant Psychiatrist Dr Ashish Kumar
The service is the first in the UK to offer and promote online an ‘open door’ policy. You can refer yourself or someone you have concerns about as a parent or carer by completing a short online form.
Family therapy is a cornerstone of the approach, embracing and empowering parents and siblings of the person with the eating disorder.
Operational manager Lindsay Lawrence says parents can lose sight of their main role as they strive to solve the problem of the eating disorder. “During difficult times no one can focus on anything other than food. We want to empower parents to be parents – to remind them that they still have those parenting skills.”
Referrals have increased dramatically since the COVID-19 pandemic. Lockdowns and social restrictions were ‘a perfect storm’ for eating disorders. Lack of contact with friends and teachers meant changes were not noticed early.
“During those two years, young people were socially isolated with lots of time to think about negative things and their weight and shape. The message was to go out and exercise, but some children struggled with the concept of eating healthily to maintain it,” recalls Dr Kumar.
He says there are many reasons why eating disorders develop.
“Body changes at puberty is a very common reason. As girls develop breasts and curves and boys start to get muscles, some become very anxious – they don’t want the changes to happen. They associate eating with getting bigger or fatter, so they restrict their food intake.”
The messages children hear from adults can play a part in shaping their views on food. “If someone has eating issues, or if they are very body conscious, they may unwittingly pass that message to the child”, he says.
Another major factor is pressure on children to achieve.
Dr Kumar says: “When young people are under pressure from those around them to succeed in studies or hobbies, they can use food to regain some control over their lives.”
Empowerment comes from good relationships based on close contact with families. During the pandemic, when it was quickly realised virtual appointments would put patients’ health at risk, the team worked round the clock, holding appointments in their waiting area to maintain social distance, and wearing full PPE to regularly check the physical health of patients.
Lindsey Lawrence recalls: “Patients would tell us they’d gained weight, but we could see that they hadn’t. We had to find a way to see them face to face.”
Dr Kumar says it was a vital move. “Young people with an eating disorder can deteriorate very quickly. If we had taken our eyes off these patients there were some who were very likely to die.”
A recognition of the power of social media in young people’s lives has led to a schools and community outreach programme to spread positive messages about food and eating.
Lyndsey recalls the discovery that at one point a hospital ward for children with eating disorders was caring for four children from the same school – all were members of a body image social media group.
“We discovered the group was being shared in school, so we approached their school and were able to work with school nurses on how to spot signs of problems.”
• Read how the service helped 16 year old
Aimee on page 10. • Contact the service – see page 12.
Consultant Psychiatrist Dr Ashish Kumar
FOCUS ON BODY IMAGE
WHAT IS AN EATING DISORDER?
Eating disorders are mental health disorders. They include:
• Anorexia nervosa – trying to control weight by not eating enough food, exercising too much or both
• Bulimia nervosa – losing control over how much you eat, binging and then taking drastic action, like making yourself sick, to lose weight and not to put on weight
• Binge eating disorder – eating large portions of food until you feel uncomfortably full.
Source: NHS UK – nhs.uk
Lyndsey Lawrence, Operations Manager with Mersey Care’s children and young people’s eating disorder service.
CHARLOTTE’S A FIGHTER
Charlotte is 19 and has ambitions of becoming a firefighter. Four years ago, she was battling an eating disorder.
She now shares her experience on Instagram in the hope of helping others. One of her main messages is about exercising to stay healthy rather than lose weight.
“There are people out there struggling. I say ‘Be open about it. Don’t be too hard on yourself. If something does set you back just say, yeah it was a bad day but I can start again tomorrow’.
“Speak to people about what’s bothering you, be wise about who you follow on social media, look for people whose content aligns with what you feel you need.”
Charlotte can now reflect on a time where she was scared to put weight on and had cut out major food groups. “I was dropping a dress size week by week. I’d do a gym session in the garden, go for a bike ride, then a walk. I wonder now how I did it all.”
Her recovery took two years. During that time she found a personal trainer who encouraged eating more to build up strength.
“I noticed myself getting better, I still had setbacks, but I’d keep on trying.”
She’s concerned at damage caused by gyms providing six week transformation programmes, putting people on very low calorie diets that encourage unhealthy habits.
Her best piece of advice? “You may have setbacks but keep moving forward.”
Follow Charlotte's journey on Instagram: @charlottemoorefitnessxx
SEE THE SIGNS
It’s easy to miss signs –children go to great lengths to hide the fact that they aren’t eating, says eating disorders service Operations Manager Lyndsey Lawrence.
