Overeating As Addiction

I have spent some lively hours debating with others on the Facething whether compulsive eating is an addiction; which asks for some reflection on the nature of the term "compulsive".


Then I did two BBC Radio stints on overeating, debating with two people who were relying on Overeaters Anonymous to help with their food addiction. It seemed that both participants had become "addicted" to eating as a way of dealing with different forms of loneliness, at different times in their lives.


There are not many eating disorder experts who buy into the notion that compulsive eating is an addiction although they agree the following;


1   You can sort of become addicted to sugar because it affects the same parts of the brain as the other suspects like drugs and alcohol.


2    Eating disorders share some features with addictions.


3 People who overeat speak in the language of addictions. "I can't carry on with my day until I have had my fix... I can't stop at one.... I can't stop when I have had enough".


On our website blog I have made a very short case in favour of not leaping to the conclusion that overeating, even quite horrible variants of it, is addiction. It doesn't help our patients to consider themselves addicts. There are lots of reasons for overeating, even the most compulsive forms. We can free people from their destructive relationships with food without you needing all the paraphernalia of overeating fellowships like group meetings, endless talking about food,  sponsors and a lifetime of thinking of your self  as "In Recovery".  Thousands of us used to overeat and  don't now. We are not "In Recovery."  We can help you to stop.


 Check out   http://eating-disorders.org.uk/emotional-eating-addiction/ 

Anorexia And Auschwitz: A Cry From A Specialist

I cannot let the 70th Anniversary of the Liberation of Auschwitz pass without mentioning it in my eating disorder post.


To honour the suffering of those who endured torture, starvation and murder in the concentration camps, I bring myself to watch the film records and listen to the individual stories of heinous crimes, sometimes the small individual torments impacted on me more than the gross depictions of the crimes of Nazi Germany.


When people describe hunger that was so unimaginably painful, I think of my anorexic patients whose starvation is arguably - "self imposed", and I quail.


Self Imposed I hear you say!  Well, I've read many, many accounts of anorexia and I have ministered with compassion to many of anorexia's prisoners, and a lot of you are going to say OF COURSE it's not self imposed, it is a mental illness. But it is self imposed, because the self has been imprisoned by the anorexic Voice, in the same way as the selfhood of the concentration camp victims was imprisoned by their captors. The Voice captured me for a short while many moons ago, until I made my great escape.


So when I see the hollow eyes of the inmates of Auschwitz, Belsen and all the other Hells, I think of my anorexic people. But the weeping of a starving man in Auschwitz, caught for just a moment on camera has rent my soul.


What has become of us in this free and wealthy age where people willingly, proudly and insistently starve themselves into skeletons. People with anorexia do lie, do cheat, pretend that they are allergic, evade and often uncaringly torment their loved ones who just wish to see them live. It's what the illness is about.


So how can I, an eating disorder specialist, come to terms with the willing, compulsive starvation of my unhappy clients while my heart and soul is full of the starvation and suffering of a generation of innocent men, women and children. I sigh, I sigh and sigh; I bring myself back to my work, haul in my compassion and carry on.

Emma Woolf Letting Go Like Elsa In Frozen?

Letting Go: How to Heal Your Hurt, Love Your Body and Transform Your Life.


A new memoir of recovery from the girl who wrote An Apple A Day a century ago. Emma does what we therapists find hard to put into words, finding recovery not just in weight gain but in healing the mind, body, heart and soul of someone who has been caught in the claws of an eating disorder. As one of my patients put it, Letting Go, is like restoration of a stately home.


Can it help someone who is still sick and listening to the unforgiving anorexic Voice?  Perhaps it can. I hope it can. You can see a short review on our website http://eating-disorders.org.uk/emma-woolf-lets-go-and-heals/




but better still, read this book, a gift for therapists and patients alike.

More About The Personalised Diet

The more I look at this programme the more worried I am becoming. There is some good stuff in it. There are strategies that benefit everyone, like eating slowly and mindfully, teaching people to eat while doing nothing else, finding out that many normal people compensate for exercising by doing less later -hoho!


But I am still absolutely flummoxed by the science behind putting constant cravers on an intermittent fasting programme.  Where is the research behind this? We learn that this group of people are always looking compulsively at food, at people eating it, at shops selling it.  I think we need to know more about it. It is like an obsession. Is it just about lacking leptin sensitivity?   Perhaps the ancestors of the constant cravers were trapped in a famine.


