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Health: Anorexia — Question for Short Debate

– in the House of Lords at 7:55 pm on 25th February 2013.

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Photo of Lord Giddens Lord Giddens Labour 7:55 pm, 25th February 2013

To ask Her Majesty's Government what steps they are taking to reduce the prevalence of anorexia and other eating disorders.

Photo of Lord Giddens Lord Giddens Labour

My Lords, what a pleasure it is to be able to introduce this debate. I shall start by saying how I got interested in anorexia and other eating disorders some while ago. It happened one Sunday when I got two newspapers-I was feeling flush at the time-and each had a colour supplement. On the front of one colour supplement there was a starving black teenager in Africa, emaciated and on the point of death, suffering from malnutrition. On the front of the other colour supplement there was a starving white teenager in the United States who looked identical in terms of her emaciated frame. It seemed to me that the dynamics of those two things must be completely different. In the first, there was a person dying from traditional starvation: not enough food to go around; in the second, there was someone dying in the middle of probably the first society in world history where there is far too much food to go around.

After that, I started looking fairly intensively at the history of anorexia and other eating disorders, especially bulimia. It is very interesting that there is a history. It goes back some way. We do not know the details, but anorexia seems to have been very uncommon historically and was mainly associated with fasting to death, especially female saints who fasted to death in pursuit of the greater glory of God. Bulimia has some analogues in history, but it was not even named until the 20th century. You can say that anorexia, bulimia and other eating disorders are essentially, in their mass form anyway, illnesses of our time. They started to spread rapidly in the 1960s and from beginnings in the industrial countries they then spread around the world.

As everyone knows, anorexia and bulimia are most frequent among teenage girls, but interestingly there is now a kind of extension through the lifecycle. There are children as young as seven who are already suffering from anorexia symptoms and there are cases of women in their 70s suffering from anorexia and bulimia combined. Male eating disorders have been called the hidden epidemic or silent epidemic. They are not out in the open to the same degree, although there is stigma associated with all forms of eating disorder. The latest stats we have on the UK suggest that one in five children in this country with a serious eating disorder is male, which is a substantial and seemingly growing proportion.

Anorexia may have a physical basis, but this cannot explain the spread of these phenomena. You find an interesting thing in some parts of the world where, in the same society, some people are starving to death from classical starvation in remote regions, and in the affluent cities people are starving from anorexia. It is a global phenomenon. This cannot be explained by physical reasons. Why did it happen?

I think that it is primarily because of the rise of supermarket culture; I do not simply mean the rise supermarkets themselves. Once you have the rise of supermarket culture, you have all forms of food available. You have to choose what to eat, and there is a sense in which everyone has to be on a diet, with a barrage of information about their bodies, their health and so forth. In the case of young women, as we know, they are also bombarded by images of what a desirable body is like. These are powerful images. We now see through the advent of the internet very young children picking up the image of the slim body as the embodiment of attractiveness. These two things come together and, like many other aspects of our culture, they develop an addictive, compulsive character. Anorexia is a compulsive cycle from which there is often no escape without specific medical and other help.

In our society we have a variety of food problems and problems with the relationship between food and the body. Therefore, anorexia and bulimia are the tip of the iceberg in terms of what has become normality. In our society, over 90% of women have been on a diet at some point in their lives. The figure for men is now over 50%. Interestingly, over 60% of women who have no history of weight problems are on a diet, which shows how extensive these characteristics are. We are dealing with a pervasive phenomenon in our society, rooted in a compulsive relationship to food. There is a sense in which, at the other end of the continuum, all of us have to wrestle with what to eat and drink in relation to our health.

Anorexia, as we know, can be treated. Bulimia can be treated but normally demands intensive treatment. About 20% of female anorexics who are diagnosed before the age of 20 die before the age of 40. It is a lethal affliction.

I ask the Minister four sets of questions. First, do the Government have a coherent policy on anorexia and eating disorders? If so, what is it? I found it difficult to locate, having been through the government websites. Do the Government recognise the connections between eating disorders and obesity? One linked factor is binge eating, which is characteristic of bulimia and some forms of obesity; all problems of the body, plainly.

