Professor Lacey answered your questions on eating disorders, here is what he had to say:
Anonymous67 asked: Dear Sir/Madam, I am struggling so so much to beat anorexia. I am now eating my 16th year of having an eating disorder. It started with over eating, then binge/purge, laxatives, strict dieting and now anorexia for almost 9 years. There is very little help and support where I live. I am starting to give up on myself as I am tired. Can you tell me; is it possible to recover from anorexia (and other eating disorders) after this long?
Professor Hubert Lacey answered: It's always possible to recover but the recovery becomes less likely the longer the period of illness. Many people are in the situation you describe and the sense of failure tends to undermine their efforts. Firstly you need to decide whether you want to recover in the sense of returning to a normal body weight, if not then there are new treatments which aim at improving quality of life rather than with maintenance and recovery. These treatments are available privately and on the NHS
Anonymous67 commented: Thank you so much Professor Hubert Lacey. I very much appreciate the time you took to reply to me. I want more than anything to recover but I feel this has become me. Me in every way possible!! I have so many health consequences due to the anorexia and I fear that because I have not made anything of my life (job degree etc.) that I will never. Each and every day I try and fight back but I end up breaking down as IT (silly as it sounds) seems more powerful. I have tried so many times to "beat it" but I seem to always fail and people are probably thinking I’m just saying I want to get better (the boy who cried wolf). It’s just so difficult and I wish I could just live and not exist. Again, I thank you for your time.
Professor Hubert Lacey answered: I'm sorry. I do understand. See my answer to Clalou below about new treatments. It's always possible to recover but the recovery becomes less likely the longer the period of illness. Many people are in the situation you describe and the sense of failure tends to undermine their efforts. Firstly you need to decide whether you want to recover in the sense of returning to a normal body weight, if not then there are new treatments which aim at improving quality of life rather than with maintenance and recovery. These treatments are available privately and on the NHS. Recent research has clearly shown that chronic eating disorders can indeed respond to therapy, if not in terms of weight gain, at least by improvement in quality of life. These treatments are available at specialist eating disorder centres such as my own
Anonymous67 commented: Thank you ever so much. Your help is much appreciated. My therapist often talks about treatment at St Georges Hospital and it seems great. Difficult but effective.
Fenella asked: Prof Lacey I have been running a successful Beat group in London for ten years but never get any men or ethnic minorities (occasional one!) why is this?
Professor Hubert Lacey answered: Hi Fenella, bulimia amosa occurs in all ethnic groups. Anorexia amosa still tends to be more common in Caucasian and Asian groups. The number of men with eating disorders is traditionally at 10% but i think myself it is much less common. In other words I’m not surprised by your statement!
Clalou commented: in your experience can someone ever recover from an eating disorder? I am Bulimic and have been for 14 years; I cannot see any end to it now and cannot imagine my life without it. Have patients ever been able to return to a "normal" life or is it just a case of learning how to manage the thoughts/symptoms?
Clalou, It's always possible to recover but the recovery becomes less likely the longer the period of illness. Many people are in the situation you describe and the sense of failure tends to undermine their efforts. Firstly you need to decide whether you want to recover in the sense of returning to a normal body weight, if not then there are new treatments which aim at improving quality of life rather than with maintenance and recovery. These treatments are available privately and on the NHS
Clalou commented: The trouble I am currently having is that the NHS have said they cannot offer any support due to waiting lists (it took me 7 years initially to get seen).. As a result I chose to go private however this condition has now been excluded on my private insurance and I am now back to square one with the NHS. I cannot think what to do.....
Professor Hubert Lacey answered: You'll notice from other replies that you have to be proactive. You can contact Commissioners direct (though they don't like it). Sometimes both private insurance companies and Commissioners do not fund treatment for patients who have had the condition for over a long period of time, claiming that chronic anorexia does not respond to therapy. Recent research has clearly shown that chronic eating disorders can indeed respond to therapy, if not in terms of weight gain, at least by improvement in quality of life. These treatments are available at specialist eating disorder centres such as my own
Anonymous72 asked: Is sugar addiction a serious problem?
Professor Hubert Lacey answered: Hi Ruth. It isn't a serious problem in psychiatric practice. It depends what you mean by sugar addiction but if it means minor over eating then you should consider contacting a dietician or nutritional counselling
Anonymous66 asked: I have suffered with disordered eating for 7 years now. At one point I was underweight, exercising obsessively, had no periods, taking up to 10 laxatives at a time after binging and making myself sick. I went to the GP but all he said 'Well you're underweight but not significantly underweight, we shall give you some blood tests' and that was it. I had told him everything. Why is it so difficult for people whose lives are consumed by food yet they don't fit nicely into a category, to get the help they need?