Perhaps the constant craver is behaving like an addict. Perhaps the constant craver has problems in the  opioid centres of the brain. Experts call it Reward Deficiency Syndrome.  Why didn't they think about that? The so called experts have PICKED OUT BITS OF THE PHYSICAL PUZZLE which suit their programme. But have they looked at the whole map?




Either way if you are a constant craver it seems to make sense that you need to eat frequently but a diet very high in protein and complex carbohydrate too. You need to wear an elastic band on your wrist and snap it whenever you NOTICE you are looking at food. You need to keep binge food out of the house.


Intermittent fasting will make the cravings even WORSE. Oh sure you will lose weight while you do the diet, but you will become even more sensitive to the sights and smells of food. I've a lot of research to prove this point.


OK I'm not trying to dismiss the whole programme, but I'm also something of an obesity expert and I'm asking valid questions. You people out there also need to be asking questions and wondering if these world class experts may have sold their souls to the BBC for the money they will be making out of this programme. They are telling a sort of lie, which is that a particular DIET suits different types of people while the work they do in the background suggests that many more psychological interventions are necessary for someone to lose weight and keep it off. And these other strategies are not just "CBT"

Intermittent Fasting: Our Professional Opinion

Hello everyone.


For an in depth overview of our latest opinion of Intermittent Fasting, follow this link.


http://eating-disorders.org.uk/intermittent-fasting-if-our-version/


We can tell its summer here, the phones have gone quieter. Does this mean that people aren't worrying about their weight and their eating?  I don't think so, this is the time of the dreaded swimming costume; this is the month of ice cream and holiday splurging.


What have I been doing? I've been reading two separate accounts of anorexia which the writers wish to publish. I have been immersed in their private and intense suffering. What a terrible illness anorexia is, I'm so ANGRY with it and so SAD about it.


What is clear to me that Anorexia is the tip of the iceberg. The ONLY reason anorexia comes in to someone's life is that there is a fundamental weakness in someone's ability to manage life and other people. Life is stressful. Relationships are the source of joy and also pain. We need a web of confidence and inner strength to be able to cope with it all. Anorexia is a story of holes in this web. We all have some holes but if there are too many holes the web caves in.


Different stories, but the same symptoms, the same presentation, the same pain. Do we need more accounts of anorexia to help us KNOW what to do about it? Your thoughts appreciated.


Happy holidays...

Anorexia Recovery Guest Blog

Hannah Brown has posted a guest blog about anorexia recovery which she equates to restoring a stately home. What a beautiful metaphor.


You can read it here at  http://eating-disorders.org.uk/weight-restoration-guest-blog/


If you can read this and share it with someone you know, you might save their life, or save your own.


Love to all

Men Hiding Eating Disorders Too

Today I've published an article on my website contributed by Anthony Organ who is interning at a journalism project called The Conversation. Nice name.


You will find it published here http://eating-disorders.org.uk/men-get-eating-disorders-too-guest-blog/


I wish a had a tenner for all the men I've met who have eating disorders.  Not in treatment mind you, journalists ask me if I am seeing more men in treatment and I say no I don't, but I meet them everywhere else, at dinner parties where they confess their struggles or in my day to day life outside the office.


They are remarkable for hiding their struggles; maybe because they do feel ashamed at their lack of control over their food and their weight. They hide their struggles inside exercise compulsions, marathon running, daily visits to the gym to work out, taking lifestyle drugs or steroids, purging - but not thinking how serious this is - you name it, I've seen how they hide their terrible struggles with control of food.


I think it will always be the same despite all the publicity; looking into the future I can't really see that it will change, men finding a million terrible ways to control their eating behaviour but never accepting that they are out of control.  It's really good that it has all come out into the open, like homosexuality.... but I still cant envisage a time when guys will willingly come forward for treatment if eating begins to rule his life.


So if you are a guy reading this blog, go and check out my website, if you don't want therapy we can offer you coaching to put your eating and body image difficulties behind you. So that you can be happier and more effective in your life.

Tips For Working with Anorexia

Everyone needs help with anorexia.


No one fully understands it. Even people who suffer don't really understand it. Anorexia doesn't happen because your mother didn't love you enough or because you were teased in your childhood.


Many people live with low level anorexia - perhaps we call them "orthorexics" or they just happen to run marathons every week.  They are quite thin but they say that they just look after themselves. Since they aren't skeletal we just pretend that they don't have "issues".


