UK eating disorder charity Beat say too many people with eating disorders are feeling as though they have to lose more weight so their BMI is low enough to qualify for treatment.
Jo’s story highlights this worrying problem. When Jo was 11, she started to turn blue at school and was rushed to hospital. Doctors said she was unlikely to last the night unless she ate something. She explains that this was the last time she ever attended school.
Jo had been a happy child, although she suffered with some anxiety. After a holiday at the age of 11, she became unwell with anorexia. She says she doesn’t know why it happened – she just started to eat less. Her local mental health service were quick to offer community care, but she was not admitted to an inpatient programme until her BMI fell lower, six months later.
Body mass index (BMI) is a calculation professionals use to assess weight in adults (there is a different method for teenagers and children). The National Institute for Health and Care Excellence (NICE) say in their guidelines they do not specify a particular level and explain that BMI should not be the only factor when considering treatment.
Beat say they are encountering a growing number of calls from people being denied treatment because their BMI is too high.
“Certainly we understand the pressures the NHS is under but it should not be the case that people end up feeling as though their need for treatment is invalid because of not being a certain weight or that they are wrong in asking for help because they are not at a certain BMI.”
Professor Chris Fairburn informs government guidance on the treatment of eating disorders and agrees that BMI should be considered, but other factors such as relationships, general health and moods should also be taken into account.
“If weight is low that’s serious, but you can have a serious eating disorder and your weight’s normal, you can be suicidal, incredibly distressed, but your weight’s normal,” he said.
Speaking about her experience, Jo says the news that her BMI was too high for her to receive treatment only fuelled her condition. She says that when you have an eating disorder you don’t see that you’re underweight, even when you’re skeletal – so when a doctor tells you your BMI is OK or ‘healthy’ it proves that you have a ‘long way to go’.
She goes on to say that it feeds the thoughts your illness is causing, setting you off on an awful spiral where you go home, restrict eating more to lose weight just so you can get poorly enough to receive treatment.
Prof Fairburn says accounts of this happening are ‘appalling’. He also says he understands why some doctors may find it hard to treat those with eating disorders – GPs may not see a lot of cases and they may struggle to get them to agree to initial treatment.
Jo, now 22, is a mother and is training to be a midwife. She says she managed to recover from her illness and that having children is motivation for her to never let it take control again.