Secondly, what are the Government doing about male eating disorders specifically? These still do not receive the same degree of attention as female eating disorders. One of the main agencies involved in analysing male eating disorders says:

"Nationwide, there is simply a massive deficit in programmes that specialise in men with eating disorders".

Are the Government taking some steps to address this?

Thirdly, what is the Government's attitude towards pro-anorexia and pro-bulimia websites? As the Minister doubtless knows, they have proliferated in recent times. They are connected with the social media whereby these ideas become propagated. Essentially, these websites argue that to be extraordinarily slim is a desirable thing, and they do so in a forceful way. The websites themselves can become addictive. There are many precepts and so forth on these websites, but I will mention just one. Supposedly, Kate Moss once said:

"Nothing tastes as good as skinny feels".

You can see the lethal impact that that might have on a young person who is absorbed into these websites. Is there some way in which the Government can intervene to help control them and the impact they have, especially on young women and, as I have said, increasingly, young men?

Fourthly, what is the Government's reaction to the case of Laura Willmott which has been extensively debated in newspapers this weekend? She suffered from anorexia and died recently aged 18. She was apparently making good progress under care. When she turned 18 she was treated as an adult and essentially fell through the system. A headline from one of the Sunday papers read:

"At 17 years and 364 days, she is a sick child. At 18 the NHS can watch her die".

What is the Minister's reaction to that?

Photo of Lord Alderdice Lord Alderdice Liberal Democrat 8:06 pm, 25th February 2013

My Lords, I express my appreciation for the noble Lord, Lord Giddens, obtaining this debate. I note that there have been a number of debates on this issue; there was a debate recently in Westminster Hall at the other end of the Building. It is something in which I have been interested for some time. It is almost 30 years since I first published a paper on anorexia nervosa. At that stage I was of course interested in the psychological aspects of things: in individual and family therapy, and cognitive behavioural therapy. The papers I was publishing were on zinc, trace elements and gastro-intestinal hormones in anorexia nervosa, trying to see if we could understand a little better this devastating disturbance and the other associated eating disorders to which the noble Lord has referred.

Of course, as the noble Lord rightly says, these disorders did not appear in the past century. In fact, the first description of the disorder was in this city by Doctor Morton in 1689. He described a patient he had treated five years earlier: a young lady who had a disorder if this kind and died after a few months. The name itself was described by William Gull in London in the late 1800s. It is not a recent phenomenon, but it has become much more pervasive.

What is really striking looking back over the past 30 and more years is how little has changed except for the prevalence of the disorder. Most of the ways we have of understanding and treating these disorders have not changed terribly much. We have not really come much closer to understanding in an evidence-based way what we are dealing with. We can see some of the resultant phenomena. I came to the conclusion with gastro-intestinal hormones, for example, that most of what we were seeing, which was not very clear anyway, was probably consequential. It is clear that when a young person's-or even an older person's-body weight gets down to a certain level, their capacity to judge their body image changes. They become impervious to any kind of psychological intervention. It is necessary to get their body weight up to a certain level. In the case of young women, their periods start to return and their thinking begins to change. This is not simply a psychological phenomenon. It is not simply a biological phenomenon.

As the noble Lord, Lord Giddens, has also indicated, there are also sociological aspects to this, which we can think and postulate about. I guess we do that a lot in your Lordships' House. One of the difficulties is trying to ensure that we have research that takes us forward in understanding these things in a scientific way. That is one of the reasons why I was a little disappointed when my honourable friend Tessa Munt asked of another honourable friend, Paul Burstow, who was the Minister in February 2012, what the Government's guidelines were for the prevention of eating disorders. What targets exist? What is the departmental budget for the prevention of eating disorders? The answer was that there are no specific targets in respect of the prevention of eating disorders. Nor has the department set aside a specific budget.

I find that disappointing because it seems clear to me that after decades, during which a good deal of research has been done, mostly in specific areas-people will take a biological approach or a psychological approach and a few perhaps even will take a sociological approach, although not very many-it is very difficult to get a multidisciplinary research project put together without substantial backing from the Government, a major foundation or whatever. That is why I am a little disappointed that resourcing does not seem to be coming forward from the department. I hope that my noble friend the Minister will be able to say that that is not true and that resourcing is available.

