'Children are still deeply misinformed about eating disorders'

We'll never understand eating disorders properly until we stop focusing on weight and start thinking of them in the same way we do depression – as illnesses of the mind, writes one mental health campaigner

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Over the past decade, mental health campaigns have succeeded in educating the public, to a basic extent, about depression.

While you’ll still hear the odd ignorant remark about "laziness", or how the condition "didn’t exist" historically, most people have now had their awareness raised to a level where they acknowledge depression as a real phenomenon and understand that it can be completely debilitating.

This is progress and a testament to the bravery and hard work of those involved.

Somehow, however, despite the first spate of awareness campaigns commencing at approximately the same time throughout the media and in education, there is still widespread confusion and misunderstanding about eating disorders.

As a youth instructor for Mental Health First Aid England, I still hear the most myths perpetuated by delegates when delivering the eating disorder section of the course. When working with children as young as 12, I worry about the amount of misinformation they have managed to glean on the topic.

Most people, when hearing the term "eating disorder", immediately think of anorexia, despite it being the least common illness when compared with bulimia and eating disorder not otherwise specified (EDNOS), which is now starting to be referred to as OSFED (other specified feeding or eating disorder). OSFED is believed to affect between 35 and 53 per cent of the total number of people with eating disorder diagnoses.

When asked to classify anorexia, the common response is to assume that it only occurs in women and is used to describe a girl who is dangerously underweight yet convinced she is fat.

In fact, so all-pervading is this definition that when I experienced the illness myself during my teens I didn’t recognise it in myself. I knew exactly how thin I was, I just didn’t consider it to be thin enough.

There is also a widespread misconception that bulimia and anorexia are interchangeable and people with bulimia are always extremely thin.

To believe this is to drastically underestimate the intelligence of the human body, which registers binge-purge cycles and desperately holds on to calories as they are consumed, rendering most people with bulimia nervosa either a "normal" weight or slightly overweight.

Binge eating disorder is also widely misunderstood, categorised as greed, and falling victim to the more widespread lack of social kindness towards overweight people.

Anorexia is somehow seen as 'glamorous'

Perhaps most worryingly, anorexia still enjoys a reputation for being somehow glamorous; the remit of supermodels and celebrities and associated with "aspirational" personality traits such as self-restraint.

Indeed, anorexia is still largely deemed inextricable from "perfectionism", with high-achieving girls considered to be at most risk.

Just last month, my friend Kelsey Osgood (author of How to Disappear Completely: on modern anorexia) and I wrote a strongly worded letter to the Sunday Times after its magazine plastered a picture of a beautiful French model across its cover with the headline "Dying to be thin". The inside feature detailed the exact calorie intake and exercise regime she used to become and maintain a size zero.

Incidentally, we received no response.

Countless magazines and television programmes have tried to depict eating disorders accurately, failing because they are, by their nature, a visual medium and cannot, therefore, portray an invisible illness which dwells within the closed walls of the mind.

Add to this the fact that most people have a complex relationship with food, in a world where capitalist agendas are considered more important than health, and we are all consuming highly addictive refined sugars and toxic chemicals on a daily basis, and it’s no wonder eating disorders so often fly under the radar.

At the other end of the scale, an obsession with eating "clean" foods under the guise of being "healthy" – often perpetrated by thousands of Instagram gurus without a nutritional qualification between them – can spiral to a level of obsession which is eating disorder-like in its nature. This has led to the use of the media-coined term "orthorexia" to describe the phenomenon.

The most important thing to bear in mind is that eating disorders always happen within the context of a unique individual and, for that reason, don’t necessarily follow the patterns you might expect.

Whilst an obsessive nature, difficulty coping with failure, personal trauma and weight fluctuation should be on your radar, it is by no means certain that a person with an eating disorder will tick any of these boxes.

Men get eating disorders, too (indeed, there is a charity of the same name). Since the medical diagnostic criteria were written assuming that the illness will present in a female (one being "cessation of menstruation"), it’s very difficult for men with eating disorders to be taken seriously, or to access expedient care.

Most worrying, it is still the case that if you visit your GP and tell them you suspect you have an eating disorder, the most likely first step they will take is to weigh you. This is what happened to me during my first, unsuccessful attempt to recover from my eating disorder back in 2001 and, 16 years later (if the countless stories I hear on the ground are correct) little has changed.

I can still recall vividly the humiliation as, standing at almost 6ft feet tall and having inherited my mother’s broad shoulders and my dad’s big feet, I was told that my BMI was technically "healthy" and I therefore didn’t "qualify" for treatment.

My own eating disorder was, I now recognise, an inevitable result of three factors.

The first was an underlying highly anxious nature which was thrown into overdrive when I left the school I had attended, loved and felt safe in for seven years.

The second was a lack of self-esteem, combined with a history of feeling "too big" since towering over the boys in my primary school.

The third was existing in a culture which ferociously and repetitiously conspired to persuade me that my life would be better, I would be happier and more loved, if only I were thinner.

If you were shrewd, you might have noticed physical and behavioural symptoms. The avoiding of social occasions which involved food; the constant, obsessional self-effacing comments; and the desperate need to understand how my body compared with those around me.

Later, when anorexia developed into bulimia, you may have noticed my constant streaming nose, dull eyes, puffy face and raw knuckles. Yet these symptoms couldn’t have given you even a hint of the distress I was experiencing mentally.

My eating disorder was a coping mechanism, more akin to self-harm than anything. I could have stopped all of the external behaviours and still felt exactly the same inside.

And that’s the crux of it, really. Mine is only one of millions of stories, each with their own unique set of circumstances.

Yet we will never understand eating disorders until we stop focusing on weight and start thinking of them in the same way we do depression – as illnesses of the mind. 

Natasha Devon is the  founder of the Body Gossip Education Programme and the Self-Esteem Team and former UK government mental health champion for schools. She tweets as @_NatashaDevon

For more columns by Natasha, visit her back catalogue of articles

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