Even people who had quite serious anorexia once upon a time find that it doesn't really ever go away.


So I'm going to write some of my thoughts about anorexia on my website blog. They are just to help us all think out of the box. I am not going to pretend that I have all the answers about helping people to stop starving, stop running marathons or going on long bike rides when the rest of us are happy to sit by the fire and rest. In fact if they don't want to stop doing what they are doing, I wouldn't have a chance.


So here we are, the first post on my lovely website is here at http://eating-disorders.org.uk/tips-for-working-with-anorexia/


 If you want to help me with your comments and ideas please do. I need and welcome your input.
Love to you all.

Go Enjoy Your Toast

Carbohydrate phobia is now officially a new psychiatric disorder. No, I'm joking, but Hannah Devlin Science Correspondent of the London Times says that almost half of all women and men are scared to eat carbs, which are an essential part of a normal healthy diet.


Carbs do some very important things in our body which cannot easily be replicated by proteins and by fats.  Not being nutritionally trained, few people really know what carbohydrates really do. They are swayed by rogue messages from daft so-called health professionals.


And few people know how much carb they should be eating. It is about 250 grams per day, but what does that mean? Its actually a bowl of cereal, some fruits and vegetables, a bit of pasta, some lentils and beans and a few bits of toast. Who is measuring?  I don't.


If you drink alcohol, that's where the trouble creeps in since the carbs are dense and the body isn't quite so sure what to do with them.


I've written more about carbohydrate guilt in my website blog. Follow the link to http://eating-disorders.org.uk/carbohydrate-phobia-go-enjoy-your-toast/




And let me know what you think?  If you want to fight your carb phobia and get your life back, I will support you in your fight. Its a crazy world we live in and your carbohydrate phobia might keep you thin and it might not and it will certainly make you less happy.

Anorexia NOT Increasing In Children?

In 2013 there was a media storm about increasing rates of childhood eating disorders that was picked up and chewed over relentlessly by eating disorder organisations.

Except by us. At the National Centre for Eating Disorders, when asked to comment about these new terrible findings, we said. Are you sure this is true?

Denying exciting and terrible news stories doesn't make good press. But we let the tide wash over us and like every tsunami it all drained away.

Now our thoughts have been confirmed. It appeared that journalists have been using the wrong information. This is wrong, and the terrible headlines should be disconfirmed.

For the new evidence and for our more detailed thoughts about childhood eating disorders please follow this link to our website.  http://eating-disorders.org.uk/anorexia-in-children-not-increasing/

Eating disorder organisations like us need not rely on alarmist stories to gain publicity. There is no need to shock the public in order to keep ourselves in profile. We must both  respond to real need and also to calm things down when they are lies, distortions and misinformation.

Sharing Meals: Carers And Eating Disorders

I haven't been here for a while, sometimes you just have to think about other things, like walks in the woods, going to the sea with family and eating ice creams (Cornish of course) and rejoicing in having the best fish and chips in the world arguably at Rick Stein's takeaway at Padstow.

And how nice that we were all able to sit down as a family and enjoy.

I think that it's possibly the worst thing in the world is to be with someone who won't share in the meal because they are on some kind of strange diet or they are allergic to fish or because they are terrified of eating. I've done a family check and everyone finds it traumatic and distressing when there is someone who won't or can't eat with everyone else.

Why? We're all individuals. Perhaps we have a caveman gene which puts us on alert when someone in the tribe is not thriving or participating. I have no idea why sharing a meal with  loved ones and sharing enjoyment is so important. Last night, youngest daughter cooked for us and eating together was central to the fun.

People with eating disorders really don't know how much of a burden they put on other people. Much more than other mental health problems. Maybe because sharing food seems to important to social health.

People with eating disorders  under-estimate the impact on carers, siblings and friends of strained atmospheres, the overall burdens of being with them and  the worries carers have about the future. Loved ones  worry about the effects of bizarre eating  on the sufferer and the effects of parent's behaviour on their children.

People with eating issues under-estimate the effort it takes to pretend not to notice bizarre eating habits or to try not to make comments. They under-estimate the stress of trying to encourage someone who is struggling.

When we offer unwanted care or attention is being offered, the person with the eating issue is likely to get aggressive or convince themselves that we are the problem not them.  Then we have to cope with their anger  AS WELL AS the stress and worry of their disorder. The carer struggles to figure out how to communicate their feelings without unleashing a tsunami.