I am disappointed that it has not been possible to put together the kind of multidisciplinary approach to research, a bio-psycho-sociological approach, which might take us a little further forward. As the noble Lord has said, this is a difficult problem to get people out of and to understand. It has proved to be a very difficult problem on which we can make any progress at all. The figures tell us that it is getting worse.

Photo of The Countess of Mar The Countess of Mar Deputy Speaker (Lords) 8:11 pm, 25th February 2013

My Lords, I, too, am grateful to the noble Lord, Lord Giddens, for introducing this topic for debate tonight. The simple definition of anorexia is a "lack or loss of appetite for food". Too often, we hear of awful cases of anorexia nervosa. I will leave the discussion on that and on bulimia nervosa to other noble Lords. The noble Lord, Lord Alderdice, has given us a very good grounding in them.

Numerous medical conditions give rise to the loss or lack of appetite for food. I think immediately of the many people with CFS/ME who are too exhausted to chew and swallow food and must be tube fed, either nasally or by a tube connected directly to their stomach. I think, too, of young girls who have had a bad reaction to the human papilloma virus-HPV-vaccine and who suffer fatigue, feverishness and an acute loss of appetite, with the accompanying weight loss. Some other conditions, including viral infections, hormonal imbalances, neurodegenerative diseases and brain tumours, have in their initial stages been labelled as CFS/ME because they present with the extreme fatigue, pain, digestive problems and other symptoms associated with that condition.

From the reports that I have had, there are many people with genuine intolerances to foods and drugs whose symptoms are profound after eating. The symptoms, which may be diverse, are a reflection of a disturbance of the autonomic nervous system and may include nausea, vomiting, bloating, abdominal distension and diarrhoea. Because they occur after meals, these people try to ascertain which foods cause their problems and they assume a restricted diet. This can occur after, for example, gastro-intestinal infection or HPV vaccination. These people, instead of being respected, as all patients should for their observations of themselves, often find themselves castigated. They are wrongly diagnosed as being anorexic, forced into psychiatric facilities and made to eat those foods that they know have provoked their symptoms. Historically, the same fate befell people with coeliac disease until the 1940s, when researchers realised that their symptoms of diarrhoea and malabsorption were caused by wheat, which was accepted by the medical profession. Interestingly, during the war, they were given bananas instead of bread.

I am particularly concerned that young people, mostly girls, are wrongly being diagnosed with anorexia nervosa. Too frequently, their parents are accused of causing their child's illness and care proceedings are initiated. Several youngsters have been obliged by social services to be confined in mental health units and are subjected to harsh "treatment" before their medical consultants realise that they do not have the condition. In other cases, the young person is blamed for failing to co-operate and not wanting to get well. I am sure that their prognosis would be much better if they were treated with more compassion.

The mother of one young girl wrote:

"After the HPV vaccine she lost three stones in three months. When admitted to hospital the professionals' first concern was that she was anorexic or bulimic. I even tried to say that she normally loves her food and she actually eats more than normal. Before vaccination her attitude to food was positive. (Her worst nightmare was someone stealing the fridge). Whilst in hospital she was shadowed by a nurse 24 hours a day for seven days to check if she was really eating or making herself sick. The final conclusion was that she doesn't suffer either from anorexia or bulimia".

This child and her mother have now been abandoned to the nightmare of CFS/ME. She continued:

"After this diagnosis was made we were pretty much left on our own as there is no ME specialist covering our locality".

Another mother wrote:

"After ... vaccination and since becoming unwell her appetite has fluctuated massively. Some days she eats very little, other days she eats constantly. She suffers constant nausea and vomiting and has to eat what she feels will keep down, which isn't the healthy choices she would have made. Eating disorders have been mentioned because she often vomits after eating but that is far from the truth. She still has a healthy attitude to food but her body is too broken to make it possible for her always to eat healthily".

Another mother whose daughter suffered badly from CFS/ME wrote:

"She did not have the energy to eat food and sadly did not get the help she required. So when food is not eaten they assume she does not want to eat. They do not face the reality that she has not got the energy to eat. Therefore they put her into a psychiatric unit for eating disorders".

