Anorexia In Children NOT Increasing?

Some people who have an interest in shock horror headlines (why?) have made a big deal about a so-called increase in eating disorders in young children.

I’ve always  hesitated to agree with all the hype and panic.

Lets look at the evidence. On 31st July the Sunday Telegraph ran the headline “Hundreds of preteen children treated for eating disorders….. including 197 children between the ages of five and nine, with cases within this age group almost doubling over the period.”

How do journalists get this information? Its easy and cheap. and often relies on reporting cards filled in by consultants to monitor rare conditions (2011;198:295-301). So is health information like this, obtained by freedom of information requests, accurate and useful?

Rachel Bryant-Waugh (consultant clinical psychologist /joint head of the feeding and eating disorders service at Great Ormond Street Hospital in London) said, “I think that there is a fundamental difficulty in confusing terms: it’s easy to see how these things get a bit muddled, and it then comes across in a way that is slightly misleading. It is very unlikely indeed that 5-7 year olds present with anorexia nervosa. … But they may have low weight and significant eating difficulties for many other reasons – for example, illness, gastrointestinal problems …..or a range of psychological factors. Such children might present with eating difficulties as the main problem, but they do not have anorexia or bulimia “.

So, when journalists use the Freedom of Information Act to ask for the numbers of children with “eating disorders”, they are not being specific enough to enable concrete conclusions. Waugh says…”Eating is a very complex behaviour in terms of all the processes required: many specialities care for children with eating problems. Formal eating disorders – that is, anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified (EDNOS) – are relatively rare in young children. However, they may be increasing in middle childhood. But the lack of consistent terminology means that there is a large difficulty in drawing conclusions here.” 

Mark Berelowitz, consultant child and adolescent psychiatrist at the Royal Free in London agrees. “The DSM puts eating disorders into two categories, one is eating disorders-anorexia, bulimia, EDNOS.  The other is feeding and eating disorders of infancy and early childhood. Its not clear that information given to journalists related to anorexia nervosa or the vast number of other conditions much more common in young children, like failure to thrive and other problems. 

The other thing is that with the best will in the world its hard to produce good data quickly during the summer holidays and in a short time scale: and ordinarily need to be scrutinised carefully before they’re submitted, and I would have been astonished if any trust would have high quality data at its fingertips”.

Of the apparent rise in anorexia diagnoses in the very young he said, “When you come across this seeming threefold rise you have to ask yourself how good are the data: if you project the rate forward you would get an absurd number”. 

It seems that journalists aren’t asking the right questions and the NHS Trusts are not giving accurate answers. “The data they got was from ALL FEEDING DISORDERS, and then in the press this was expressed effectively as anorexia nervosa. I suspect that if the Sunday Telegraph had asked the Royal College of Paediatrics and Child Health or any specific clinical service how many patients had these disorders in these young age groups we’d have very different numbers.”

So lets not alarm parents and doctors and lets not tar all children with funny eating issues with the same brush. It makes Good Press but it is…. LIES

Alcohol And Diets

Alcohol Ruins Dieting Efforts for 1 in 4 persons according to research into the dieting efforts of 1000 people by Forza Supplements in 2013 .

We already knew this, but the research makes worrying reading. Alcohol shows effects on willpower, wishes to indulge and impulsivity. It’s calorific too, and very few calorie conscious people calculate how much energy is in a tipple. A moderate drinker can ingest up to nearly 1000 calories in a gentle night out.

Alcohol is known to increase appetite due to its effects on leptin (which is suppressed) leaving the brain ignorant of whether a person has eaten enough or not. As few as two standard drinks can slow down the ability to burn fatty acids by up to 73%.

Alcohol compromises the liver which recognises alcohol as a toxin. As the liver works to get rid of the toxins in alcohol,  it favours the burning of empty calories in the sugar. When those calories are used up, more may not be needed; leaving the calories from more nutritious food to be laid down as fat.
A drink, anyone?