It's not YOUR business says the sufferer. It's my choice to eat what I please. And so it is. No-one wants to be forced to eat things they don't want or like. Yet there is a fine dividing line where we can see that eating has become a form of self harm, and we react to it.

Poor carers.  How can we bridge the gap to make sure that people with eating issues are at least sympathetic to the trauma of living with someone who cannot eat around  the campfire with us.

Why Is This Eating Disorder Death Different From (Some) Other Deaths?

Georgia Willson Pemberton aged 26 dies as a result of taking Dulcolax laxatives to help achieve her anorexic longings to be thin and empty.

I am sad and frustrated about another needless loss of life. Who was egging her on; with whom was she competing, who was telling her that the only way to live was to be a princess on a pedestal?

Laxative abuse is a horrible way to die, these are dangerous - dangerous substances which ruin the liver and the gut, sometimes permanently. Deluded users think that they help weight loss. But they don't.  They change metabolism and make people gain weight easily, adding to their problems.  It's only the starving which goes alongside laxative abuse which keeps weight down.

Condolences to her parents and family.

I'm not surprised that she was a Head Girl. She probably left school "magna cum laude" (with great praise); the kind of girl who would appear to have it all.

What strikes me about this death is that,  here she was in 2013 with all the king's horses and all the king's men trying to put her back together again. Nothing that money can't buy. But they couldn't beat the demon anorexia -  not with all the money and all the new wonderful state-of-the-art eating disorder services out there.

This was not some poor family trying to get noticed by the national health services. This was a girl whose parents could buy the best there is.

So never mind all the chatter about "there isnt enough help for people with eating disorders".  The sad thing is that we could pour millions down into the black hole that is anorexia.  Even the best is not good enough to dent this serious mental illness.

But sometimes, someone can make a difference. What we can't always do is "bottle it".

Implants for Anorexia Nervosa

Last week the Press around the world reported on some partial success for electronic implants given to people with long standing anorexia nervosa. The research was done in Canada and reported in the Lancet.

Partial, meaning that about 2 in 3 of the people in this small trial had positive results. The research is blighted in part by not having a comparison group of people who BELIEVE that they have had an  implant, which might have tested for the placebo effect.

This is a very important piece of news which deserves our attention. To get more of my thoughts on whether this is the next best thing, please follow the link below.

http://eating-disorders.org.uk/news/

Eating Disorders In Boarding Schools

On Monday Feb 25th I gave a talk to a group of 80 teachers, nurses and other representatives of boarding schools across the UK.

Schools are there to educate and help our children to grow and become good citizens and expand their potential - did I miss anything out here?

But kids come along with issues which seriously affect their ability to be present and learn. Eating disorders are more likely to hit in adolescence just at the time when they are facing their exams and the culmination of their years of preparation.

It's clear from the voices in the room that an eating disorder has serious effects. It affects the child, their class mates, their teachers and their brothers and sisters. Schools are ill-equpped to deal with the fall out of an eating disorder and schools are not supposed to be hospitals or treatment centres. When I was growing up, matron was only supposed to bandage a wounded leg or a bump on the head, not to counsel us for "stuff".  What are they to do?

I heard some stories about young boys who are drinking protein shakes and exercising excessively to the point where they can hardly stand up. I heard stories about young girls who are making themselves sick and refusing to discuss this with their teacher. I heard stories about kids who are very thin, pretending that they are eating when they are not,  and insisting that nothing is wrong with them at all.

Can a school do anything to prevent eating disorders?  I am not really sure that they can. Well- meaning education describing eating disorders can do more harm than good. I think that some of you will disagree with me. Anorexia begins, they say, at birth.

Some things might be useful like body image work and media awareness training, emotional reslience work should begin when kids are very young.

And eating disorders are severe, sometimes chronic mental health conditions. They emerge because of slight or serious emotional deficits which can be healed in time with the right treatment.  They are not just a silly phase.

Schools should not be trying to treat an eating disorder on their own. A young person with a problem needs urgent long term expert help. A school should be part of a treatment plan that has been designed and written down by someone else.

