Presenter: Hello, today we have with us, Melissa Nobile, our Psychologist and Clinical Operations Manager. Hello, Melissa.
Melissa Nobile: Hi.
Presenter: We are actually discussing a topic which has been very much on the rise: eating and body image disorders linked to the COVID-19 pandemic. Thank you very much for taking the time to answer these questions.
The referrals of young people with eating disorders for NHS treatments shot up by almost half last year in England, according to the government data, with doctors warning that lives are being ruined. There were close to 20,000 referrals of under-18’s with eating disorders to NHS-funded secondary mental health services in 2020, a rise of about 46%.
So these are big numbers which indicate that the anxiety caused by the pandemic manifests itself in a number of different ways, doesn’t it? So Melissa, how do you explain this?
MN: You’re going to get used to me saying this, I think, but I always say, Oh, it’s complex.
Presenter: We do believe it’s complex. That’s why we have you as an expert, to help us today.
MN: So it’s complex. I know that in your question you said the link between anxiety and eating disorders? That’s one of them. That’s one of many. My second question would be, well, what’s causing the anxiety that’s behind? That’s the job of a psychologist or psychiatrist to figure out by the way.
Presenter: It sounds like I’m asking complex questions too right?
MN: It’s fine. I like it. But yes, with the pandemic, off the top of my head, examples of factors that could contribute would be, maybe, people who lost their jobs, maybe people who had relationship problems that were more difficult to handle because they were in closer proximity. And, in addition to that, it was harder to access support; so you couldn’t go see your friends, you couldn’t go do your sports, etc. So loads of different factors.
There was also a huge contributor, in my professional opinion, because I’d observed it during the first lockdown, especially, and that was social media. There was this big message about needing to look after your body, online personal training became a huge thing. On Instagram, there was a lot of the ‘use this time to get in shape, get in the kitchen, etc’.
And, obviously, eating disorders, they go hand in hand with how you perceive your body image. And so a lot of individuals started dieting during that time or they started working out, with the goal being ‘I’m just going to aim at this body’. But, very quickly, for some of them, there’s a loss of control over the process and they get stuck in a cycle, maybe dieting or exercising or both. Or ‘I’m going to lose weight a little bit more quickly so that when lockdown is over I’ll look better’. And before you know it, you’re in an eating disorder and you’re stuck in a pattern of restricting and bingeing. I think that would be one factor.
And then, I think, never to forget that all these symptoms, whether it’s an eating disorder, or a major depressive disorder, or agoraphobia, whatever it is, they exist in the context of a broad environment and someone’s life story.
And I think of a client I had recently who was 16 years old and had an eating disorder that had developed during the pandemic. I worked with the family, in a family setting in this situation, by asking questions, we quickly realised that this teenager, who was going to boarding school before the pandemic, was having some problems at school with bullying, wasn’t getting great grades, came back home in the pandemic and experienced that as a safe place.
It’s all these things we’d discuss in therapy that had never been discussed together as a family, and as soon as the lockdown was coming to an end this teenager was starting to develop eating disorder symptoms. In his case, it was anorexia; so he was really, really restricting and his BMI dropped quite low, quite quickly.
So he stayed home, didn’t go back to boarding school and got stabilised during the summer. And then in September, when it was time to go back to boarding school, the symptoms started all over again. And we could see in this context, and by exploring all these questions with the family and the youth, how the symptoms of the eating disorder allowed this youth to not go back to boarding school and stay home in the safety of the family.
And that was something completely unconscious, it’s dynamics that come into place. And once that was addressed we could work differently and the symptoms faded away, actually, really quickly because we discussed, okay, how do we stay in a relationship as a family when we’re not living together? And we could talk about loads of questions, and we didn’t even talk that much about the anorexia. And now that person is already doing, I think, a lot better.
So the reason I gave that example from my clinical practice is really to illustrate how it’s complex and the job that we do at The Kusnacht Practice, or a psychologist, psychotherapist, psychiatrist, is to understand, for each family, for each individual, what are the contributing factors that explain why it is that, you specifically, are having an eating disorder?
Presenter: That’s fascinating, for two reasons. Number one: the conjunction of factors that you’re explaining is not just appearing as an eating disorder, there’s an underlying cause of it. And the conjunction of those factors is still to be analysed to precisely understand where it’s coming from. This is my first understanding, listening to you.
And the second thing I’ve understood, listening to you, is actually how close this is to the programme that we are running with the boarding schools, here in Switzerland, that we now plan to expand to the rest of Europe. Because we’ve come to realise that the impact of kids going back to their homes and not being able to go back to school, or having an eating disorder as a reflection of insecurity, is just such a vivid reality that we’re living, as we’re discussing with those schools.
