Halting the rise in eating disorders

The number of children and young people with eating disorders has risen sharply in recent years with waiting times for treatment also increasing.

An analysis by the children’s commissioner for England found the number of young people starting NHS treatment more than doubled in the past six years.

Roughly 11,800 children and young people began eating disorder treatment in 2022/23, up from 5,240 in 2016/17, found the analysis of NHS data.

Under-25s account for nearly half of the 24,300 people admitted to hospital for eating disorder treatment in 2020/21 – an increase of nearly 84 per cent since 2016/17. The vast majority were women and girls but there has also been a rise in the number of young men admitted to hospital with an eating disorder.

Meanwhile, the data shows the NHS is failing to meet targets for timely treatment. Figures for the last quarter of 2022/23 show 45 per cent of urgent cases face waiting times of more than 12 weeks. This figure was 16 per cent in 2016/17.

Eating disorders such as bulimia, anorexia and binge-eating are serious mental health issues that can severely affect children’s quality of life. They may go hand in hand with other conditions such as depression and anxiety that need to be managed together.

Left untreated, eating disorders can cause life-long health problems and sometimes early death. They can also have a negative impact on family life and relationships.

So what is behind the surge in cases? The increasing influence of social media on young people’s lives is almost certainly a key factor (see research, below).

Research suggests there is a link between increased use of visual social media platforms such as Instagram and TikTok and a deterioration in children and young people’s mental health. The popularity of platforms featuring photos and videos has also been linked to increased dissatisfaction with body image.

There is evidence to suggest increased prevalence of disordered eating among young people with a social media account compared with those who do not have a social media account. The research suggests young people are adjusting their eating habits in an attempt to achieve the ideal body type displayed and praised across social media.

Coroners’ reports into the deaths of young people have warned of the dangers of “pro-ana” and “pro-mia” forums and websites that promote anorexia, bulimia and provide so-called “thinspiration”.

Another major factor behind the alarming increase in eating disorders is the impact of the Covid-19 pandemic, which has had a well-documented detrimental impact on young people’s mental health.

The loss of normal routine, social isolation and uncertainty increased the risk of disordered eating, especially among those with a history of anxiety and depression.

There were mixed messages about exercise which was tightly controlled but also heavily promoted.

The closure of schools during lockdown periods made it easier for young people to conceal potential eating disorders and contributed to a post-pandemic spike in referrals to child and adolescent mental health services (CAMHS).

At present, CAMHS is the main service that supports young people with eating disorders but services are struggling to meet demand.

Programmes with a focus on early intervention are being trialled and rolled out in an effort to reduce pressure on CAMHS.

These include the First Episode Rapid Early Intervention for Eating Disorders (Freed) model, which was developed and tested by South London and Maudsley NHS Foundation Trust and King’s College London.

Aimed at young people aged 16 to 25 who have had an eating disorder for three years or less, the approach provides rapid access to specialised treatment that focuses on the challenges young people face as they move into adulthood.

It has been shown to be more effective than traditional approaches when it comes to reversing changes to brain, body and behaviour caused by eating disorders and has been adopted by eating disorder services in all 54 eligible NHS mental health trusts in England.

One limitation is the fact young people need to be referred to the programme by a GP, which can be an issue in areas where it is harder to get an appointment.

Eating disorder charities such as Beat are also playing a crucial role in supporting young people and families.

Beat provides a national helpline for those with eating disorders, their family and friends and a wide range of evidence-based resources for families and professionals.

Organisations like Beat provide good-quality information and guide young people and families towards specific support.

However, there is a clear need for more action to prevent children and young people from getting to the stage where they may need specialist help.

Schools and early years settings have a key role in promoting healthy attitudes to eating and exercise – as well as spotting early warning signs of disordered eating.

The latest figures on childhood obesity in England show the proportion of children classed as obese has fallen slightly but rates are still high. Obesity rates among children aged four and five fell from 10.1 per cent in 2021/22 to 9.2 per cent in 2022/23.

Meanwhile obesity rates among year 6 pupils aged 10 and 11 fell from 23.4 per cent to 22.7 per cent in 2022/23 – but this is still higher than the pre-pandemic level of 21 per cent.

Addressing the rise in eating disorders at the same time as reducing obesity requires a balanced approach focused on promoting good health with careful consideration given to the language used.

This may include referring to “always” and “sometimes” food rather than “good” and “bad” food and ensuring all forms of movement from walking to high-impact sports are seen as equally important in promoting good health.

School nurses can play a pivotal role in ensuring an informed, evidence-based approach as well as in identifying children at risk, making referrals, liaising with other support services and guiding families through diagnosis to treatment.

They can deliver regular mental health sessions that encourage children and young people to have open and honest conversations about mental health.

Schools nurses can also help raise awareness among teachers and other school staff and ensure they have the training they need to identify pupils with possibly eating disorders and provide appropriate support.

Teachers and other children’s services professionals will work more closely with children and young people so it is important they are confident in spotting warning signs and raising concerns.

Public health budgets are tight but investment in school nursing teams, mental health support in schools and training for children’s services professionals will save millions down the line by reducing the need for more costly interventions.

