Guided Self Help for Young People with Eating Disorders:

Request for participants

I am a PhD student at UCL Great Ormond Street Institute of Child Health, working under the supervision of Professor Roz Shafran. The aim of my PhD is to develop and evaluate a guided self-help treatment for children and young people with eating disorders.

I am currently running focus groups to better understand stakeholders views on guided self-help interventions for children and young people with eating disorders. We will then use these findings to inform the development of the treatment to ensure that it is sensitive to the needs of children and young people with eating disorders, their families and the clinicians that work with them.

We are looking to recruit young people (aged 11-17) with eating disorders and parents/carers of young people (aged up to 17) with eating disorders for the focus groups. The focus group will be online and will last approximately 1.5 hours. Participants will receive a £40 Amazon or Love2Shop voucher for their time. The study has received ethical approval from the UCL Research Ethics Committee.

If you are interested please email admin@ncfed.com

Eating Disorders in Pregnancy

Pregnancy can be a difficult time for people with eating disorders.

In normal circumstances, hormones lead to weight gain and eating changes to support the additional 80,000 calories needed for the pregnancy and ongoing breastfeeding.

Regular weighing takes place to check the health of the mother and child, and to ensure that the baby is getting adequate nutrition for central nervous system health at the least. Weighing helps to against gestational diabetes and alert about dangerous conditions like pre eclampsia. Weighing can be traumatic for people with body image issues.

Sadly, there is a great deal of pressure on social media for women to gain as little weight as possible during pregnancy as a “badge of pride,” ignoring the effects that this might have on a child’s future mental and physical wellbeing.

For people with eating and body image issues, pregnancy can be very difficult.

Here are some of the dangers associated with different types of ED in pregnancy.

Bulimia

Binge eating and purging during pregnancy is dangerous, for example loss of potassium as a result of purging including laxative abuse might impair development of the central nervous system of the developing baby. Nutritional support to help prevent cravings is needed alongside urgent help to manage their eating disorder.

Anorexia

Some people living with AN give themselves a holiday from the ED and permit themselves to eat only to begin restricting after childbirth. Others continue to restrict and may not cope with looking pregnant. The risks to mother and child in such situations are critical and the person with AN during pregnancy needs a great deal of compassionate help.

Binge & compulsive eating

Binge eating is not just taking in a lot of food. Because binge eating is usually highly processed sugar rich food that provides emotional comfort, there are profound metabolic effects. These in turn can switch on epigenetic changes that predict future weight struggles in the developing child. People who enter pregnancy with pre existing struggles to control eating and weight need informed help to manage their relationship with food from the get-go.

They do NOT need being shamed by health professionals about size or weight gain and they do NOT need well-meaning advice about how to eat a healthier diet.

Every single pregnant woman with runaway weight gain during pregnancy will benefit from compassionate help from someone who can talk to them without blame about their relationship with food.

Pregnant women do not respond well to midwives and doctors telling them what they should do for the good of their baby. The best way to protect the baby is to look after the mother and the people who support her.

Resources

Kings College London has a Video to support women in Pregnancy https://www.kcl.ac.uk/archive/news/ioppn/records/2018/february/new-animation-enhances-support-for-women-with-eating-disorders-during-pregnancy?fbclid=IwAR319Yju4dSQXJkAaJpd7h4JbMWCmqTEEOU4IxrJPrSlgvus4JG_lp7v740

Here is another perinatal support website

The British Journal of Midwifery has an article to support midwives – hope they read this

https://www.britishjournalofmidwifery.com/content/clinical-practice/eating-disorders-in-pregnancy-practical-considerations-for-the-midwife/?fbclid=IwAR3R0G-OPxXZDvgcejWeP3RtAw0gpuK6y6UGhnXSkssKubSDdqIaHnCBOXU

Susie Orbach talks about the needs of eating disordered women during pregnancy. See her podcast Life After Diets with Susie Orbach, https://youtu.be/OhaVwcp9pqc

If you are expecting a child, and need compassionate help with your eating disorder, call us now
0845 838 2040

Research into Anorexia Treatment

Sophie is writing to you about the research project that she is conducting as part of the Doctorate in Clinical Psychology at UCL. My project aims to explore how Externalisation of Anorexia Nervosa can Help and Hinder Recovery from this Eating Disorder.

