Content warning: this article contains mentions of eating disorders, disordered behaviours, and other content. It may be triggering to those in recovery or who are currently suffering from an eating disorder. Reader discretion is advised.
Eating disorder services in the UK are failing the thousands of sufferers seeking treatment. Throughout this four-part series, I will be investigating the reasons why the services are unable to provide the help so many people desperately need
The NHS is failing people suffering from eating disorders across the UK. But what about treatment options in other countries? Some people, if they are fortunate enough to be able to afford it, even travel overseas to access treatment. In the US, despite the inequalities and issues its privatised system creates, there appear to be greater options and more effective treatment schemes. Are medical professionals’ approaches to treating conditions like binge eating disorder (BED), bulimia, and anorexia better? If so, what could the UK’s health service learn from its American counterparts?
This is part three of a four-part series. Part one, which you can read here, explored the state of eating disorder treatments under the NHS with insights from Ann McCann, the head of Eating Disorders Association NI (EDANI). In part two, which you can read here, I spoke with a friend who suffers from anorexia. She candidly and frankly explored her experience of NHS services and how they often fail to help those most in need. In part three, I look at eating disorder treatment in the US. I also speak with the doctor who helped me recover about his treatment methods and lived experiences with disordered eating.
We could take a leaf out of the US’s books when it comes to treatment
Over in the US, there is a great deal more success and creativity in terms of treatment offered. There are inpatient programs for bulimia and BED, such as Timberline Knolls in Illinois, where Demi Lovato received treatment for their bulimia. Inpatient programs offer a high level of care. Patients get a structured meal plan, group and individual therapy, psychiatric medication, and nutritional education. There is a set follow-up treatment plan when a patient is discharged. Facilities such as these enable the development of better behaviours and coping mechanisms. The constant access to psychological and medical professionals supports a person’s recovery significantly. With all these factors, inpatient programs are highly successful in helping people recover fully.
US treatment is certainly better, for those who can afford it, than in the UK. Inpatient treatment for bulimia and BED isn’t an option on the NHS. Although there are private options for treatment in the UK, few of them are tailored to bulimia and BED. However, even with the greater number of options in the US, accessibility is a very real issue, especially if someone cannot get health insurance.
Even if someone has health insurance, that doesn’t guarantee it will cover the fees to attend a treatment centre. Although there have been improvements in terms of insurance coverage, barriers still remain. Oftentimes, insurers won’t authorise residential treatment until a person has undergone a medical assessment at the facility. Astonishingly, even if a facility determines that a person will require inpatient care, the insurer can still deny the admission. Although California recently adopted a law requiring insurers to cover all medically necessary mental health services, this isn’t the case across all states. Insurance coverage still remains a huge barrier for people seeking the treatment they desperately need.
Licensed and approved medication for bulimia and BED is readily prescribed
Another difference between the UK and the US is the psychiatric medication offered to eating disorder patients. Psychiatrists in the US can prescribe medications tailored specifically for eating disorders, not just general antidepressants. Lisdexamfetamine dimesylate, also known as Vyvanse in the US and Elvanse in the UK, is prescribed for BED treatment. It has been proven to be effective in reducing urges to binge and aiding in recovery. It is the first FDA approved medication to treat moderate to severe BED.
Whilst many doctors have started prescribing Vyvanse, it doesn’t come without its issues and health risks. As Vyvanse is a type of amphetamine, it is a stimulant and can be addictive. As such, Vyvanse is a Schedule II controlled substance due to its high potential for abuse and dependence. Even with its positive impact in terms of reducing binge eating, it carries serious side effects such as cardiovascular and circulatory complications. Due to this, its use needs to be regularly monitored and it cannot be prescribed as a long term option for people with BED.
Despite this evidence, the NHS will not prescribe it to anyone with BED. It is only prescribed for ADHD, which it also treats. In addition to more options for psychiatric medications, the psychological treatments on offer are more varied. Options range from holistic approaches to interpersonal psychotherapy. Individuals can more readily find a treatment approach that works for them.
Unconventional but effective addiction treatments also helps those with an eating disorder
As I mentioned earlier, there is a huge variety of psychological treatments which can be used for treating eating disorders. One such example comes in the form of Dr. Glenn Livingston, a psychologist based in the US. He has written several self-help books and offers coaching for those suffering from disordered binge eating. He takes an approach used in substance addiction treatment rather than traditional therapy. This is based upon the concept of ‘separating’ the urge to binge from your own conscious thoughts. It was his treatment method that finally helped me to recover. Despite having to pay for my treatment, which I acknowledge I am lucky enough to be able to do so, the benefits and freedom it brought me made it worth it. Unlike other services, his treatment does not require people to have health insurance.