I know that this young lady was discharged several months after being admitted in a worse condition than before she was admitted.

I cannot stress enough the importance of getting the diagnosis right, of listening carefully to the patient, of taking a proper history, and of ensuring that the right treatment is given early. Young lives can be ruined, family relationships destroyed and huge amounts of taxpayers' money wasted when this is not done. I ask the noble Lord the Minister what measures are in place to ensure that these awful histories that I have been hearing for years are no longer repeated.

Photo of Baroness Crawley Baroness Crawley Labour 8:16 pm, 25th February 2013

My Lords, the House is grateful to my noble friend Lord Giddens for bringing this desperately sad medical condition to our attention again this evening. While reliable statistics are a problem at the centre of this debate, and one that I shall return to, we understand from the National Institute for Health and Clinical Excellence that 1.6 million people in the UK are affected by an eating disorder, of which 11% are male, the vast majority being young women. Hearing and reading about the case studies of some of these young sufferers is a sobering experience. The self-loathing, hugely distorted body image and seeking after some control-any control-over their bodies, is enough to make one ashamed of the societal pressure that we have put on these mainly young people. The cycle of bingeing as a self-punishment for not losing enough weight, as they see it, is often accompanied by self-harming and, in extreme cases, a spiral into sectioning and force-feeding. Children, parents and the whole family are affected as the young person tries every device possible to starve themselves. Trust is replaced by fear and worry.

Why, we ask ourselves, should a significant proportion of our young people want to starve themselves in 21st century Britain in order to have some control over their lives? Is it the pressure put on them through advertising and the media to attain someone else's idea of the perfect body? Is it the connections made by society between thinness, worth and value? Is bullying on the internet exacerbating the problem, and does the easy access to internet pornography reinforce a falsehood about the way young people, especially young women, should look? We should do all we can to reinforce young people's confidence and sense of their worth. In a time of austerity, we should think once, twice and three times before applying cuts to young people's services.

In conclusion, there is at present a lack of data detailing the number of people in the UK suffering from an eating disorder. Although the Department of Health provides hospital episode statistics, they include only those affected by eating disorders who are in-patients being given NHS treatment. Those figures leave out those being treated in the community, as out-patients and privately, and those who have not been specifically diagnosed with an eating disorder. Could the Minister ensure that the Department of Health conducts reliable surveys to provide us with accurate statistics in future? This condition can blight a young person's life for years and years and, in extremis, kill them. We have to reinforce our work in this area and our commitment to our precious young people.

Photo of Lord Carlile of Berriew Lord Carlile of Berriew Liberal Democrat 8:20 pm, 25th February 2013

I congratulate the noble Lord, Lord Giddens, on initiating this debate. I agree with everything that has been said so far. This is an extremely important subject, which we should address more often, both in this House and in another place. In a very densely packed sentence in its College Report 170 of 2012, the Royal College of Psychiatrists said:

"Eating disorders are serious mental disorders with high levels of physical and psychological comorbidity, disability and mortality".

It is not just a free-standing condition, in other words.

Anyone who has ever been close to a serious eating disorder knows that it can prove extremely debilitating to the whole family in which the sufferer lives. Indeed, it is an ordeal for families that can lead to permanent effects, even if the person concerned appears to recover, although there can be and sometimes is good recovery. If there is to be good recovery, it is vital that there should be early interventions, which must be the right ones-not just any intervention. In too many parts of the country, the wrong intervention is provided because the services needed for that person are simply not available. If a sufferer from anorexia needs cognitive behavioural therapy, it may damage them to give them drugs, and vice versa. It is a very subjective illness.

My perception of how the illness is treated throughout the United Kingdom is that it is very unevenly dealt with. For a number of years, I was a Member of another place for a constituency in rural Wales. Today, as then, the services available in rural Wales-in an area affected by its rurality-are far less clear and certain than in many urban areas.