Professor Hubert Lacey answered: The diagnostic categories in eating disorders are a bit of a mess! A new system shortly to be published in the States will make it easier for minor variants of anorexia and bulimia to seek help. Treatment for anorexia should not be based on weight so your GP should not have withheld treatment because you were not sufficiently underweight; I suggest you discuss it again with him.
tiller asked: Prof Lacey, I am a private therapist working with weight & food issues. A recent client told her GP she was binge eating & wanted help. Her GP did not recognise it as an eating disorder. What is considered an eating disorder within NHS guidelines? What can she do to get help from the NHS?
Fenella commented: Binge Eating Disorder is in NICE guidelines and eating disorder services should offer help. BEAT group offer support to BED sufferers too. Contact Beat help finder to find groups.
tiller commented: Thank you Fenella, I have already mentioned BEAT to her as we have local services.
Prof, can you still confirm the various categories and what about the newer ones that are in the news, like orthorexia?
Professor Hubert Lacey answered: I agree with Fenella, the definitions of the two major diagnostic categories - DSM4 and ICD10 - which are reprinted in NICE guidelines will define the disorders. The main thing to realise is that anorexia is a phobia of normal body weight. Your general practitioner is your gateway to NHS treatments but unfortunately the availability is very variable across the country. If you are unhappy with what is available, you should always consider writing to your local MP.
tiller commented: Thank you for the information. I will also pass on suggestion regarding MP's help.
Anonymous3 asked: My friend has experience anorexia and bulimia in the past (has been hospitalised previously) - and now seems to be on the road to recovery. However I feel her eating habits are not healthy - she is veggie and even then she hardly eats any vegetables or protein, it's mostly carbs she eats and in small problems. Whenever she gets a cold she is ill for weeks, which I feel must be in some part down to diet. How can I bring this up with her, as it's a sensitive subject due to her previous problems.
Professor Hubert Lacey answered: Anorexia amosa and bulimia are difficult to treat. Even patients who respond well continue to have some features for many years afterwards; this can be helped by specialist psychiatric treatment. The difficulty you have is raising the matter with her, and this is a personal one on which is difficult for me to comment. You may find however that if you raise it with her, she'll welcome the opportunity to discuss her anxieties, and you can reassure her that treatment is available.
Heather asked: What other types of hidden eating disorders are there other than the most common like anorexia and bulimia? I've heard of Orthorexia but I'm not entirely confident at what it is.
Professor Hubert Lacey answered: Hi Heather. There are many eating disorders but in essence they are sub-categories of anorexia or bulimia. For instance a person with anorexia might temporarily return to a normal weight but the psychological illness remains. Orthorexia is an old term and isn't used nowadays. More details on diagnosis can be got from the NICE guidelines or the AXA PPP website.
fiona asked: How can emotional eating be avoided? I often put on weight at times of intense stress and neglect to follow a healthy balanced diet during such times.
Professor Hubert Lacey answered: Hi Fiona. It appears that you have got into the routine of dealing with emotionally stress with food, rather than addressing the emotional issues directly. This is a common reaction. Some people find it satisfying and supportive but clearly in your case it is causing more distress. After discussing it with your GP, you may consider a short term therapy, particularly one that focuses on CBT therapy (see the CBT fact sheet on website).
Professor Hubert Lacey answered: The response to treatment is usually good
Andy_M asked: How can someone truly overcome a hidden eating disorder? I hear of so many people overcoming an eating disorder but then maybe a year or so down the line fall back into the same issues
Professor Hubert Lacey answered: Most people who have had anorexia continue to have some features of the disorder for many years afterwards, sometimes more treatment is required but for many they are transient and they are managed without formal help. For anorexia on full weight restoration will allow recovery and the problems you describe are mainly with people who have only achieved a partial weight recovery.
Anon1 asked: Does being overweight indicate that you can have an eating disorder as many people associate disorders with people who are underweight rather than overweight?
