What does health look like? How do we interpret and apply public health campaigns to our own health?
According to the World Health Organization (WHO): ‘Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’. There has been a lot of information in recent days outlining the Government’s “Better Health” campaign towards obesity. This has mainly focused on physical health, and while we are not denying the importance of this, the strategy fails to recognise the nuances around the messages that are being put forward or the importance of recognising our mental and social wellbeing when considering health.
This narrow focus on health is despite Beat asking the Prime Minister and Public Health England to avoid a repeat of previous anti-obesity campaigns that have been distressing and harmful to those affected by or at risk of developing an eating disorder. Our recent report on the evidence around these dangers can be found here. We would encourage you to read this report of the evidence, and if reading other sources of information about the topic, to look critically at the source of information. Obesity and eating disorders are both complex topics. This is why Beat are calling for a review of the policy, and to ensure that eating disorder experts are involved in discussions around this area – you can find out more about this campaign here.
Definition of health
The “Better Health” campaign from the Government is a blanket campaign that focuses on physical health and does not address the complexities of obesity, and the interaction that can often occur between living with obesity and being affected by an eating disorder. If you are living with overweight or obesity and affected by an eating disorder or eating difficulties, we would encourage you to reach out to our helpline or a medical professional rather than engaging in the “Better Health” campaign. We know that people affected by eating disorders often experience ‘a morbid preoccupation around food, weight and shape’, therefore the behaviours endorsed by these types of campaigns are likely to exacerbate the difficult thoughts, feelings and behaviours that come with this.
It might also be that you are not living with overweight or obesity, but you are still experiencing thoughts that you “should” engage with the campaign. Often these thoughts may be intertwined with the eating disorder – therefore we would encourage you to share these thoughts with your support network or the helpline, and to engage in techniques that support your recovery.
Try to recognise your emotional triggers around weight loss campaigns. People affected by eating disorders have told us that weight loss campaigns can cause distress and confusion about their own situation. We would encourage you to listen to this distress, acknowledge it and to think about whether it might be helpful to discuss your concerns around it.
During the week of 3rd August, our online support groups will be focusing on this issue. Please do join one of these groups to help process the information you are hearing and the emotions you are experiencing.
Ask yourself: is it helpful for me to focus more on food at this time? Is my eating disorder driving this choice and could it impact my mental wellbeing? People who have recovered from eating disorders have told us that part of their recovery from an eating disorder means that they need to protect their mental health. For them, they have said that focusing more on food/weight/numbers/diets, which these campaigns can encourage, could lead to a relapse in behaviours.
Has the noise got too much? It may be helpful to take a break from social media or from listening to the news about weight loss campaigns.
There can often be a lot of focus on weight in eating disorder treatment and when thinking about recovery. This can bring up lots of anxieties and distress, particularly if someone feels their weight is sitting higher than they are comfortable with. This may lead to heightened thoughts of engaging with campaigns against obesity.
Amy (who has fully recovered from anorexia nervosa and bulimia nervosa) shares how she manages this:
When I arrived in treatment for my eating disorder, I was told I had a “healthy BMI”, and I struggled to be referred for treatment as it was said that my BMI wasn’t low enough. I now know that this shouldn’t have happened, and I should have still received a referral since someone’s BMI should not affect this. Recovery from an eating disorder and being able to eat without restriction or eating disorder thoughts has meant that my body naturally sits at the ‘upper end’ of what is categorised as a “healthy BMI”. At times, when I have physical tests done where they need to weigh me, I have been told that I need to lose weight and this has really upset me in the past. However, I know that for me to maintain my recovery and to stay healthy, this weight is what is right for me. I know that if I were to engage in calorie counting or dieting, then this could lead me to focus on food, weight and shape, and that would compromise my mental health.
At present, evidence-based treatment for bulimia nervosa and binge eating disorder can often centres around specialised cognitive behaviour therapy for eating disorders (CBT-ED). If a person living with overweight or obesity who is affected by bulimia nervosa, binge eating disorder or other specified feeding or eating disorder uses CBT-ED, this approach to treatment is explained to them and they are informed that losing weight is not a ‘goal of treatment’. This is because as mentioned above eating disorders involve a ‘morbid preoccupation around food, shape and weight’. In treatment for eating disorders, if we were to focus on weight loss, it would exacerbate and exaggerate the preoccupation and distress around food.
This highlights the importance of recognising the emotional and psychological factors in a person’s relationship with food, which is why we are asking for eating disorder professionals to be consulted on obesity campaigns.
Sam talks about this in his journey of recovery from binge eating disorder:
What does recovery look like from binge eating disorder? Well… for me, it all centres around the amount of time I think about food, weight and shape. When I was in the ‘grips’ of binge eating disorder, all I thought about was food. I’d start the day being ‘good’ and only eating foods that were considered ‘good’. It was almost a measure of how good I was as a person. As the day would go on, I would find myself wanting foods that I wouldn’t allow myself. I’d eat one thing that I viewed as ‘bad’ and then say… STUFF IT! I would eat the whole packet. This led to such a huge sense of shame, failure and guilt. My mood would sink and I felt awful. The irony was, that at times when I felt awful, I would then find that I turned to food for comfort. This then continued the cycle of overeating and shame/guilt. In treatment I learned that no food is ‘bad’ and that it is ok to eat all foods in moderation. So often, I would try to turn back to dieting to gain control over my intake. It took me a long time to realise that this was never the answer. I was never going to feel ‘good enough’ by eating perfectly and actually… eating perfectly doesn’t exist. I always ended up feeling awful. I’m now in a place where I eat what I want, when I want. I’m able to exercise in moderation too. I’m able to say yes and no to food. Do I emotionally eat? I suppose I do now and then. However, not depriving myself of certain foods and not labelling foods as ‘good’ or ’bad’ has taken the emotional drive and connection with my self-esteem away. Although I am living with overweight, I’m more free than ever. I’m no longer stuck in a prison of preoccupation around food/weight/shape. For me, that is what healthy has to look like.
Enhanced CBT (CBT-E) – a type of CBT-ED, provides a useful tool to help you think about how much time you spend on thinking about food weight and shape. This is through completing a pie chart with the percentage of each piece of the chart being representative of how you value yourself. Lots of people affected by eating disorders may place a lot of value on their weight and shape, which can lead to this section of the pie chart being bigger than we would otherwise hope for.
Use the pie chart to divide your life into sections to represent how you value yourself and the amount of time you spend thinking about or investing in areas of your life. There is an example of this below.
When you complete the pie-chart, use it as a measure to think about whether the information you are seeing e.g. a public health campaign might increase or decrease your preoccupation around food/weight/shape. If the aim of the information is to increase your thoughts around food/weight/shape, maybe look at the pros/cons of doing this and discuss it with someone you trust.