Thank you very much for connecting those. The next question is regarding the signs that the family and friends should look out for in their loved ones when they suspect that they may be suffering from body image issues or eating disorders. How would you advise the families to be aware of those forthcoming signals?
MN: So I’ll list the main signals or main signs to look out for. And before listing them I’ll also add, so that some families don’t feel guilty that they develop in a very secretive way, that it’s not always that easy to notice them as a family.
But keep your eyes open for changes around their general behaviour around food; someone who’s skipping meals, someone who’s eating a lot in the bedroom and didn’t used to do that, someone who’s suddenly eating a lot less than before or eliminated food groups suddenly, someone who’s going to the bathroom after each meal – actually, that’s purging behaviour. Or someone who’s spending a lot of time in front of the mirror, which would be more in the body image problematics. And someone who’s hiding food in their pockets maybe.
Anything that shows you that there’s a complicated relationship with food and their body would be signs to look out for. And they’re various, and people with eating disorders also get very creative with them.
Presenter: I was about to ask. I mean, of course, it’s a very serious disorder, so we are not making anything funny out of this, but it’s impressive to see how creative people can be with that, right?
MN: Yes. I’ve seen, when I was meal monitoring, clients cutting very small pieces of food and hiding them between the broccoli or the meat. And that’s why I say it’s actually not that easy to spot them. But what you will see, depending on the eating disorder, is the weight. You’ll see a sudden drop in weight or a very worrying gain of weight, you can’t question it, it can also be for medical or lots of other reasons too.
Presenter: And I’m tempted to add that the family that lives close to the person of concern doesn’t see that evolution, because it’s a slight evolution. It’s a very, very, continuous evolution, it’s not like from one day to the next. It is gradual.
Presenter: It’s basically that story of the pan with the water in it. If you’re putting a frog in cold water or if you’re putting it in boiling water.
Presenter: That’s the kind of difference you see, right?
MN: Yes, it’s very insidious, small changes day to day. What I tell families who ask that type of question, or they’re calling the practice because they want to have a bit of information, ‘could he be having an eating disorder?’ Other than to ask a question directly, It could be to organise a meal, where it’s an invitation, and see how the person reacts. If they come, and they eat everything, and it’s normal interactions, then I wouldn’t say to be completely reassured, but it gives you some information. If the person says ‘oh, well, I’ll come after the meal’, or ‘I have a meal, last minute planned, at the same time, but I’ll drop by right before’, I’d be more worried because those are pretty typical signs that the person’s avoiding being seen around food.
Presenter: That’s a very good insight.
MN: Not to trick your loved one, but simply to gain information. And again, the best thing is always to ask.
Presenter: We’re coming to the conclusion that, basically, people living closest to the person of concern may not be able to see that difference. And this is a really striking reality because I would have thought people that would be closest to the person of concern would be actually able to spot it from a distance. But what you’re telling us is that, actually, it’s more like a friend that would come every other month that would be able to say, ‘oh, my God, you’ve put on weight’. Whereas people living close to that person of concern may not.
MN: And sometimes nobody at all, because it’s a lot of obsessions, also in the head, and it’s a whole process in the mind of the person. Sometimes your body doesn’t change shape at all. And I gave that as the obvious sign, but sometimes, even that one, we don’t pick up on it and it’s not easy.
Presenter: Okay, I’m not throwing difficult questions at you, but it’s a passion we have in common on this subject. So another study that I found was showing that anxiety and stress, directly linked to COVID-19, is causing a number of body image issues among, not only women, but also men.
The research, led by Professor Viren Swami of Anglia Ruskin University, known as the ARU, and published in the journal: Personality and Individual Differences, involved 506 UK adults with an average age of 34.
Among women, the study found that feelings of anxiety and stress caused by COVID-19 were associated with greater desire for thinness. Among the male participants, the study found that COVID-19-related anxiety and stress was associated with greater desire for muscularity, with anxiety also associated with body fat dissatisfaction.
Melissa, how common are such disorders in men? And have you seen a rise in such cases at The Kusnacht Practice? And would you be able to tell us what that projection would be on women too?
MN: Sure. So first, I’m really glad that we’re talking about eating disorders in men because it’s a fairly recent topic. And I’ll explain more about how you see the influence of cultural factors as well. When I said earlier that it’s complex, it’s biology, psychology, social factors, and also cultural, and it also shapes eating disorders and other mental health conditions. Because men, there are men with anorexia. And anorexia, for those who are listening who may not know, is really a pattern of restricting food, and having a weight that’s way below what it should be.
Presenter: So we’re talking BMI?
