People With Eating Disorders Feel The Devastating Impact Of Coronavirus With A 140% Rise In Calls For Help
Among the many hidden victims of the coronavirus pandemic are people with eating disorders, many of whom have seen their symptoms intensify in lockdown. Now Christmas – already a difficult period for those with eating disorders and their loved ones, with pressure to eat large amounts of food and socialise – presents fresh difficulties.
“This is notoriously one of our most challenging times of years,” Dr Emily David, a clinical psychologist with Hampshire Children and Adolescent Mental Health Services (CAMHS) tells The House.
David said that referrals already spike just after Christmas, and notes the devastating impact of the Covid-19 pandemic on people with eating disorders. “Absolutely, the numbers have increased. That's not just initial referrals, but it's also the intensity of the needs of young people already known to us have increased, so they're struggling more.”
Dr Agnes Ayton, a consultant psychiatrist in adult eating disorder treatment in Oxford and chair of the Royal College of Psychiatrists Eating Disorder Faculty initially found there were fewer referrals when the pandemic hit, “and that kind of gave us a false sense of security”.
But that’s since changed. “There's been an increase of really quite severe presentation across the age range… quite late referrals, severe presentations needing hospital treatment,” Ayton explains.
Shocking new statistics from eating disorder charity Beat, seen exclusively by The House, show a 140% increase in people reaching out to them for support across the pandemic, from 4,277 per month in February 2020 to 10,279 in November. A recent investigation by the Guardian revealed that urgent referrals for children with eating disorders had doubled during the pandemic, with adult services seeing a 20% increase in referrals.
While some think that the smaller Christmases forced by pandemic restrictions may actually be a relief to those with eating disorders, who may now find it easier to sit out big family dinners, pressure is mounting on the government to increase provision to an already struggling service put under increasing strain as lockdown restrictions have continued.
Dr Rosena Allin-Khan MP, Labour’s shadow mental health minister, told The House that: “It’s deeply worrying to see how many people’s pre-existing health conditions are being exacerbated by this crisis and the government’s response to it.
"Christmas is known to be an extremely difficult time for people with eating disorders, and the government must provide more support.”
Although many people do recover fully with proper psychological support, eating disorders have the highest mortality rate of any mental illness. An NHS England survey in 2019 showed that as many as one in five women in England may have an eating disorder.
Lockdown has created the perfect storm for people with eating disorders
But why has the pandemic been particularly damaging for the mental health of those with eating disorders?
“Any significant changes to routine and things like unpredictability and uncertainty cause additional anxiety and when young people, and adults too, are anxious, they default to coping mechanisms and things like restricted eating, purging, exercise, those are coping mechanisms ultimately for managing distressing thoughts and feelings. And clearly that's very, very difficult to do during lockdown,” David explains.
Hope Virgo, a mental health and eating disorder awareness campaigner, says that an increased mainstream focus on diet and weight is especially difficult for those with eating disorders. "From stockpiling, to the exercise messaging, to this obsession with food and weight, lockdown has created the perfect storm for people with eating disorders,” she explains.
"As we approach Christmas, this uncertainty is getting harder to navigate with last minute changes to rules, to a fear because someone may not have eaten around anyone for months. If the government doesn't make eating disorder treatment and training for medical professionals a priority, we are going to continue to see more people losing their lives."
As well as restrictions on how much exercise was allowed at the height of the pandemic, for many the initial public fear about stockpiling, and lack of access to “safe foods” (foods that won't cause weight gain, or do not pose the risk of overeating) caused additional stress, and even relapse. For someone who has taken months or years to allow themselves to drink semi-skimmed milk, suddenly only finding skimmed milk available can be a huge setback.
“More generally, many young people with eating disorders have struggled with anxiety about the pandemic, a loss of routine, worries about school work, and uncertainty about the future,” explains Tom Madders, Director of Campaigns at YoungMinds. Like Beat, their Parent Helpline has been busier than ever.
Eating disorder professionals also point to the prominence and tone of public health messages about obesity, which can increase the risk of severe coronavirus symptoms.
In particular, the language of the government’s July launch of the obesity strategy, in which Boris Johnson urges people to “do our bit” by losing weight and “taking pressure off the NHS”, drew ire.
Beat described the government’s obesity strategy as “disappointing”, lacking nuance, and overly focused on calorie counting. While eating disorder specialists recognise that obesity is a major problem in the UK, they fear that the voices and needs of their patients are being drowned out and ignored.