At any one time, EVERY school will have some pupils with dangerous eating practices. This is never going to change. A teacher or parent who is concerned can access help and information on our website http://eating-disorders.org.uk or call us on 0845 838 2040

Two Die From Dieting

Laura Willmot dies from anorexic collapse one week after being sent home by her doctors.
In another world, a millionaire's ex wife freezes to death in her car after her wine binge. In a barely noticed throwaway remark, her husband noted that "we ate separately, she was always on one sort of diet or another". Living these separate lives, the couple drift apart. Had they remained together, she would not have met her lonely end in the cold.

Maybe I'm stretching a point about the untimely death of Nicole Falkingham - but no-one has ever looked at the effect that constant dieting has on marital bliss. But from where I am sitting, I can see the toll that is taken by diets, nutritional quirks, men and women chasing hours at the gym in the pursuit of a perfect body and partners left alone at home while one or the other pounds the streets.

Two wasted lives. 1 in 5 people with anorexia are going to die sooner or later. And countless others are going to meet their end directly or indirectly through the need to be thin.

India Knight has written in the Sunday Times of her frustration sitting  in group therapy sessions listening to people wittering on about their stuggles with food and weight, psycho-babbling about things that may not really be going to help. I also sat in at one session at a very famous Addiction place listening in growing frustration as the therapist did not intervene in what I felt was a swirl of very toxic talk.

Anorexia is one special illness in which I feel the right of confidentilaity should be suspended. I know that many of you will disagree with me. Please check out more of my thoughts and questions about the death of Laura on http://eating-disorders.org.uk/two-die-from-dieting/

The Theft Of Perfect Souls: Facebook?

Today I was reading about how girls as young as 11, 12 and 13 are persecuted on Facebook and Instagram etc to perform sexual acts.

They may be encouraged to self harm on camera, they are threatened if they don't do what they are told and they are slagged off if they dont obey.

They can be called slut,s slags and whores. The perpetrators of such horrible abuse can be the boy next door, or the classmate in school or the chap she thinks has been her friend, perhaps someone she played with when she was younger.

We now know that there is a link between the onset of eating disorders and this dreadful behaviour from which they can't escape.

I've already written more about this on our BRAND NEW WEBSITE (hurray!) Please check out what I have said at www.eating-disorders.org.uk  - the blog links are on our home page.

Dignity and self respect carry a young woman through the tumult of adolescence and protect her from substance abuse and eating distress. How are we going to protect our children from this filth?

Avoiding the Big Six To Cure Or Prevent A Weight Problem?

At a recent eating disorders conference on emotional eating, Prof Haslam who is chairman of the National Obesity Forum has stated as follows:

“My advice for avoiding obesity? Stay away from the Big Six: pasta, rice, bread, sugar, potatoes and flour.”

One of the delegates is quoted as saying "Surely humans have been eating bread, potatoes and grains for many centuries – is it really the fault of the humble carb? What he explains is illuminating: that refined carbohydrates and sugars are present in ever-higher quantities in our diets, but they’re hidden. Crisps or pizza or fizzy drinks, for example, are classified as high-fat or high-sugar items, when in fact they’re loaded with carbohydrates. "

Is that so?  There are millions of people who remain reasonably slim who try one way or another to negotiate a clearly obesogenic society. We all live in central heating and this has been implicated in obesity. We sit down a lot and that is implicated (whether or not we try to compensate by going for a morning run). We are upsizing and downsizing and that is implicated too. Don't get me started on the causes of obesity, I could write a book.

So is the problem the hidden sugars in food? Yes, but only if you eat the foods with "hidden sugars" to excess - not by eating the humble carb.  Is there danger in such categorical opinions. (Has he been hi-jacked by the Dukan brigade?)

I weigh about 7 1/2 stones and my diet is largely based around the humble carb. I daily eat bread, slightly undercooked pasta with vegetables (another carb). I eat rice, couscous, barley, honey on my porridge, potatoes with and without skins and a bit of flour here and there for fun. I am highly trained in how the body works and I know that you need a good supply of carbs from many dietary sources. I have many people who recover from obesity while continuing to eat the humble carb.  Prof Haslam you are a doctor too, so where is this nonsense coming from. Recant!

Its really easy with a little knowledge and wisdom to avoid "hidden sugars" and high fructose corn syrups while continuing to embrace the lowly carb. in all its wondrous glory, with the fibre that helps us to maintain a healthy digestion and with the resistant starches that support the flora in our gut.  That reduces obesity too by the way.

I am uneasy about statements such as the one above which fosters fears about food, all or nothing thinking, good and bad food mentality etc which fosters obesity and leads to disordered eating. A professional needs to be careful about opinions? Without qualification?