In opening the debate, the noble Lord referred to the internet and I agree with him entirely about its effect. There are far too many sites on the internet that worship the slender. I am shocked, too-for I still sometimes see teenage magazines in my household-by the primacy given to thinness in magazines. These are everyday, perfectly respectable magazines, purportedly edited by responsible people. With my children, stepchildren and grandchildren, who regard me as quite a decent sort of shopper, especially if there is a credit card in my pocket, I sometimes go into well known clothing stores. Some barely have anything larger than a size 10, yet that is a very small size which probably truly fits a minority of young women in their undieting state. It seems shocking that we are not capable of addressing in a more realistic way the natural state of our young women and young men.

I also believe that there is a complete failure in outcome monitoring, as the Royal College of Psychiatrists has said. We would have more consistent services if we knew the results. We even talk about paying for prisons by results but we do not pay for psychiatric services by results. It seems to me that one way of disciplining the relevant providers of services would be to judge their results. If they do not perform properly, someone else is available to do the job. The principles applicable to child safeguarding standards, which include removing child safeguarding from local authorities in certain circumstances, should also be applied to psychiatric and psychological services, especially those affecting eating disorders.

There are some innovative ideas around which really are not all that innovative. In some respects, it is a case of returning to what happened in the past. However, I suggest to your Lordships that annual medical examinations of every schoolchild, up to and including year 11, could be introduced. Looking around the House, those examinations were certainly undergone by everybody who is here today. Very simple and rudimentary checks, such as weighing, measuring and looking at teeth and feet, tell you an awful lot about a young person, especially if the figures can be compared with those taken a year or a term ago. I do not understand why we have abandoned these rudimentary measures, apparently on the grounds of cost, when any cost-benefit analysis shows that this kind of examination saves a great deal of money further down the line.

Finally, I wish to say a word in favour of school nursing and school health services. They seem to have been abandoned in an awful lot of educational institutions, yet the rumour mill that takes children to the school nurse saves lives. I wish we could look at that more closely for the future. There is a great deal to do and we do not seem to be doing it.

Photo of Lord Brooke of Alverthorpe Lord Brooke of Alverthorpe Labour 8:26 pm, 25th February 2013

My Lords, I, too, am grateful to my noble friend Lord Giddens for promoting this very important debate. I commence by declaring an interest as a trustee of the charity Action on Addiction, which provides day and residential accommodation for people suffering primarily from drink and drug addiction, but additionally we have many people who are cross-addicted. We deal with people with eating disorders, gambling difficulties, sex addictions, nicotine problems and a whole list of difficulties. Invariably, it is unusual to find a person with just one addictive issue that we have to address.

Anorexia nervosa is an extraordinarily difficult disease to deal with. The level of success when people leave at the end of treatment is often fairly small by comparison with the progress that can be made when dealing with people with drug and alcohol addictions and indeed, to a degree, with those with obesity. It is on the obesity side-the other eating disorders-that I wish to address my remarks. I address them as a founding member of the All-Party Parliamentary Group on Obesity, which is due to be launched in Parliament on 16 April and is long overdue. I hope that there will be a good response to it from the Government.

Last week, I was moved when I read the report highlighted in the Guardianwhichreferred to the UK asthefatmanof Europe. The full-page coverage of the report from the Academy of Medical Royal Colleges referred to the almost unstoppable growth of obesity and said that the number of people falling ill with it is almost beyond what can be coped with by the NHS. The Academy of Medical Royal Colleges is united-as are many other people-in seeing obesity as a problem of epidemic proportions and one of the greatest public health crises currently facing the United Kingdom.

I wish to pose a number of questions to the noble Earl on that topic. Does he agree with what the Academy of Medical Royal Colleges stated last week? What do the Government think about the report? The academy wants a dramatic increase in efforts to counter obesity and has made 10 recommendations for action. Time does not permit me to go into those tonight, but I specifically ask the noble Earl to address one of them. It asks the NHS to spend at least £300 million over the next three years to tackle the serious problem of the shortage of weight management programmes so that more patients can be helped in a supportive and sensitive manner. Since reading this, it is difficult to find the extent to which support is currently being given. As I will tell the Minister in a moment, people indicate that that support is declining rather than increasing.

I also heard in the course of my inquiries last week that an estimate has now been made that more than 70% of the million people employed by the NHS are classed as obese. Could the Minister please make an observation on that? As the principal person responsible for employing them, could he say what he intends to do about it, as it is an area in which the Government have a degree of responsibility?