Professor Hubert Lacey answered: It depends what you mean by being overweight! Many people are overweight (BMI 25 to 29) and although there are some health risks, they are not substantial. An overweight person can though be distressed by their shape and the preoccupation becomes consuming. This may benefit from short term therapy. Obesity is a different matter and a combination of therapy, nutritional counselling and perhaps surgery should be considered
tiller asked: Prof Lacey, other than binge eating disorder (and interventions related like interpersonal psychotherapy or CBT) do you know of any research being undertaken to provide support to those with 'eating disorders not otherwise specified'?
Professor Hubert Lacey answered: There are many therapies that are shown to be effective, though not all have been subjected to rigorous research. Taking the advice of your psychiatrist, you might consider a mixed behavioural-insight directed therapy. Also many people are benefitting from specialist supportive clinical therapy. These and nutritional counselling are available in specialist eating disorder clinics.
ianto asked: What things can we do to help ensure children and young adults in the family are less likely to develop eating disorders?
Professor Hubert Lacey answered: Hi Ianto, family meals are important. If the whole or most of the family can sit down and eat together in the evening good nutritional habits can be developed and maintained. Teenagers, particularly girls, are under much pressure to control their diet and parents should bring the discussion into the family to reassure them.
Professor Hubert Lacey answered: A clear family ethos that adulthood is more than a question of weight and shape, is essential
ianto commented: Thanks for the information - much appreciated.
Anonymous72 asked: I have a friend who has been treated for anorexia since we left school 10 years ago. She's been in and out of facilities and she claims she wants to recover but she keeps going back to her old habits. Is there anything you suggest I could do to support her?
Professor Hubert Lacey answered: We've answered a couple of questions above which might be useful. However, i suspect your friend says she wants to recover but struggles with the idea with going to a normal weight. Remember anorexia is rational fear of normal body weight and only if your friend goes to a normal weight and deals with the emotional feelings she has of that weight, will she recover.
flick_nightshade asked: is there anything I can do to help with my eating disorder as I only get worse when I see specialists as I can't cope with the weekly weigh ins. I was told they have to inform me of my BMI as a legal responsibility but I find it triggering and spend each week trying to get it lower in response to the previous week’s appointment. My GP wants to refer me back but I can't go back to them. they told me I wasn’t sick enough for admission when I asked to be admitted as I couldn’t cope despite numerous admissions for hypokalaemia and only accepted me after a heart attack and then refused to take me and I had to transfer to the trust where my mum lives as my hospital admission made me lose my flat and they wouldn’t treat me as I’d lost my address in their trust. I can’t go back to that but I’ve been told they are my only option...
Professor Hubert Lacey answered: Informing you of your BMI is not a legal responsibility but does make clinical sense. Please read other replies, particularly anonymous72 (I suspect your friend says she wants to recover but struggles with the idea with going to a normal weight. Remember anorexia is rational fear of normal body weight and only if your friend goes to a normal weight and deals with the emotional feelings she has of that weight, will she recover.). In other words it is essential for you to return to a normal healthy weight to stop the stress that you describe.
flick_nightshade commented: I did gain weight back as an in-patient, they told me i was there to gain and not for therapeutic intervention. I left treatment and my other medications had increased and I found myself unable to leave the house. but since leaving treatment I’ve never been more depressed or had my eating habits more disordered. I was being sick in hospital towards the end and this was noted by staff, I was discharged as I had gained weight not because I was 'better' and even though I was on the psychiatric ward they did no mental health intervention. Services in Northern Ireland are not up to standard and I’m at a loss as to how to get help. when I want help I can't get it, and when i don't want it anymore due to the wait it's forced upon me...
AXA PPP healthcare asked, on behalf of a facebook follower: My questions fit more under case study examples as they are easier to explain that way.
At 17 I was diagnosed with anorexia nervosa.
However, I suffered with a combination of EDNOS, BED, and AN since the age of 11.
However, because my weight was not "low" enough, my condition was not taken seriously.
How do you propose to improve early intervention in eating disorders so that ALL eating disorders receive the necessary treatment at a much earlier stage. And so that permanent damage is not done?
Secondly. Following my hospitalisation, I have relapsed several times. I did not receive any aftercare, and at university, and now living on my own have often been too embarrassed to admit to my family or close friends that I am struggling when times get difficult.
Again, my weight does not fall into the criteria and so must endure a lengthy waiting list.
It worries me that many other sufferers are less proactive, and can allow a rapid deterioration of their condition.
What plans do you have for aftercare systems following hospitalisation periods, or do you think a drop in system when patients are struggling would work to get them back on track or even a nurse buddy or monitor every so often?