“[The obesity strategy messaging] fails to recognise that for some, weight loss is potentially deadly. Messages like this may be heard by those affected by an eating disorder as something they need to engage with, and may encourage eating disorder behaviours,” a Beat spokesperson told The House.
For both eating disorder outpatients and inpatients, many treatment plans include clinics where patients are held accountable for their food intake and offered group and individual talking therapy. These often take place in small rooms where social distancing is impossible – forcing some to move online or not happen at all. Like the rest of the workforce, eating disorder specialist staff are also struggling with the challenges of staff having to self-isolate and the additional time taken for enhanced cleaning and hygiene measures.
Labour are now calling for clear guidance from the government on whether people can meet in person for support sessions, whether you can meet up in a group session, face to face, and clear guidance on exactly what support is available to people to help tackle the issue.
What we're seeing across the board is people waiting longer times for treatment, people not being able to get appointments, appointments being cancelled
For the most severely ill patients, the waiting times for admission have gone from a maximum of 30 days to over 60 days as eating disorder services shudder under the pressures of the pandemic. “That is a major risk factor when you're talking about a life threatening eating disorder,” Ayton explains.
It is not just Labour who are calling for greater action on helping those with eating disorders. Conservative MP Caroline Nokes is the chair of the Women and Equalities Committee, and former chair of the APPG on Eating Disorders. “Covid has caused a backlog in so many health care services. And what we're seeing across the board is people waiting longer times for treatment, people not being able to get appointments, appointments being cancelled.” Nokes says.
“In many instances, it's when the sufferer first reaches out for help, it's crucial that that opportunity isn't missed, because they're clearly in a place at that time where they recognise that they have an issue, and they want help. And if assistance isn't coming at that time, then it can sometimes have a really detrimental effect.”
While David says that Hampshire CAMHS team’s “service has gone on as normal”, combining virtual provision continuing with face to face appointments where needed, there have been challenges with provision in adult services.
Even before the pandemic, vacancy rates for eating disorder consultants in the NHS were at 15.6%, while hospital admissions for eating disorders had risen by 37% across all age groups over the last two years. Many referrals for adult services faced a 12-18 month waiting list.
In the south east’s inpatient network, where Ayton works, around 20% of patients end up in acute hospital wards due to a lack of specialist eating disorder bed capacity, compounded by hygiene and distancing restrictions on wards and staff. Even before the pandemic, a lack of capacity saw eating disorder inpatients from the south east being sent long distances for treatment.
“If the hospital admissions [for eating disorders] were at 5,000 13 years ago, I don't think there has been any investment in inpatient services since, and we are talking about almost 20,000 [hospital admissions in 2020],” Ayton says. “So we're talking about four times as many. And that causes a lot of pressure on patients, families and staff, which is not really sustainable.”
Eating Disorder Advice:
If you, or someone you know, is struggling with an eating disorder, the following resources may be helpful:
If you are in need of urgent help for yourself or someone else please contact 999 or the Samaritans on 116 123 if you or someone else is in immediate danger.
Get support from Beat
Helpline: 0808 801 0677
Youthline: 0808 801 0711
Studentline: 0808 801 0811
Beat’s helplines are open 365 days a year from 9am–8pm during the week, and 4pm–8pm on weekends and bank holidays.
Get support from Young Minds
24/7 Crisis Messenger: https://youngminds.org.uk/find-help/get-urgent-help/youngminds-crisis-messenger/
Advice for parents: https://youngminds.org.uk/find-help/for-parents/parents-guide-to-support-a-z/parents-guide-to-support-eating-problems/
Hampshire CAMHS eating disorder information and crisis support
Information from Beat on eating disorders at Christmas:
“The Christmas period can be extremely difficult for people with all kinds of eating disorder – even without the added upheaval of a pandemic. The pressure to eat large amounts can be triggering for people with binge eating disorder and bulimia, as well as causing anxiety for people with anorexia.
People with eating disorders often try to hide their illness and at Christmas when eating is a social occasion – often with people who they do not see frequently – they may feel ashamed and want to isolate themselves from others. At the same time, Christmas can be a source of distress for families who are caring for someone with an eating disorder.
It’s important to plan ahead and openly discuss when and how food will be involved over the Christmas period. It can help to steer attention away from food, so once meals are over, find activities that focus on something else, such as a family walk, playing board games, or watching a funny film together. It is also worth having a quiet word with relatives, as well-intended comments such as “Don’t you look healthy?” or “Haven’t you done well eating your dinner?” could be misinterpreted and cause more harm than good.
Anyone worried about their own or someone else’s health can contact Beat’s Helplines, which will be open every day over the Christmas period.”