Change at a national level is also needed. The government has pledged to invest an extra £2.3bn a year in NHS mental health services in England by March 2024.

The Department for Health and Social Care says it has boosted capacity at children and young people’s community eating disorder services across the country, allowing them to treat nearly 50 per cent more young people in 2022/23 than in 2019/20.

But there is a clear need for significant, long-term funding for mental health services as well as much greater investment in early intervention and prevention work.

The government has resisted calls for a national eating disorder strategy and instead promised action on eating disorders will form part of its Major Conditions Strategy launched earlier this year. Children’s commissioner for England Dame Rachel de Souza says the strategy, which focuses on six conditions including mental ill-health, is an ideal opportunity to tackle this growing problem.

Meanwhile, the hope is new laws designed to make the internet safer for children will help clamp down on dangerous content.

The Online Safety Act – which passed into law in October this year – puts the onus on tech firms to protect children from seeing harmful material including content promoting self-harm and eating disorders with regulator Ofcom given new enforcement powers.

A combination of tighter controls on social media, improved mental health support, investment in community-based early intervention and prevention and training for children’s services professionals should help reverse the rise in eating disorders among young people.

EATING DISORDERS AND YOUNG PEOPLE
WHAT THE RESEARCH SAYS

Social media use

Study by: University College London

Published by: PLOS Global Public Health, March 2023

Method: The researchers examined evidence on social media use and body image concerns or disordered eating from 50 studies in 17 countries.

Key findings: They found social media use was a “plausible risk factor” for development of eating disorders. The evidence suggests social media increases the risk of social comparison and promotes the idea that it is vital to be thin or fit. Access to pro-eating disorder content or platforms focusing on appearance compounds the problem. The researchers found young women with a high body mass index and existing body image concerns were most at risk of being affected by the content they see online.

Impact of Covid

Study by: Keele University, the University of Manchester, University of Exeter and mental health research charity The McPin Foundation

Published by: The Lancet Child and Adolescent Health, June 2023

Method: The research team analysed UK GP health records for more than nine million 10- to 24-year-olds from 2010 to 2022. They looked at rates of self-harm and eating disorders and – based on trends before the pandemic – calculated what rates might have been had it not happened. They then compared expected rates with the actual numbers of cases recorded.

Key findings: The researchers’ calculations suggest self-harm and eating disorders substantially increased among teenage girls in the UK in the two years since the pandemic. According to their analysis, about 2,713 girls aged 13 to 16 might be expected to be diagnosed with an eating disorder. But the number of recorded cases was 3,862 – 42.4 per cent higher than expected. The number of cases was 32 per cent higher than expected for those aged 17 to 19.

Prevention & early intervention

Study by: University of Sydney, La Trobe University, Melbourne, and specialist consultancy Health Management Advisors

Published by: Journal of Eating Disorders, March 2023

Method: The researchers reviewed 130 studies published in English between 2009 and 2021 and relating to eating disorder prevention and early intervention programmes.

Key findings: Prevention and early intervention programmes – especially those delivered in schools and universities – can significantly reduce risk factors for eating disorders, help increase awareness of symptoms and boost motivation to seek help and treatment. Many studies looked at interventions for older adolescents and university-age students. Body dissatisfaction can be identified in girls as young as six so more research is needed to establish what kind of programmes work best for younger age groups.

EARLY INTERVENTION AND PREVENTION KEYS TO SUCCESS

Ensure support is accessible

Ensuring there are multiple ways for children and young people to engage with a service increases the likelihood they will seek support. This could be through the medium of text, video call or drop-in, face-to-face sessions. ChatHealth is an NHS text messaging service that can be adopted by school nursing and other teams, enabling secondary school pupils to seek confidential advice from health professionals. www.chathealth.nhs.uk

Create a safe, neutral space

It important to create a safe space where a young person can access support. In a school setting, this should ideally be a dedicated space, located away from teacher’s offices or staff rooms. Gateshead Council and Education Gateshead have produced some useful guidance on how to create and use a safe space in primary schools. www.educationgateshead.org

Provide training for professionals

School nurses and other professionals that work with children and young people benefit from specific training around eating disorders to help them identify and support those at risk. Eating disorder charity Beat offers free School Professionals Online Training (Spot) for school nurses and others comprising interactive e-learning modules, Q&A sessions and webinars delivered by expert clinicians. www.beateatingdisorders.org.uk

Support parents

The abundance of information and advice on eating disorders available online and via social media can make it difficult for parents to know what is useful and what is nonsense. Professionals such as school nurses can play an important role in providing information and advice to families through face-to-face or online interactions or informative emails. The charity YoungMinds has an excellent online guide for parents and carers that is a great starting point for anyone worried about their child. www.youngminds.org.uk

Work closely with CAMHS

Given the lengthy waiting lists for child and adolescent mental health services (CAMHS) it is important professionals working in schools and community services work closely with CAMHS colleagues to minimise delays. Establishing a clear, straightforward referral process to a named CAMHS professional can help ensure timely support for those who need it and prevent distressing A&E visits and emergency admissions to hospital.

*Compiled by Emmie Hopkinson