Secondly, last week, prompted by the prospect of this debate, I went to visit an outfit in south London called Discovery. It is an organisation in the private sector, verging on a charitable operation, which provides two levels of service: contracts with the NHS to provide direct weight management programmes for individuals who are obese and in real trouble; and training for people in the NHS and related bodies who are endeavouring to start weight management programmes for those who are classed as obese. Discovery tells me that it is extraordinarily fearful about what the future holds for it under the changed arrangements set out in the Health and Social Care Act, which comes into force on 1 April. It says that the PCTs, which previously provided funding and contracts, are now disappearing. The contracts are also disappearing and not being renewed anywhere. Many weight management providers are facing the possibility that, although we have this growth in obesity, unless something happens in April, they may well go out of business later in the year. This is apparently a fear held not just within the organisation I mentioned but elsewhere as well. Therefore, I would like to know what the Minister intends to do about the immediate problem faced by people in this arena, when all the calls are for greater investment, not less.

Photo of Baroness Gale Baroness Gale Opposition Whip (Lords) 8:32 pm, 25th February 2013

My Lords, I also thank my noble friend Lord Giddens for bringing this important debate before us tonight. As others have said, it is well known that the majority of those who suffer from food disorders are women, but there is now a growing problem now among men. Many people who suffer from food disorders turn to websites for help, but often these websites glory in anorexia, giving tips on how to eat even less or avoid eating for long periods. Chatrooms are available to give more encouragement to continue not to eat.

I looked at some of these websites yesterday. They show photographs where all one can see are young women with their bones showing through their skin; they are horrific. One site even had the "Thin Commandments" for eating less. I will mention just three:

"Being thin is way more important than being healthy...Thou shall not eat fattening foods without punishing yourself accordingly... Losing weight = Life, Gaining weight = Death".

Only last week, the Sunday TimesStyle magazine featured the fasting diet, which advocates the "5:2 diet", which involves fasting for two days every week and then "the pounds will disappear". This new fasting trend has been widely reported this month, with another national paper even working its way through an all-month diet plan, including a list of recipes for 200-calorie "fasting suppers" to help us on our way. The Sunday Times article encouraged people not to overlook the importance of rigidly counting calories and cutting down to one meal per day. It quoted a woman teacher at the University of Illinois, who said:

"If you are having more meals, be very careful about measuring exactly what you eat. Don't guess. People don't realise how calorie-dense certain foods are. You can blow 100 calories in less than a minute, which, in this scenario, is not good".

It also includes advice from a woman professor at the University of Surrey's psychology department, who said:

"If I get through the next two fast days, I can buy a new lipstick or treat myself to a massage. If I stick to four fasts, I can buy that new pair of shoes".

Frankly, it is absolutely disgraceful to suggest that if you give up food you can buy yourself a new lipstick or a new pair of shoes, especially these days when people have to go to food banks. Yet, a national newspaper tells us to give up food and buy a new pair of shoes.

These articles tell women that it is okay to fast. Whether they are overweight or underweight, they being told that it is okay not to eat and that body shape is the most important thing about them. It is well known that body image and low self-esteem affect many teenage girls. There is social pressure in which the fashion and advertising industries play a part. There are many ways in which responsible behaviour within these industries can be promoted.

My noble friend Lady Kingsmill, who I am pleased to see in her place tonight, produced a report for the British Fashion Council in 2007 called the Model Health Inquiry, which made 14 recommendations, including one that no model should be aged under 16 and that the ban should be rigorously enforced. I believe that that recommendation has been accepted. Will the Minister say whether the Government are working with the fashion industry to implement all 14 recommendations in the report, especially the one which says that Ministers and British fashion industry sponsors should review the level of financial support to the BFC as a matter of urgency, to allow it to sustain the wider role proposed in this report? I appreciate that the report is six years old but perhaps the Minister can say something about working with the fashion industry on this matter.

How do we get the message across to vulnerable teenagers and those who need help? Where do they go for help? Is the information on food disorders advertised in GPs' surgeries? What support is given to schools and further education colleges to advertise on the premises? Is there a case for teachers learning how to look for the signs and then offering practical support? Left to themselves, sufferers may seek help on websites and get the unhelpful advice that I spoke of. We know that advertising works and I hope that the Minister will be able to give some idea of what help the Government can give in the places where young teenagers are.