We Need You For Research Please: Eating Problems & / Or Self Harm

Are you 18 years old or over, with an eating disorder and with or without self harm?  We need your help.

I am looking at the reasons why some people have difficulties with impulsive behaviours, such as self-harm and what their feelings are around food. This study  aims to look at how people pick up on what others are thinking and feeling, as well as how people think about their own thoughts and feelings. Greater knowledge in  this area will help in designing better psychological therapies for people who have impulsive behaviours or strong feelings they find it difficult to deal with.

Eating disorders and impulsive behaviours represent two very common, but under-researched areas. I want to focus especially on people who present with difficulties
around food, as well as difficulties around self-harm so I can see how things like
understanding other’s feelings impact on their capacity to engage in
therapy.

I am attaching the link for the survey. The participants information is all in the link and
comes up by clicking on the relevant words.

https://cityunilondon.eu.qualtrics.com/jfe/form/SV_9sOL7WgeajExeGF?Q_JFE=qdg

We would love to hear from you. You will be helping us to help other people. Thank you.

I Would Not Eat With You

Someone said that they would not (be able to) eat with me, when I wrote a blog on behalf of carers. So I have written a reply because it has been on my mind. Yes YOU I do take notice of what you write to me!

http://deannetalks.blogspot.co.uk/2013/10/i-wouldnt-eat-with-you.html?spref=tw

Have a look and feel free to let me know what you think. When you become a carer you learn what loneliness means. When you are the one with the eating disorder you discover a new and very lonely world. The eating disorder won’t go away by itself. It takes a lot of courage to fight it. It isn’t good company for anyone.

I really hope that we can help you, even if it is just one baby step at a time.

Eat Butter Eat Butter Eat Butter – Yay!

There’s growing evidence that our favourite fat can not only be good for us, it also wont make us fat in moderation says one of my favourite nutrition experts, Dr John Briffa.

For years and years we have had the illusion that all foods can be measured in calories and all calories are the same. We have bought the story that all fat is dangerous and rush like lemmings to buy skimmed or semi skimmed milk, fat reduced sludge that we call margarine,  and low fat everything.

I’m not going to replicate all the physiological arguments here, but the body doesn’t work like that. We have been sold many pups by people who are interested in making money out of our fears. We buy strange yoghurts with plant stanols in our fear to reduce cholesterol and we buy fat-reduced chocolate biscuits and low-fat crisps that taste like cardboard. Fat-reduced biscuits? Who are these people really kidding!

In addition to being made fearful of fats, we are also fearful of particular kinds of fat. Saturated types of fat like butter is supposed to be bad for our waistline and our hearts.  We don’t even know that the second most plentiful fat in butter is unsaturated, which is supposed to be good for us like nuts and seeds and cold pressed olive oil.

But does butter make us fat? Strangely there isn’t much good evidence. Taking fat out of food and milk can make it higher in sugars, which is associated with weight gain. Adding butter to your diet might be good for your brain, make you happier and reduce your cravings for sugar.

So next time your hand hovers over the full cream milk and your eyes wander over the butter in Tesco, let yourself buy it. Full cream milk is a low fat food which will keep your blood sugar stable and light your inner fire. Butter tastes nice, won’t make you fat and is good for your heart.

People with eating disorders and weight problems have become terrified of fat. It’s often the first thing that gets ditched with the dieting.  We need to eat fats and we needn’t be scared of butter. Follow the informed arguments, not the advice of people who want to make money out of your fears. I’ve started eating toast with butter and drinking full fat milk again, and it makes me very, very happy that I can, without fear.

 

 

 

Starving and Scoffing Kids

Children aged less than 2 years old are finding themselves in hospital to treat their morbid obesity. This is consistent with Britain becoming the fattest nation in western Europe.  Childhood obesity was the subject of a breakfast meeting chaired by Rod Liddle, another well-known journalist, only this week. At this meeting, a great deal of time was spent worrying about mothers who are downright abusive; feeding their children the kind of rubbish I would perhaps give to the family pigs (if I lived on a farm that is).  Or mothers who are too busy to cook proper food for their children.