Professor Hubert Lacey answered: Access to treatment for anorexia should not be based on weight; it is a psychological condition - fear of normal body weight. This psychological problem can be address by therapy, irrespective of the patient.
Professor Hubert Lacey answered: I agree with you on the importance of early intervention. If local services are not adequate then pressure needs to be placed on local Commissioners, preferably via general practitioners. Individual patients sometimes have to work to try and get treatment but always remember you have access to your local MP.
Professor Hubert Lacey answered: As for your second question, i again agree with you. It is a tragedy that many sufferers have to be very resourceful to get the treatment they require after hospital discharge. In many parts of the country specialist eating disorder centres are overwhelmed with cases or don't have adequate resources. At the end of the day the answer is political rather than medical
Janice asked: Hi, can you tell me how effective the 5:2 diet is? Everyone seems to be doing it lately.
Professor Hubert Lacey answered: Over the years there have been many fashionable diets, I have no doubt that the 5:2 diet will join a long list! If you wish to lose weight for cosmetic reasons then a minor reduction in calories and regular daily exercise, without being excessive, will lead to a gradual weight loss. This is by far the best approach. There is no miracle diet!
Anonymous73 asked: I am an extremely fussy eater. Some of the foods I don't touch are Rice, Pasta, Fish, Vegetables. And my food has to be very bland as I can't eat spicy things.
Is there something I can do to help myself eat better?
Because of this I don't eat out, as finding something I like is nearly impossible in some restaurants. I also can go days without eating, as I really don't feel like eating.
Is there any advice you can offer???
Professor Hubert Lacey answered: I don’t think I am able to help unless I know more. I recommend that you seek a Psychiatric assessment via your GP as clearly this is having a profound effect on your quality of life. I would think you will need a mixture of nutritional counselling and psychotherapy but I would make the obvious point that you won’t be able to get better unless you change your current eating pattern.
AXA PPP healthcare asked: Professor Hubert Lacey can you recommend any tips for dealing with the emotional side of an eating disorder, or are there any support groups available?
Professor Hubert Lacey answered: There is no quick fix; few sufferers respond spontaneously. There is now a broad range of therapies available but no way of determining which treatment is likely to be most effective for any one person. Sufferers who don't respond should insist on being referred to a major centre. Beat offer excellent support groups and many of the major treatment centres offer them, some open then to patients from outside. Support groups though offer support, not necessarily treatment aimed at recovery.
Anonymous75 asked: I find that when I'm upset I'll binge on junk food. I find it really difficult to stop. How can I fix this?
Professor Hubert Lacey answered: It can be fixed! It appears that you have got into the routine of dealing with emotionally stress with food, rather than addressing the emotional issues directly. This is a common reaction. Some people find it satisfying and supportive but clearly in your case it is causing more distress. After discussing it with your GP, you may consider a short term therapy, particularly one that focuses on CBT therapy (see the CBT fact sheet on website).
Anonymous75 asked: Also, when I was in high school I had a lot of trouble with my weight and was bullied. I started obsessively exercising and starving myself and lost a lot of weight, but I was never underweight. I'm out of that cycle now but was diagnosed with hypo-thyroidism in my 20s and I find it really difficult to lose weight now. Is this because of how I was in high school? Are there long-term effects?
Professor Hubert Lacey answered: I can't give a meaningful reply without properly assessing you. Some of the information you ask can be got from your GP.
Little_Em asked: Hello. I wondered whether you had any advice on getting 'unstuck' from restrictive eating patterns. I am still an anorexic bmi (16.5) but because I am stable and comparatively 'healthy' I am not able to access eating disorder services. I need to gain weight and become less restrictive but it is easy to minimise any health risks because I am better than I was, 'look' ok and family and friends are not concerned. But I know I am still trapped and I really want to recover fully. Any advice would be gratefully received. Thank you.
Professor Hubert Lacey answered: I am concerned to read your note. You are quite right, you won’t recover if your weight remains at BMI 16.5 and also you will require therapy to deal with the fear of going to BMI20. I agree with you that you are "trapped" and if you really want to recover, that is you are prepared to go to a normal weight, then you will need to demand help from your local NHS services or your insurance company. Speak to your General Practitioner and tell him that you know recovery is unlikely unless you get treatment speedily. Also recognise that you will feel worse initially rather than better. Note, however, you can’t half get better. You either go to a normal weight or you will remain ill. Best of luck.
Little_Em commented: Thank you so much for your response. I really appreciate it and will take your advice and pluck up the courage to be more assertive about accessing support.