She says

We are carrying out this research because although externalisation (viewing and talking about anorexia as a separate entity that is external to the individual receiving treatment) is a widely used therapeutic technique within therapies for anorexia, research exploring how externalisation helps and hinders people’s recovery from an eating disorder is very sparse. Our research aims to further our understanding of people’s experiences of externalisation in treatment for anorexia in order to learn how this approach may or may not support recovery from an eating disorder. We hope that by exploring a common strategy used in therapies for AN, this project will help to inform and improve treatments for anorexia. To help increase people’s chances of recovering fully from an eating disorder, it is important that we understand the views of individuals who have received treatment for anorexia. Therefore, we aim to obtain people’s views through semi-structured interviews which I will be conducting online.  

We are looking for people aged 16 and above who have received at least one or more NICE recommended therapies for anorexia, who may or may not have reached a point of recovery from an eating disorder, and who are familiar with the notion of externalisation in treatment for anorexia.

To recruit participants, I have posted on my linked in, twitter and facebook accounts. However, I would be enormously grateful for any support that NCFED may be able to give to raise awareness of the study among the target population which NCFED have greater access to. I would be happy for you to post about the study or alternatively you can share / retweet my posts. Below I list my accounts on social media, however, please do let me know if there are alternative or additional methods of raising awareness that NCFED may be able to support with. I attach my leaflet for your reference.


Twitter: https://twitter.com/SophieCCripps/status/1545072159919308801

Facebook: https://www.facebook.com/sophiecharlottec

Linked  in: https://www.linkedin.com/feed/update/urn:li:activity:6950852244699283456/

Bikini Body Outrage

A Brummie Mummy has has invented a wooden bikini into which you can insert coins for every pound of weight you lose to get into a bikini body.

To get summer bikini body ready.

There is a WEDDING DRESS version for women to get sized down for their big day. I wonder how many men “fit-up-slim-down for their big day?

is this what women are supposed to eat so that they can have fun at the beach?

There is not an equivalent wooden weight loss “trunks” for men. We have to put an end to this kind of nonsense

https://www.bbc.co.uk/news/business-61881412

Children with ARFID Family Support Group

A monthly family support group with Jenny Phaure

Family Skills for Autism and Disordered Eating Monthly Psycho-Education and Coaching Group.  

This group is now open for referrals and bookings from Charities, Mental Health Teams, Eating Disorder Services, Social Care, Allied Health Professionals, GP’s, Therapists and independent providers.  

Why is there a need for this group?

Up to 70% of Autistic Children may experience atypical eating behaviours, many have issues with food or eating. Whilst research indicates that between 25-30% of those with Anorexia Nervosa also meet the diagnostic criteria for Autism there is a much larger number of autistic children, young people and adults who experience avoidant, restricted and disordered eating patterns.

Avoidant, Restricted and Disordered Eating patterns may be a precursor to Anorexia Nervosa or may exist alongside other Eating Disorders such as Bulimia Nervosa or Binge Eating Disorder.   This group is the only Family Skills for Autism and Disordered Eating Group in the United Kingdom and has been set up due to the need to provide more immediate support to families living with Autism and Eating Disorders.   With limited recourse to local or national autism specific services it is vital that parents/families are given access to essential psycho-education, tools and strategies to support their loved ones at home or in the community. Families are often the most important resource.

A Monthly Psycho-education and Coaching Group   with Jenny Phaure (Child and Adolescent Psychotherapist)  
2 hours on line via zoom   Wednesday 20th July (10.00am – 12.00pm)    

Family Skills for Autism and Eating Disorders  

Using positive psychological approaches to improve mood and food regulation.    

Cost: £45 per person     Bookings via service contracts or block bookings are available for those referred via a service provider. Please call: 07545 190915 for more information.  

Your facilitator Jenny Phaure

Can an Eating Disorder Service also offer Obesity Treatment

Yes, if the service is specified as two -sided and clear about the distinction between eating disorder treatment and weight loss coaching.

