The causes of eating disorders might not be as obvious as you think, and looking out for wider signs and symptoms could help you spot someone at risk

Over 1.25 million men and women in the UK are affected by eating disorders, according to eating disorder charity Beat, with young people aged between 13 and 17 at the highest risk.

It is often reported in the media that the fashion industry has a negative impact on body image and it’s certainly true that the industry can promote a very limited picture of the ‘ideal’ body type. But blaming fashion for causing eating disorders oversimplifies the issue. In fact, eating disorders can be caused by genetic, psychological, environmental, social and biological factors.

A new report from the University of East Anglia (UEA) published in the journal Eating Disorders states: “One patient said that suggesting seeing ‘a skinny model in a magazine’ influenced the development of eating disorders ‘completely trivialises’ the many reasons people develop body and eating distress.”

With this in mind, the report highlights the need to focus on social and cultural aspects of eating disorders, specifically gender expectations and pressures. Being mindful of these issues can widen the scope of pharmacy’s ability to help people with eating disorders, so what do pharmacy teams need to be aware of?

Gender pressures

Stereotypically, eating disorders are seen as a ‘female disease’ but there are gender expectations and pressures on males as well as females. Eating disorder charity Beat says research suggests that up to 25 per cent of sufferers may be male. And while the charity adds that recent statistics show the number of males accessing treatment has increased, Sam Thomas – founder and director of Men Get Eating Disorders Too, which offers information and support for men with eating problems – says men are still reticent about getting help.

“Typically people assume that eating disorders are a young girl’s problem but it’s not the case,” says Sam. “In reality, eating disorders are indiscriminate and can affect people of all ages, backgrounds and indeed gender. It’s this societal assumption combined with masculine ideals that prevents men from coming forward and seeking help.”

Social expectations

The rise of social media may go some way to explain the proliferation of stereotypical ideals of how men and women should look, but Sam says it is remiss to lay the blame for eating disorders at its door.

“Eating disorders can be caused by a variety of factors that are exacerbated by social media but they are, in fact, a combination and culmination of different contributing factors built up over time. Some of the main factors can include bullying, peer pressure, issues around identity, self-esteem, work and academic stress, to name a few examples.”

However, Beat warns that images can also be dangerous. “Pictures of thin bodies or body parts, like ribcages or exposed shoulder blades, can negatively affect people who suffer from an eating disorder”, says a Beat spokesperson. “For those affected by such complex mental illnesses, these images can present an idealised body type that can encourage them to continue or worsen their disordered eating.”

In the same way, the charity says that some messages promoted by the food and diet industry, while “unlikely to be the sole and direct cause of an eating disorder, may exacerbate the problem or be a contributing factor for someone who is vulnerable to developing one or is already ill”.

Sometimes comments, either positive or negative, about someone’s weight can act as a trigger too. “People who conform to society’s picture of an ‘ideal’ body by losing weight or are seen to be able to control their appetites, are sometimes praised and rewarded”, says Beat, so these, often ‘off the cuff’, remarks can have a negative effect on individuals with an eating disorder, or those vulnerable to developing one.

Cultural issues

Sadly, the UEA report suggests that eating disorder treatments still don’t do enough to consider – and tackle – these social and cultural implications of the illness.

Lead researcher Dr Su Holmes says: “Although there is now extensive evidence on how eating disorders are bound up with cultural ideas surrounding gender, the contemporary focus on evidence-based treatment, and particularly the rise of cognitive behavioural therapy (CBT), has all but forced these issues off the agenda. If cultural elements are addressed, it is through a limited focus on ‘body image’ work, which often invokes the significance of the media in perpetuating unattainable images of the body.

“The bottom line is that, although eating disorders are now widely recognised as being shaped by biological, psychological and social factors, the social aspect of the equation is poorly served.”

Food and fitness fads

Sam also has concerns about the dynamics of ‘healthy’ eating and fi tness cultures. He says: “Healthy eating is about eating a balanced diet and is not to be confused with the ‘clean eating’ culture we often hear about. Too often, people regardless of their gender, will overfocus on their diet when aiming to strive for a fitness goal. Instead, it needs to be considered as ‘fuel’ for energy with a balance of healthy eating and a regulated exercise regimen.

Beat says excessive exercising is a symptom of eating disorders in men, which observers can mistake for a sign of a healthy lifestyle rather than cause for concern. And Sam says it can be the case that men who are building muscle will measure their fi tness success in part by weight and calorie consumption, with an aim to achieve a certain weight and size.

Signs and symptoms

Eating disorders are very complex mental health illnesses and while they cannot be necessarily seen, there are different signs and symptoms that pharmacy teams can look out for to help spot customers suffering from or at risk of eating disorders.

A common misconception is that someone with an eating problem will be over- or underweight, but this is not the case, and eating problems are not just about food. For example, someone might be going through a difficult situation or have feelings that they are finding hard to express, face or resolve, and focusing on food can be a way of disguising these problems, even from themselves.

Sam says it can be especially difficult to tell if a man has an eating disorder, but he stresses that “for pharmacy teams in particular it may be apparent that someone is wanting to use medications and/or supplements in order to control weight, including diet pills, fat burners and laxatives, for example – so it’s about asking the basic questions on purpose of use and whether the product is suitable for their desired goal.”

For some people, eating problems are linked to self-harm, but it’s also possible to have problems with eating and keep them hidden - sometimes for a very long time.

Pharmacy Support

Beat's mostrecent research found that it takes sufferers over 18 months to realise they have an eating disorder and over a year following this before they seek help, with men and boys waiting 28 weeks for a referral compared to 10 weeks for women and girls.

What’s more, the charity says sufferers often face a three-and-a-half-year delay between falling ill and starting treatment, with fewer than 50 per cent of patients receiving all the information they need.

These findings are very concerning as it is crucial that people are treated as soon as possible to improve their chances of a quick and sustained recovery – so early intervention can make a real difference.

If you spot signs of an eating disorder in a customer it can be a delicate conversation to start, but if someone admits they are having an issue with eating, or they ask for help, the first step is to refer them to talk to their GP, who should be able to refer them on to specialist services.

The National Institute for Health and Care Excellence (NICE) recommends talking treatments for eating problems, which can also be accessed via the GP, although there can be long waiting lists. Customers can fi nd a private therapist through the British Association for Counselling and Psychotherapy (BACP), or free counselling services and support groups through Beat.

When it comes to medication, mental health charity Mind says that while there are no drugs specifically for eating disorders, patients may be offered medication to treat some underlying factors (such as depression or anxiety). The most common medication prescribed are antidepressants or antipsychotics, but Mind stresses that “most people are offered these drugs alongside talking treatments – medication shouldn’t be the only thing offered”.

Mind also points out that being underweight can mean that drugs are absorbed more quickly into the bloodstream, so pharmacy teams should tell patients that this “could make medication harmful or not as effective as it should be, [so] before prescribing you any medication, your doctor should explain to you what the medication is for, and discuss any possible side effects and alternative treatment options”.

The good news is that the sooner someone gets the care and support they need, the more likely they are to make a full recovery from an eating disorder.

Eating disorders and indiscriminate and can affect people of all ages, background and indeed gender