Barbie Doll In The Family

My 3 year old granddaughter has fallen in love with her first Barbie doll; given to her by someone else of course. She has a beautful pink dress and is called Princess Dayna.

Until now, the Barbie has been known to us as she-who-shall-not-be-mentioned; the toy equivalent of Lord Voldemart. She who is the cause of body image problems in young girls and the one who stimulates anorexia and bulimia. The doll with breasts and a BMI of 13. If she was a real woman she would probaby be dead by now.

We tried.; we swore that no Barbie doll would cross our threshold. We bought ragdolls with real size bodies and we bought boy dolls and pirate ships. To no avail.  Delilah wanted a fairy doll with wings and asked Santa for one at Christmas. I found a long legged Fairy Barbie in our local department store and refused to buy her, so Santa honoured her request with a curvacious Princess Belle.  We hid the Barbie, but our grandchild hunted for her day after day. We gave in.

So I got to thinking; what is the appeal of this Barbie thing that eating disorder professionals despise. Is she really responsible for all the bad press she is getting in the eating disorder world?

Perhaps but perhaps not.  She is certainly easy to carry around and it's very easy to move her different parts. That's part of her hand-appeal.

I think that we have given the Barbie too much influence. We have been looking for something to blame for the self worth issues faced by our daughters and for the growing appeal of breast enhancements and liposuction. Perhaps first we need to look at ourselves, the TV programmes we allow our kids to watch and the examples we set them with our fat comments, silly diets and excessive exercise habits.

So perhaps in the right home environment Barbie and Ken could be benign. Just a nice little dressing up toy for girls and boys. Or am I wrong?

What Hinders Eating Disorder Recovery

Following from an earlier post about what helps. There are also things that don't work for recovery.

Having a label pinned to your chest.

Too many therapists label you as anorexic or bulimic, or an addict. Having a diagnosis doesn’t fully describe who you are or how you got the problem. We don’t call depressed people “depressives”. The ED is an illness, but you are not the disorder. Discovering the pathway into your disorder and what is keeping you stuck is better than a label for aiding your recovery.


Trivilialising your symptoms and experience.

Some support systems are not supportive, with family members ignoring the eating disorder altogether or not taking it seriously as a difficult issue that needs attention. Some people call it stupid or vain. They might say “Don’t you know better, you are an intelligent girl.” Or they say you are not fat or thin enough to warrant concern.
Families and friends need to understand what an eating disorder is. They may think that if you just eat more, the problem will be fixed. One girl said that if her parents had come and said lets all talk about this, how you are feeling, what is our role in this, it would have been awesome.


Too much focus on food or on weight.

I’ve heard it said, it’s not about food, it’s about feelings. It is both of course. Your weight might be important, but it is not the only thing we have to attend to. Many people say that the scales are too powerful. So many people don’t feel good enough because they are not thin enough according to their value system. So feedback about their weight can be hurtful.

Focus on health trumps focus on weight for sufferers and no-one must make a big deal of small changes in weight. Emma Woolf, writing in the Times said that focus on weight is crazy. Half the population is given brownie points for losing weight, while people with anorexia are told that to gain is good. How is it helpful to have one rule for some and one rule for others? Therapists must pay attention to overall health and wellbeing. Weight is part of that of course because you cannot be healthy too thin or morbidly obese. Moving focus away from weight and weighing fosters self acceptance. You can learn to stop using the scales as a way to gauge if you are OK, or not.


Being secretive.

Some therapists listen to what you have to say without giving you any feedback. They take notes about your story without helping you to make sense of it. Talking on its own isn’t helpful. Practical skills are helpful, like teaching someone how to eat healthfully and, significantly, how to reconnect to their natural appetite. (how many therapists know how to do Appetite Sensitivity Training?)


Isolation hinders recovery.

But I’m not sure if being in a group with other people with an eating disorder is the best company. There are times to stop thinking and talking about eating disorders and get on with life. Relationships suffer as a result with eating disorders and repairing these relationships is one reason why people decide to try and get better. Helping people to make these repairs and especially helping someone to forgive themselves for all the wasted time and family disruptions must be major part of treatment.

It also helps if we can teach our clients to eat with other people, and socialize without having to put on acts with other people. Learning to be comfortable with other people breaks the wall of isolation that can keep someone trapped in an eating problem.

Being stereotyped and stigmatized.