In an interview with Livingston, he candidly described to me his own personal struggles with binge eating. He noted that for many people with BED or bulimia, shame plays a huge role in the mental stress of having an eating disorder:
People are really ashamed… take myself. I was going through several different Drive-Thrus a day to make sure nobody knew what I was eating
How a simple ‘mind trick’ proves to be empowering and effective
From his own struggles with binge eating, Livingston came across a simple ‘mind trick’. This allowed him to dismiss urges to binge quickly. By creating clear ‘rules’ about what, when, and how much to eat, the urges become easy to spot. Every thought suggesting you break a rule is your lower brain sending a misguided survival impulse. These impulses are urges to eat whilst food is plentiful. His method is simple to enforce and can help people get their bingeing issues under control rapidly.
Livingston described his method as “a thinking game”. This ‘game’ involves “thinking about your constructive versus destructive thoughts about food in a different way”. Through his book and coaching, he aims to teach people to “rationally disempower a destructive food thought”. By learning “how to relax and switch nervous systems at the moment the impulse is firing”, you can stop acting on urges.
Although there is an opinion that any restriction of food, even mental restriction, will trigger a binge, Livingston disagrees. He notes that provided the rules a person sets do not deprive them of adequate calories and nutrients, rules can successfully stop bingeing. By self-regulating what you eat, a person can avoid or limit the number of trigger foods they eat. For some, total avoidance proves to be more freeing than trying to juggle moderating certain foods.
Tackle urges to binge FIRST, then look at underlying causes
Livingston also stressed that addressing underlying trauma or past issues of past trauma first can actually hinder a person’s recovery. He suggests tackling the urge to binge first to recover more quickly:
It takes years to work through those emotional issues. Whereas you could identify the destructive thoughts and disempower them within a couple of months
Recognising that you do have control over whether you act on urges or not often empowers those who struggle with binge eating. It removes feelings of powerlessness, where bingeing feels ‘automatic’ or that they can’t stop. However, addressing trauma is also a hugely important step. Therapy for trauma can be massively beneficial for anyone with any kind of mental illness and can greatly improve a person’s quality of life. Livingston stresses that getting the urges to binge under control first frees up more mental space in order to undergo the difficult process of addressing trauma or other co-morbidities. Trauma should never be ignored and, without the stress of bingeing, a person may be more able to cope with the long-term task of going through trauma therapy.
The food industry has a big role to play in contributing to binge eating issues
Livingston also mentioned a factor that is often overlooked in regard to binge eating: the role of food companies. They make fast food and processed food highly palatable, due to a combination of sugar, salt, and fat. These foods are nutritionally lacking yet incredibly stimulating. When consumed, people will not feel satisfied by them, leading to overeating in order to try to become satiated. Food companies are highly attuned to how to psychologically and biologically get people to eat their products. Companies use this knowledge to increase sales. The colours used in food packaging, the excessive additives (mostly sugar and salt, the two most addictive), and the cheap price persuades people to buy these products. Livingston described how food companies put hugely varied artificial flavours in processed foods to make people eat more:
on an evolutionary basis, when you sense variation in flavour… you are probably sensing a variation in micronutrients… So we are hardwired to keep eating when we find something that tastes a little different… The big companies know this.
This manipulation results in the loss of the ‘hunger and fullness’ meter in people. An upset in the meter causes them to have urges to eat large amounts of these foods to satiate themselves. In an attempt to lose weight, they may over restrict their food intake or begin purging after eating. “A big part of the bingeing problem is the restriction also”, Livingston commented. The ‘feast and famine cycle’ only fuels the fire of an eating disorder.
The hyper-palatability of food is a serious public health risk
Even those without a diagnosable eating disorder struggle with overeating due to the hyper-palatability of these foods. Again, Livingston noted that:
2.8% of the [US population] is diagnosable as a binge eater but 40% of the population is obese… there’s a problem there.
Considering that 28 % of the UK’s adult population is obese and 36.2% are overweight, it would be foolish to overlook that a huge majority of people have issues regulating their eating due to the strategies food companies use. Boris Johnson’s woeful attempt to tackle the obesity crisis by putting calorie counts on restaurant menus is like sticking a plaster over a bullet wound. Tighter regulation on additives, accessibility to whole foods in deprived areas, and better education on diet are the solutions needed. These preventative measures could save many from developing an issue with overeating or binge eating.
You can listen to my full interview with Livingston here:
In part four, I’ll explore my personal reflections on the situation with the NHS, the food industry and our approach in the UK to eating disorders more broadly.
Helplines and resources for you or if someone you know is struggling with an eating disorder of any kind:
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