Or mothers who are unable to convince faddy eaters to eat their broccoli. Or mothers who are too lazy or too poor to buy nutritious food.  Or at least tell themselves they are too poor. And mothers who are thwarted by cafeteria eating at school. And what about the fathers too?

Mothers came in for a lot of stick at this meeting – as did the food industry.  Some mothers do deserve to sit on the naughty step. And the food industry- well that’s another story altogether.  But I think that the problem of childhood obesity is more elusive and clearly shows an interaction between our genes, which favour gaining weight in times of plenty and the environment.  These fat genes can easily switch on at any time, for example if a certain amount of sugar in the diet is present at an early age, or, if weight increases at a slightly higher rate than normal for any reason you care to name, and once those genes are on they are on for life.

We have all agreed that we are living in an ocean of food and perhaps it isn’t helpful blaming mums. Having said that, I sometimes wander round supermarkets and want to say to a parent, why are you buying this STUFF don’t you know what’s in it?  Why are you giving this toddler a packet of crisps to keep them quiet while you do your shop? Do you know how much sugar is in that cereal?  I did it once to see what happened and got a mouthful of abuse.

When I went to the fair when I was a little girl – it was candy floss or nothing. Now its Hagen Daaz, toffee apples, pizzas, doughnuts, fizzy drinks, and fries.  We don’t eat now to survive, we eat to have fun and to spend time when we are bored and we slurp up coffees in big sizes in a mindless way, we buy foods to give us brain pleasure like crisps or chocolate just as smokers smoke cigarettes to make the tasks of everyday life just a little more pleasurable. Where childhood obesity is concerned, no one knows what a fat child really looks like any more unless they are significantly overweight and no one likes to get the fat letter from school.  The “fat letter” doesn’t come with cast iron solutions either,  since kids who are put on a diet just gain more weight when the diet comes to an end.

Writing in the Sunday Times on October 13, India Knight asks why so many of our kids are scoffing themselves to death while so many starving themselves in the quest to look like Miley Cyrus at the same time. She rightly questions the value of telling a child that they are fat. I’ve blogged about that somewhere else. And she rightly puts out a plea to dieting, weight obsessed mothers of young girls to do their stuff in private.  I would add this warning to gym and health obsessed fathers of young boys. India wonders if obesity in children should be classified as a mental health disorder like anorexia which are signs of underlying unhappiness.

I would say to India that we are all less happy than we used to be, Oliver James has written about this in his book Affluenza. In the developed economies, our aspirations have spun way beyond our ability to meet them.  Social media and Instagram culture have added to the sense that everyone else is doing better than you are. Journalists who are also parents in the Times are celebrating their excessive use of alcohol or their occasional use of lifestyle drugs as if we are interested in it. In the Times also this Sunday there was an article of a teenage boy who was made miserable when he was given a smartphone. Our children really do not have a hope.

So if you look for unhappiness in any individual child with a fatness or a slimming problem you will find it. When I work with an overweight child I am definitely going to help them gain confidence and self esteem.  But years ago, most unhappy children did not become fat nor did they become anorexic. How you address the deeper unhappiness in our wealthy society, and whether it will solve the problem of childhood obesity is another thing altogether.

Childhood obesity programmes like MEND or the Carnegie Programme are well intentioned but they are a finger in the dyke of what we will need to fund the health risks of obesity which will cost this nation more than the cost of education. As for the Health At Every Size Movement, which ostensibly exists to deal with fat stigmatision,?  By all means, lets deal with stigma but if this deflects efforts from trying to get the nation to eat a healthier diet, then it will do us and our children a disservice.

