Eating disorders
Feature
E
ating disorders impact one in 50 people in the UK . They affect all areas of an individual ’ s life and hold the highest mortality rate of any mental health disorder .
The urgent need to improve eating disorder services , including a review of the medical education doctors receive , was recommended by the Parliamentary Health Service Ombudsman ( 2017 ).
A recent study found that doctors receive less than two hours of eating disorders training during their medical education ( Ayton and Ibrahim 2018 ). This alarming gap in vital professional knowledge has instigated BEAT ’ s ( the leading eating disorder charity ) 2022 campaign for Eating Disorders Awareness Week .
This campaign seeks to highlight the need for all UK medical schools and foundation programmes to increase their training in eating disorders .
The importance of prevention
Evidence suggests that early detection and timely access to eating disorder treatment improves recovery prospects ( Zipfel et al 2015 ).
However , the ethos of gatekeeping in the NHS to optimise the lack of resources means that the majority of individuals are denied access to evidence-based treatment ( Brown et al 2018 ), with only one in three people diagnosed receiving specialist care ( Hoek and van Hoeken 2003 ).
Delayed access is made up of many factors , often attributed to the individual , including lack of insight , denial of a problem or resistance to accessing help . However , there are wider systemic factors , beyond the individual . These include : poor detection , due to societal stereotypes of eating disorders , patchy service provision , and poor detection and management between primary and secondary care .
GPs are often responsible for detecting the early warning signs of an eating disorder . However , research suggests that they can adopt a ‘ wait and see ’ approach . GPs can also express resentment and frustration , sometimes considering an eating disorder ‘ lesser ’ than other illnesses ( Walker and Lloyd 2011 ).
A survey found that only 4 % of GPs use evidence-based guidelines when presented with an individual for an eating disorder ( Currin et al 2007 ).
Knowledge is power : it is important to be aware of all eating disorder presentations and dispel any misconceptions around eating disorders .”
Poor knowledge and misconceptions can result in prioritisation of individuals mainly based upon BMI , as well as disproportionate age and gender delays . This is contrary to National Institute for Health and Care ( NICE ) guidelines ( 2017 ), which recommend against using ‘ single measures such as BMI or duration of illness to determine whether to offer treatment ’.
Weight contingent services incentivise weight loss and can be a barrier to those who are not at physical risk ( Rance , Moller and Clarke 2017 ). Challenging conventional eating disorder service access , the First Rapid Early Intervention for Eating Disorders ( FREED ) model has recently developed , providing fast-tracked , specialised treatment for young people with early onset eating disorders .
Although government funding and waiting time standards have materialised for children and young people ’ s mental health services , no parallel funding or service has been made for adults who often face multiple hurdles before accessing specialist care .
What can occupational therapists do in this campaign ?
Undisputedly , GPs want the best care for those with eating disorders , but they need training to be able to detect and signpost accordingly . Occupational therapists are not GPs ; nevertheless , they can play a role in this campaign .
Knowledge is power : it is important to be aware of all eating disorder presentations and dispel any misconceptions around eating disorders .
Eating disorders are often associated with individuals who are underweight ; in reality , according to The Hearts and Minds Genes Coalition for Eating Disorders , only 6 % of individuals with an eating disorder are underweight ( 2021 ).
Occupational therapists are holistic , and although many of us may not be able to address eating disorders specifically , it is important to recognise that eating disorders are not solely about food , weight and shape .
February 2022 OTnews 29