Seeing your child visibly looking thinner in a short space of time should be a cause for concern. Other signs include exercising for more than two hours a day, reducing food intake to less than 500 calories in 24 hours, or noticeable dizziness when standing from a sitting down position.
The child may begin to avoid eating with the family or going out to restaurants together. Wearing thick jumpers might be an attempt to mask body changes.
Everything the team does goes back to their core approach – get in early and treat mind as well as body. Says Lindsey: “The benefits of treating someone early are that you’re able to treat the psychological and the physical elements at the same time.“
You can self refer to the service – go to merseycare.nhs.uk
SHE TREATED ME LIKE A WHOLE PERSON
Aimee loves meeting friends, listening to music and walking her dog. She’s enjoying college and dreams of becoming a doctor. Yet two years ago, the 16 year old was hospitalised by an eating disorder.
She’d struggled with eating, but her problems worsened during the COVID-19 pandemic lockdown. “I became obsessed with exercise”, she said. “I’d spend hours walking and doing high impact workouts.”
She recalls mealtimes, where she’d go to great lengths to hide her behaviour from mum, Suzanne. “We’d eat together,” recalls Aimee “but I’d wrap mine in a dog bag and put it in the bin.”
Alarm bells rang for Suzanne when her daughter’s periods stopped and she began losing her hair. Blood tests were clear, but Aimee’s GP notes included the words ‘possible ED’ (eating disorder). When Suzanne researched she was horrified. “All of the symptoms were happening to Aimee. I felt like I’d been hit by a bus.”
When Aimee was referred to the children and young people’s eating disorder team, she was hiding food, secretly exercising and purging. She also began to self harm and in September 2020, as she should have been starting her GCSE studies, Aimee was being admitted to hospital.
Suzanne was distraught: “She had reached a point where she couldn’t eat at all. We were watching her 24/7.”
The situation was hard for Aimee too. “I wanted to get better, but my eating disorder didn’t want me to get better.”
She responded well to the support she was receiving, including a structured eating regime, but when tragedy struck and her uncle died unexpectedly, Aimee once more stopped eating. The next step was an inpatient eating disorder unit, but thanks to the team’s innovative approach Aimee was able to stay home with expert support.
She is full of praise for her nurse Margie Pardoe. “She would phone every day, but she didn’t focus on the eating disorder. She would ask me how I felt about my uncle –she treated me like a whole person.”
With Margie’s help Aimee responded to treatment, but her method of having some control shifted from food to self harming. Margie supported her through anxiety and depression. Aimee’s weight increased and with individual and family therapy, her mental state has steadily improved.
Suzanne rewarded her daughter’s efforts with a puppy - Jim the dachshund is now a key part of the team. Aimee describes her mum as ‘my rock’ and praised her grandad Roy for his constant positivity.
She shares information about her recovery journey on Instagram and has received many positive messages, including from a young girl who had been inspired to seek help.
Aimee’s advice to others in her position? “When you have no hope and you think this is your life forever, remember – you will never, ever be ill enough for the eating disorder.“
Aimee blogs on instagram: @aimsrecovery
NEED SUPPORT?
• Help yourself – our self help guide on eating disorders can be read online, downloaded or watched as a video. visit: merseycare.nhs.uk
MORE HELP
BEAT Eating Disorder Support Online 9am-midnight during the week, 4pm to midnight on weekends and bank holidays. Telephone: 0808 801 0677 Email: help@beateatingdisorders.org.uk
PAPYRUS (prevention of young suicide): 0800 0684 141
CHILDLINE: 0800 1111
CALM Helpline (males only): 0800 585 858
KOOTH.com
GET IN TOUCH WITH US
Mersey Care’s specialist children’s eating disorder service is based at Knowsley Resource and Recovery Centre on Whiston Hospital site. The service treats and supports children and young people aged 8 to 18 years old living in Halton, Knowsley, St Helens, and Warrington boroughs with symptoms of an eating disorder and supports their families and carers.
If you are experiencing symptoms of an eating disorder, please don’t delay and make an appointment to see your GP, or use the self referral form which you can reach via the QR code on this page, or at merseycare.nhs.uk
HOW DO I REFER MYSELF OR MY CHILD?
You can self refer through the Mersey Care website: www.merseycare.nhs.uk/childrens-eating-disorder-service. You can call the team Monday to Friday, 9am to 5pm on 0151 430 1321.
Referrals are also accepted from GPs, teachers, school nurses, social workers, CAMHS teams and other health professionals.