Feeling ashamed puts up a barrier between the sufferer and other people and we know that poor connection makes the disorder even worse. If someone had cancer, people would have been there for them, but people think that an eating disorder is self inflicted. If other people can’t always be kind, start being compassionate toward yourself.
Make sure that everyone around you learns what an eating disorder is and why some people fall ill, not others. Carers and friends all need to have this information so that they can be a source of help.


The wrong treatment.

While some people get good treatment, others get treatment from judgmental professionals who do not know how to work effectively with eating disorders. Being patronized and criticized destroys your confidence that therapy can work. Providers can inadvertently look down on someone who is struggling with food, and even make threats or hurtful comments rather than trying to understand. Working shoulder to shoulder together rather than face to face is how providers should behave.
Therapists who don’t even talk about food (it’s about feelings, not food) aren’t helpful. Patients express appreciation for learning how to start eating safe foods, and how to listen to their bodies for hunger cues. Getting in touch with hunger and satiety in recovery is important, as well as learning how to eat in front of other people, changing eating rules, and learning how to cook.

It’s really sad that very few people know what good treatment really is, they just have to take what they can get. If a sufferer is difficult, angry and combative, this is the disorder speaking. Good therapists should be able to work around this.

The 5:2 Diet? Good, Bad or Mad?

Laura and Miriam asked me to comment about the Intermittent Fasting or 5:2 diet which has been attracting rave reviews on the “inter-web”.


Scientists have long known about some of the benefits of fasting for longevity. Fasting reduces levels of hormones like IGF1 (insulin growth factor), implicated in accelerated ageing and age-related diseases like cancer and diabetes. It also seems important to reduce your protein intake, so calorie reduction can’t be attained by eating lots of protein – a la Dukan.

Scientists at the University of Illinois have trialled a variant of continual fasting, which they describe as Intermittent Fasting. In an 8 week programme,  people eat fewer than 600 calories on 2 days a week with eating what you like on the other 5 days. They have claimed that it improves IGF and other ageing markers as well as enabling weight loss. Here I insert a warning, this trial was only for 8 weeks and we don’t know what happens in the long term.

There is a Fasting For Longevity movement in the USA. Members have been studied extensively. While they claim to have no issues with weight and eating, most show similar personality characteristics to people with anorexia and they display all the signs of people with classical eating disorders, preoccupation with food, cravings and high levels of emotional distress.

The 5:2 way of eating intended for longevity has been captured by the weight loss movement. Now there's a surprise!   For weight loss, this isn’t new. In the 1980’s it was deemed useful to eat sparingly during the week and eat everything you like at the weekend. Many people lost weight on this regime and then- hey - they put it all back on again. Feasting and fasting isn’t the good idea that it is supposed to be.

Behind the hype, even the BBC admits that current medical opinion is ambivalent about the benefits of fasting. Psychological opinion concurs. Fasting and feasting drives people into polarized thinking, good and bad day mentality and catastrophic reactions when dietary rules are breached. Apart for providing fodder for the pro- anorexia movement or the orthorexic community, this insensitive publicity may lead people to thinking that they are doing something that they should be proud of, when they may be doing something which isn’t really very good for them at all.

Let’s take some of the research which was NOT given head space by Michael Molesey and his team. A number of robust studies show that after one month on intermittent feeding, experimental aniamals show a series of behaviours similar to the effects of drugs of abuse. They begin bingeing, and during fasting periods there are withdrawal signs indicated by signs of anxiety and behavioural depression together with enhanced longing for sugar.

Brain imaging shows gross and complex changes in opioid systems such as decreased enkephalin expression in the appetitive system in the nucleus accumbens, with reduced dopamine levels (reward chemicals) and increased acetylcholine (stimulating appetite). The net effect is the creation of sugar dependency together with cross sensitising to other drugs of abuse.

Feasting and fasting thus risks bringing forth long term problems with control of food together with the emergence of compulsive behaviours and emotional problems too.

So with humans as with rats and other primates, it’s useless to test one set of behaviours in a vacuum for 8 weeks and present it as a panacea for weight and other issues. Mr Mosely may have felt good on this diet, but it's pointless for the millions of people out there who have eating disorders and for who this diet could make things considerably worse. I have given this issue lots of head space and I conclude that programmes like this are unbalanced and risk creating false hope for anxious people who are trapped in a poor relationship with food. As the man said, “fasting, like eating, is best done in moderation”