At the National Centre for Eating Disorders we do a holistic assessment of a person to ensure that no significant eating disorder is present; if it is present we make it clear that there are to be no weight loss attempts during treatment for the eating disorder and such a person might not in the future be suitable for intentional weight loss.

It is incorrect to assume that all people wanting weight change have an eating disorder.

If we agree after assessment to support a client in their weight change intentions, we will engage in a manner consistent with good practice and we have transformed many lives. Some of our clients have had a history of binge eating / bulimic disorders and have gained weight throughout the years because they have not had timely treatment for their eating disorder. We empathise with their desire to change weight if the time is right.

In such a case we would not do anything that would reactivate their eating disorder.

Weight loss “guidance / therapy”, does not imply dieting or food rules or boot-camping nor does it have goal weights. Nor does it require endless searching into childhood adversity. Nor is it HAES although they have some but not all, very good points.  The service includes bariatric counselling. Some people, with our help, decide that they are happy as they are. The ultimate outcome is flourishing.

We market obesity treatment because of the numbers of desperate people INCLUDING therapists who seek our help. It must mean something that over the course of 40 years no one entering our service has complained about stigma.  No therapist training with us over the same period has raised a complaint about anti-fat bias.

Activists who have not done our training are pitching against us with total ignorance about what we do. It interests us that while they are intolerant of the word “obesity” they bandy the term “fat” as if it means something different. Really?

What worries us at NCFED is the number of activists who actively try to deny people from having access to good weight change help; who wish to prevent therapists from learning about strategies that might work, and who wish to withhold from the public factual information about some health risks of living in a larger body. On top of this, no activist is able to come up with a single client or psychotherapist trained by NCFED who has been “traumatised” by weight stigma.

The NCFED has no need to make a big deal about inclusivity. We have therapists of all genders, races, religions, tribes and colours. We treat people without needing labels. Inclusivity is woven into our trainings and the first thing we do is delve into the history, generational issues, declared identity and value systems, of each individual in a place of complete acceptance.

I will not give the litmus of attention to angry people. Certainly, it is right to question the old “sacred cows” and reflect on their meaning and purpose. Having reflected, we feel good about what we do and we will not kowtow to aggression. People in the community who do not have a clinically significant eating disorder, who desire intentional weight change, deserve far better help than the traditional diet and lifestyle methods that do not work. They can come to us for that help, given by people we trust.

Meanwhile, Our amazing course, Essential Obesity: Psychological Interventions, next date June 2022

BACP advertising unethical Weight Loss Plan

I and my colleagues are angry and disappointed that a weight loss consultancy company advertised for “weight loss counsellors” in Therapy Today, the main journal from the British Association of Counselling and Psychotherapy (BACP).  This Company is selling Very Low Calorie diets based on milk shakes and “treat” such as “protein bars” to help people supplement the boring shakes with tid-bits that will help “keep them on track”.

Weight loss counsellors are paid according to their success in motivating clients to stick to the programme and to buy the Company Products. So, the counsellors are invested in tricking, or persuading or coercing people to stick to the programme.  Why wouldn’t they?  After all there is money in it for everyone except for the poor client who will be led to think that what they are doing is good for them.

As for the company (Cambridge) – having a “trained counsellor” on board means that their diet is legitimised.  The “trained counsellor” can deal with the psychology while the diet helps with the fat. Win-win all round for everyone concerned.

Can you see what is going on? It is horrible. Extreme weight loss plans like Cambridge can be dangerous, can lead to eating disorder behaviour, and liver damage. They are guaranteed to cause runaway weight regain in most people who embark on programmes like this in hope and desperation. There is a high risk that a person will end up fatter than they were before they invested their hard-earned money on a quick fix solution to their weight issue.  I know that most of you don’t want to read this, but diets like this don’t work.  Extreme calorie restriction teaches the brain that there are famines to come and your weight thermostat tends to rise. There are other ways to bring the thermostat down but this deserves another blog.
So, you might argue, would a counsellor help someone to avoid that kind of risk and somehow help a client stick to the diet and maintain the weight they have lost?  Perhaps they will tweak your emotional life or do some work on your early adverse experiences.  Perhaps a compassionate buddy will help you to be the 1 in 100 success case from a milkshake diet.