I’m an eating disorder specialist who cooks her own healthy food who had one fat child and two thin ones. I think that no child was significantly unhappier than the other. So I know from personal experience that obesity in children is a complex subject and wish I could come up with a solution.

Until we can, we have to keep writing about it though.

Diet Drug Kills Young Man

A young male just over his A-Levels, living not far from me, has died taking DNP, an industrial chemical popular with bodybuilders to help them to lose body fat. Easily available online, this drug has recently killed a young female medical student who had been battling bulimia with the help of a counsellor.

Women and men are increasingly concerned about their weight and would turn to desperate measures to lose weight at any cost. Some are prepared to risk their lives, they say it would be better to be dead than overweight.

Overweight is often a state of mind not a state of the body. You can feel unbearably fat if you are just a few pounds bigger than you want to be. I don’t think anyone really knows how horrific it can feel to be inside a body that is driving you to madness.

I am terribly sad at the waste of this young life. I ask myself, did he know the risks? If we could bring him back from the grave and ask him if he would do it differently, would he let his dangerous habits go? Or would he just try something else instead?

Life inside a body you hate is the most miserable thing in the world unless other things are just more important to you. Life inside a body you hate is the breeding ground from eating disorders which steal your time, your relationships and your health.

Part of me thinks that if this boy couldn’t bear to be a normal size and shape his death may have spared him endless years of torment. Is that a terrible thing for me to say?

What a mad world we live in. What terrible things we do to ourselves in the pursuit of thin. If you are a coach, a teacher, a parent or a sufferer and if you are reading this blog. Just stop whatever you are doing. Nothing and I mean NOTHING is more important than health or wellbeing. Not winning at sports, not being a good dancer or a pretty daughter or the thinnest person in the room.

NOTHING IS MORE IMPORTANT THAN LIVING A HEALTHY LIFE IN A REASONABLY HEALTHY BODY.

End of story.

 

 

Carers’ Burdens

This post has been reproduced on our other blog at http://deannetalks.blogspot.com

During the summer I have been in Cornwall with family and we had a great time, trying new restaurants, eating a couple of 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 or grumble about the food.
It is awful 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 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 important to emotional well being as well as physical 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,  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 worry 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. Its normal to reject things we 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 sympathetic to the trauma of living with someone who cannot eat around the campfire with us.

Exercise: Does It Make You Thin

We are fascinated by Jacques Peretti’s series on BBC Channel 4- The Men Who Made Us Fat and “Thin” i.e. made us try to lose weight.

So from the horse’s mouth, exercise does lots of good things for you but it may not make you lose weight.  People who exercise and lose weight are usually controlling their eating very carefully. I was amazed to discover that an elite male tennis player was not allowed chocolate for a year, then he indulged after his Wimbledon final by having a couple of chocolate squares.

Wow!

I’m also delighted to have it confirmed that fat people and fat children aren’t lazy at all, that they probably move around less because they are overweight not the other way round.   I’m delighted to learn despite all the government hype that children are moving around as much as they ever did, and that everyone who exercises a lot compensates by resting a great deal too.  Exercise makes you eat more too, there is no backing away from the evidence on that.

And I am horrified that the Food Industry has convinced everyone including people in Government that our problem is being sedentary and it is not their horrible food that is to blame for people being fat. They are so, so wrong.

I’m in favour of exercise, for lots of health reasons but I’m against the message that you are a slob if you don’t go to the gym and work out. I also want to help people who become addicted to exercise as part of their eating disorder.

The real causes of weight gain, apart from food it seems, is not exercise as such – which burns very few calories if you go to the gym a couple of times a week. It is long periods of time sitting down, which lowers the fat burning enzymes which turn energy into fuel which can be burned. For that reason, people who fidget a lot burn much more energy than people who sit down all day and then go out for a run at night.

So people – move around just to have fun and rest when you feel like it. Moving around for fun and being happy is one of the best weight control strategies I know.