Photo of Lord Collins of Highbury Lord Collins of Highbury Shadow Spokesperson (Work and Pensions), Opposition Whip (Lords) 8:38 pm, 25th February 2013

My Lords, I, too, thank my noble friend Lord Giddens for initiating this debate. As we have heard, the causes of eating disorders are both complex and multifaceted. At times of stress many of us resort to what is euphemistically called comfort eating, and the consequential results impact on self-esteem that can cause a very negative spiral.

Whatever the physical or psychological factors are it does not help that in our modern society we are constantly urged on the one hand to look sleek yet on the other to consume fattening foods. More often than not the food industry through its advertising campaigns manages both in one ad. Why is it that only on television does the person stuffing a bar of chocolate down their mouths appear to be so thin?

The excellent work of the All-Party Parliamentary Group on Body Image has shown that the constant portrayal of the man with the perfect six-pack or a young woman in a bikini does have an impact. It has highlighted the growing evidence that body image dissatisfaction is high, and on the increase. It is associated with a number of damaging consequences for health and well-being. We should contrast this with the way we are encouraged to eat foods packed with calories and made up of saturated fat and simple carbohydrates, the two food types most likely to make us put on weight. I remain concerned that so many so-called low-fat products are packed with sugar and calories.

Eating disorders can stem from a combination of issues, including distorted body image and low self-esteem. As I know from personal experience, someone with an eating disorder is very good at hiding the fact, often using a great deal of deception to fool the person or people to whom they are closest. This partly explains why there is a lack of data on the number of people who suffer from eating disorders. However, as we heard tonight, the numbers are great and the costs to the individual, their family and society can be devastating. Although eating disorders are considered to be a young girl's disease, they can affect anyone at any stage in life, and up to 20% of sufferers are male.

It is clear that early intervention is vital. However, that relies on greater openness and understanding of the issues on the part of all of us. The excellent campaign launched by the eating disorder charity Beat just two weeks ago used as its theme, "Everybody Knows Somebody", to flag up the fact that these illnesses are far more common than most people think. The Minister for Women and Equalities, Jo Swinson, in supporting the campaign, highlighted the fact that we are bombarded with all kinds of images, and that we need to equip young girls and boys to be more resilient to these pressures.

The Government's Body Confidence campaign has worked for the past 18 months to identify non-legislative solutions to tackle the causes of low levels of body confidence. It is a great initiative that includes representatives from the health and fitness, fashion and retail, youth and education, media and advertising, and beauty sectors. That is to be welcomed, but we still have a fashion industry that portrays extremely thin women and girls, and we have also heard that we face a proliferation of websites promoting images of anorexic girls. What assessment has been made of the impact of the Body Confidence campaign? What action will the noble Earl's Government take against these appalling websites? What action are they taking about the growing number of eating disorders among men?

The NICE guidelines on the treatment of eating disorders, published in 2004, are due for review in 2014. Many excellent services exist-we have heard about them tonight-but what impact will the new commissioning arrangements have on the fragmentation of these services? In my own area there is now a six-month waiting period for the first appointment for someone referred by a GP. Will the Minister ensure that best practice is maintained and that the gap between youth and adult services is addressed? Is it not time for a more coherent government strategy that encourages us all to understand better that what, when and how we eat really matters?

Photo of Earl Howe Earl Howe The Parliamentary Under-Secretary of State for Health

My Lords, perhaps I may begin by thanking the noble Lord, Lord Giddens, for securing this short debate on eating disorders, not least because it affords us a twofold opportunity: first, to let sufferers and their families know that their voices and experience are influencing what we do at the highest levels of government; and, secondly but no less importantly, to give prominence to a range of disorders that so often are hidden.

The noble Baroness, Lady Crawley, described eating disorders as desperately sad. I agree with her. The statistics are grim. Anorexia nervosa has the highest mortality rate of all psychiatric conditions. It disrupts education and quality of life, and in 20% of cases continues to create difficulties in independent living for up to 10 to 20 years after the onset of illness, as a number of speakers said.