Think again.

I train many fully trained counsellors to work with eating disorders and obesity.  Up to half have serious eating disorders themselves, regularly go on and off diets and are struggling to control their own weight. Weight and eating issues simply do not form a good-enough part of the general counselling curriculum.  So, after they qualify, many counsellors stick eating disorders and obesity on their marketing material, but do not (yet) know what they are doing.  Some of them think (wrongly) that obesity and disordered eating is all about trauma. It is not.

I don’t want here to argue a case against all diets, because many people who control their weight do adjust their eating habits and manage their weight reasonably well. There is a difference between lifestyle change and the thousands of weight loss plans out there. However, a weight loss plan that relies on calorie restriction, fasting, or carving macronutrients out of your life though, works in the short term but makes things worse long-term. The only people who might be suited to a short term fix like this is someone suffering from Diabetes Type 2 – and only then under medical supervision. To impose this kind of diet on the public is harmful. Liver damage, gallstones, reactive binge eating, bulimia nervosa are common side effects, not to mention the stress of having to eat differently from the people you love.

For a counsellor to understand the psychology, the neuroscience and the physiology of eating and weight problems requires a large amount of additional specialist training. If you don’t use a counsellor with this training is like asking a GP to conduct brain surgery. You just wouldn’t let him or her loose on you.  And, to harness counsellors to sell diet Milkshakes for weight loss is not only wrong, it is wicked. For counsellor to engage with this  is also unethical unless they can prove their appropriate qualifications.

For one thing, agreeing with a client that they “need to lose weight” contributes to the weight stigma that may have led to their problems in the first place. People exposed to stigma find it harder to motivate themselves to eat well, and to engage in activity. They engage in more emotional eating and are likely to be black and white in their thinking. They divide food into good and bad, if they eat a good food, they are worthy people and if they eat a bad food they call themselves weak-willed and greedy. Restrictive diets plus stigma forces a client into a very all-or-nothing relationship with food and with themselves.

 I and my colleagues from the NCFED have spoken several times to the BACP advertising department and their Ethics team to express our opinions. We have also dredged up evidence to demonstrate to the BACP some of the dangers of extreme liquid diets.

The advertising department has ignored us, and as for the Ethics Team, we have had nothing other than an undertaking, since disappeared, to alert counsellors to the ethics of promoting themselves as weight loss consultants without appropriate training.  It seems that counsellors have to promise to regulate themselves and they do not. On a counselling forum recently that clients do not read, one counsellor confessed to having a binge eating client. She wrote “I will deal with all the other things and leave the binge eating alone”. I was horrified – the binge eating was probably causing all the emotional fallout that this poor client was experiencing. The counsellor should have referred the client straight to an eating disorder specialist but thought that it was not important. Maybe she just needed the money.

On another Facebook page peopled by counsellors, it was suggested that obesity was caused by trauma, and most of the members agreed that this was so. When I tried to explain that there are alternative explanations of why people gain weight, I was shouted down. There are a lot of charlatans out there and some of them may be the Cambridge counsellor consultants.

If you want to work with a proper weight change counsellor, you need to find a person who is properly trained to work with body image and the psychology of eating. You will need someone who understands the effects of weight stigma including the stigma that a rises in the counselling space, and to understand the physical and mental health effects of engaging in dieting practices.  Obesity is a very complex condition and its association with mental health is also complex and bi-directional. A Counsellor more than anyone should be aware of fostering the belief that weight loss is desirable and will bring happiness and success in life.  While it is true that weight change can greatly improve QOL, there are good and bad ways to achieve this and it is not a quick fix.

As part of their ongoing training, the counsellor will have done a great deal of work on their own relationship with food.   Quoting an eating disorder advocate – “there’s a sad irony to advertising weight loss consultancy to the very people who are key in helping others with their mental health”.

By encouraging this KIND of dieting, especially restrictive diets like the Cambridge one, Therapy Today/ the BACP are contributing to the harm caused by the diet industry and are encouraging eating disorders. This is unacceptable and unethical.