MN: BMI that’s below 18, or heading somewhere near there. And in men, we see anorexia too, but now we call it reverse anorexia or muscle dysmorphia, which is not an obsession with being thin, which is more of a women’s eating disorder, but not to say, again, that there’s not men.
For men, it’s this obsession with being as lean as possible. So really as much muscle as possible. So where someone with anorexia will restrict most food groups and they’ll eat very little and become very thin. Someone with reverse anorexia, so more men, but again, not to eliminate that some women also fall into that, they will eat a lot of proteins and they’ll eliminate maybe sugar columns and they’ll eat protein every meal. Nothing else for prolonged periods of time with the idea of, again, being lean, lean, lean, etc.
Presenter: But muscle?
MN: Muscle. Yeah.
Presenter: So just muscles on skin. That’s a very precise description of the situation.
MN: It’s exactly what we see, more frequently, in male eating disorders. And it goes a lot more unnoticed, which is why we talk a lot less about it. Because a man that’s very muscular, we don’t necessarily see as problematic in our society. For a woman that’s very thin, there’s this message which, in publicity, it’s very thin women, models – but you’re also anorexic, so you’ll go to treatment. But men, we won’t send them to treatment as easily so they don’t have the same access to healthcare all the time, which isn’t supportive of these people either.
But if we look at the process behind the level of obsession around food and the suffering, it’s immense for both. It’s exactly the same process behind, it just manifests itself in different behaviours. That was a brief explanation of the impact on men, since you asked, as I thought it was very interesting to talk about it, and we see it a lot in bodybuilders. That’s a population with a lot of eating disorders.
And then at The Kusnacht Practice, I can’t really pronounce, myself, if we saw a rise, specifically, in eating disorders. But we work very interactively, in the sense that people may come to us with a specific problematic. We work on the mind, we work on the body, we work with nutrition; on so many different aspects, that we, anyway, always address this question around food and nutrition.
And, often, we discover quite a lot of things actually in the relationship to the body and whether it’s disordered or not, for a lot of clients that we work with, in order to improve that relationship with themselves, for their overall quality of life.
Presenter: And then, in the same vein, the research also indicated that it wasn’t only fears around the virus itself which has contributed to serious mental health issues, but the restrictions and lockdowns that have been brought in to combat it. So, in your opinion, Melissa, how big are factors like isolation and curbed movement and socialising In cases of body image and eating disorders?
MN: I think that depends on the person. Some people love isolation and have no problem with it. Some people even seek it, they’ll go camping in the middle of nowhere, to be sure they’re unreachable. For some it’s very difficult. So, I think, like I explained at the beginning, that it’s the interactions of many factors.
For some, it will come into play that being isolated doesn’t give them, perhaps, access to some support, or makes them feel anxious or isolated and lonely, which is not the case for everyone, some are isolated and not lonely.
And all of that is going to be some of these many factors, more of the psychological factors actually, in these big pictures of all the things that can lead someone to develop a problematic relationship with their body and food.
Presenter: And finally, to close this interview, what advice do you give to someone who, you believe, may be suffering from such disorders?
MN: Actually, my first advice would be to try and have three meals a day. There’re lots of different eating disorders, we didn’t go into that today, but most have in common that meals are either eliminated food groups, or skipped, or too much, etc. Try to have three small meals a day. That could be a first step. And experiment – see what happens. If that’s very difficult, or if the obsessions are really taking over your life, my only advice, really, would be to seek professional help, because you can get out of it, there’s help available. And it’s not easy to get out of these eating disorders alone.
And with The Kusnacht Practice, for example, we do, what we call, personalised medicine, where we really look into ‘the not one diet fits all’, because that just doesn’t work. And, as I said earlier, with the lockdown influences, diets usually set you up for failure, because you’ll restrict and then you’ll end up bingeing, and for some they get lost in this cycle.
And there are places like here, at The Kusnacht Practice, where we do this personalised nutrition medicine, where we look at what your body actually needs. And it will help you reach some goals, it will help you recover from these obsessions, etc. But in a way that doesn’t create suffering and that will really allow you to lead a happy life again.
Ultimately, that’s the goal, right?
It’s that you’re freed from this disorder that’s eating away at your whole life, which is how people truly experience it. They become isolated and lonely and just a prisoner from these obsessions.
Presenter: This is a great way to conclude this interview, by talking about finding your way back to living your best life. The development of eating disorders certainly prevents finding this opportunity, and very much measures what we’re doing, here at The Kusnacht Practice, to achieve this.
Thank you very much, Melissa, for being with us today and we look forward to hearing from you again as it’s really a very interesting topic and we have way more to discuss on eating disorders.
Presenter: So stay with us, as there will be more podcast to come. Thank you again.
MN: Thank you very much.