My plea to counsellors is this. Please do not associate yourself with the Cambridge Weight Loss plan. If you really want to help people who struggle with their relationship with food and their weight, without implying stigma about their size and shape, get proper training.  I am certain that you will never again want to promote a milkshake diet. And let the BACP know how you feel about their behaviour and their failure to rise to the concerns of people who work on the coalface with eating and weight.

How to Help People with an Eating Disorder to Recover: Guest Blog

The term “eating disorder” covers a wide range of conditions such as anorexia, bulimia and binge eating. If you have a relative or friend suffering from one of these conditions, it is only natural that you will want to help.

The first thing you can do is learn about their particular eating disorder so you can understand what they are going through. There are many articles on our website. Another option is to persuade them to seek professional medical assistance. Unfortunately, this can often prove challenging. You cannot force someone to see a doctor if they don’t want to go (except in certain circumstances). It would be far better if you could encourage them to seek help willingly or even offer to accompany them.    

There are ways of providing support:

  • Help them build up their self-esteem. Tell them how much you appreciate having them in your life. This can give them confidence and help them feel better too.
  • Make them feel valued. A person with an eating disorder may feel depressed and less inclined to go out or join in with your usual activities. Nevertheless, ask them anyway; even if they decline, they will be happy that you made the effort.
  •  Lend an ear. This is sometimes not an easy thing to do, especially if your friend says something about themselves that you disagree with. such as that they are fine. Remember, you don’t want to argue, you just want to be there for them.        

Healthcare perspective on eating disorders

The NHS is aware of, and in fact alarmed by, the rising numbers of eating disorder sufferers. Many of these cases involve children. It is believed that the best option for people struggling with this type of mental health problem is for healthcare professionals to carry out an early intervention.

However, in the UK, only the most extreme cases get the help they need, or hospital treatment if it is appropriate. More often than not, your relative or friend if help is offered at all, they will need to attend counselling support as an outpatient. According to this article, one possible reason for this is that there are not enough mental healthcare nurses.

Treatment for eating disorders

The recommended treatment for an eating disorder is usually some form of talking therapy targeted specifically toward eating disorder behaviour. A therapist will try to uncover the motivation behind the patient’s refusal to eat, or behave in other ways that are harmful. Part of what keeps some one trapped in an eating disorder is that it has become a way to manage their feelings. The therapist could then help the person learn a better way of coping with emotional difficulties. Some people with eating disorders can benefit from a self help programme. They may also undergo regular health checks to ensure that they are sticking to their treatment. As a friend, you can accompany them on their journey and provide moral support.

Eating disorder treatment does not force people to change. Forcing people to eat is only possible if they have lost an extreme amount of weight or they are starving themselves to death. In either circumstance, a doctor’s approval is required for this type of drastic measure.

Recovery may take several weeks or even years if the eating disorder is severe. It is a slow process but it will at least ensure that your relative or friend has time to get accustomed to their treatment plan. The earlier the treatment is started, the better their chances of making a swift recovery.

Conclusion

People suffering from an eating disorder are likely to need the support of their loved ones, especially during the recovery process. It is important that you encourage them to seek professional help, especially if they are denying that anything is wrong or promising that things will be different tomorrow. They will also need to recognise how they can cope more positively even in challenging circumstances. An optimistic attitude is essential as recovery may take some time. Unfortunately, there is the possibility that they will relapse and return to their old ways. If this does happen, try to offer your support and help them get back on the path to good health.

The Crown: Netflix and Diana’s Bulimia

THE CROWN: Bulimia and The Princess of Wales

Netflix are about to broadcast their latest edition of The Crown showing Diana in the throes of bulimia nervosa. We are led to believe that her unkind and thoughtless treatment at the hands of the Prince of Wales was responsible for her decline into poor mental health and a ravaging eating disorder that dogged her life for years.

We are told, but will never know if this is true, that she first purged before her wedding, in the context of knowing that her future husband was close to another woman, Camilla Parker Bowles.

We will believe that dealing with a huge amount of stress was responsible for her poor mental health and eating issues. This stress included her loveless marriage, her unkind and dismissive husband, and the pressures of the expectations heaped upon her shoulders as a future queen.

If Diana had been put in this position in 2020, there is no doubt that she would have had access before even becoming engaged, to much better guidance and support than was available to her then.

I, like many viewers have struggled not to feel a great deal of pity for the situation in which this young woman found herself, together with anger about the unkindness of the family in which she had been thrust. But, I also find it hard to blame the Royal Family or any of its members for her eating disorder. With courage or confidence, she could have expressed her outrage differently, but then she simply didn’t know how.

We know that bulimia nervosa is not “caused” by anything. It has its roots in the personality of the sufferer and any adverse events they may have suffered in childhood that have weakened their self- esteem and stopped them from being able to express their wants and needs. One example of such a trauma was her mother; abandoning her at a very young age, leading her to believe perhaps that she was not important enough to the most important person in her world.

We know that people with bulimia tend to be sensitive, perfectionist, they tend to over-think and they lack a great deal of self-confidence. Diana will have brought all of these traits into her relationship with the Prince of Wales. A person carrying that deadly disposition to developing a mental health problem will not be able to cope when the going gets rough.

Diana has flagged up her eating disorder as a “cry for help” and perhaps she is convinced that it was, or maybe this was offered as an explanation by her various therapists. I prefer to think of bulimia nervosa as the preferred way of coping with emotions that are overwhelming when someone lacks the language of emotions or the permission to express what they feel.  It is no surprise, therefore, that bulimia lost its hold – and, she was able to tolerate being a healthy body weight, when she discovered her confidence and found a more authentic purpose for her life.

What triggered her act of purging in the first place will never be known. It pre-dated her marriage and from that moment the eating disorder was ready to blow up and engulf her.  I would imagine that blaming the cruelty and the thoughtlessness of other people did not lead to change even if she was only able to thrive outside of that toxic and loveless environment.  What helped her to recover was rediscovering her voice and gaining permission to deserve to eat. Anyone with bulimia nervosa will need specialist help to recover, by targeted focus on self and building something much bigger than the relationship with food.

Covid19, Obesity & weighing children

I’ve been watching the Twitterstorms and the media circus about the virus, lockdown weight gain, weight loss plans and weighing children in schools

I don’t approve of weighing children in schools after the age of 11. Secondary school children are too weight sensitive and have enough on their plate anyway without the additional shame and worry that is caused by weighing them.

Weight gain is part of adolescence anyway. Bones and organs are growing, boys are adding muscle, girls might be weighed before menstruation, when their weight might be a little higher than usual due to hormones.

Kids think that dieting is the best response to weight gain. What do they know! Dieting is a high risk factor for getting an eating disorder. It can provoke anorexia in some, compulsive eating in others, bulimia in a few. One an eating disorder has its claws in you, it doesn’t go away soon. So please please THINK AGAIN, this proposal is INSANE!

Weighing kids before 11 is OK if it goes along with the usual stuff, height, nits, foot health, weight. OK so we are worried about obesity? Well I accept that. We cant put our heads in the sand and pretend it doesn’t matter. If the virus likes a well-covered person too much, it is what it is.

Fat CAN make some people sick. Sedentary lifestyle can make some people sick as well. Even some healthy diets can make some people sick. Shame and body hatred makes people sick.

Weighing children could be useful if there was proper joined up thinking. The parents of an overweight child mustn’t get the dreaded fat-letter. What use is that going to be other than make them mad. Don’t call my child fat! Who cares anyway! Its only puppy fat!

Parents worried about their child’s weight need access to a coach, someone who is properly trained to help without conferring judgement, shame and guidance. They don’t need diet sheets or good advice given by someone who probably lives on salad and mung beans.

I did something on live TV last night. I forgot to point out that weight gain during lockdown isn’t a cause for shame, alarm, weighing or panic. I forgot to point out that some kids are growing normally. Here it is
https://www.mailplus.co.uk/tv/good-health/18961/what-has-covid-done-to-our-sex-lives-from-couples-who-cant-stand-each-other-to-singletons-hitting-the-dating-scene-we-investigate