Although relatively little research has been done into long-term outcomes for bulimia nervosa, binge-eating disorders and other less well known conditions, anecdotal evidence suggests that these disorders can, for a significant cohort of patients, have equally life-limiting, long-term consequences. These disorders can affect anyone at any time, regardless of gender, but most cruelly the peak age at onset for the majority of sufferers is the mid-teens.

The noble Lord, Lord Giddens, asked what the Government's policy is in this area. The answer to that has several strands to it. Early intervention is vital, and that is why it is a key national priority for the Government. Our cross-government mental health outcome strategy, No Health Without Mental Health, takes a life course approach, recognising that the foundations for lifelong well-being are already being laid down before birth and that there is much we can do to protect and promote well-being and resilience through the early years, into adulthood and on to a healthy old age.

The strategy's implementation framework, published last July, sets out that public services intervening early is one of the 10 key changes that will be needed to turn the mental health strategy into reality and the specific actions which local organisations can take to achieve this, including: children and their parents receiving evidence-based health promotion from birth; public services, including GPs, recognising people at risk of mental health problems and taking appropriate timely action; and schools taking a whole school approach to supporting all pupils health and well-being, including both universal approaches and targeted services for those at risk of developing mental health problems.

We are investing £54 million over the four-year period 2011-15 in the Children and Young People's Improving Access to Psychological Therapies programme to drive service transformation, giving children and young people improved access to the best mental health care by embedding evidence-based practice and making sure that whole services use session-by-session outcome monitoring. In February 2012 the Government announced a further £22 million over three years to the CYP IAPT programme. Some of this money will be used to extend the training offered by CYP IAPT to two further therapies-systemic family therapy and interpersonal psycho therapy. These therapies are invaluable in addressing some of the major mental health problems of adolescence, including eating disorders, as well as providing much needed support for the families of those affected.

The noble Lord, Lord Giddens, mentioned the tragic case of Laura Willmott. I, too, saw that coverage. I know that transition can be a huge issue, often pitching sufferers and their families into crisis at a critical time. Sudden changes in treatment and services can be bewildering and dangerous for patients and their families, and parents can find themselves excluded from decisions about care. I was very struck by the powerful remarks of the noble Countess, Lady Mar, on this theme. Charities such as Beat and Anorexia & Bulimia Care, which do so much to raise awareness as well as provide support and advocacy in action, are working with experts in the field on the feasibility of improvements to the care system, with a specific focus on introducing the option for students to receive care wherever they are.

It is this kind of grass-roots action that will make the difference the Government envisage when we have freed up health and social care services from micromanagement, empowering localities to make vital decisions that are tailored to meet the needs of their communities.

My noble friend Lord Carlile referred to the variation in services. I recognise his concern. New arrangements for the commissioning of services for eating disorders should also result in better planning and co-ordination of specialised services, greater equity of access, care and outcomes for patients, and a more proactive and systemic approach to service development, research and innovation. The child and adult specialised eating disorder services will be commissioned by the NHS Commissioning Board from April this year.

Within the board there will be a central team that will have a clear focus on specialised services organised around programmes of care. The team will develop a national service specification for each service while at the same time ensuring that it is sensitive to local needs. Work on eating disorders services has been underpinned by expert clinical reference groups on eating disorders and child and adolescent mental health services. The groups have explicitly recognised that targeted work is needed on the issue of transition.

However good our intentions, beneficial change does not always keep pace with the urgent desire of patients and families to feel the impact of those changes, but there are areas where direct action can yield swift dividends. The Time to Change programme, England's most ambitious programme to end mental health stigma and discrimination, now has the potential, with funding from the Department of Health and the Comic Relief fund, to reach 29 million members of the public with its vital messages on mental health. As is so often the case, it is the courage of individuals as evidenced recently in a debate in Westminster Hall in which Mr Brooks Newmark spoke. Events like that do much to challenge stigma and secrecy, and I think the honourable Member is to be commended for shining the light on an underreported aspect of eating disorders. The fact is that they are not simply the preserve of teenage girls. Male sufferers are growing in number, and I shall have something more to say about that in a moment.

The noble Baroness, Lady Gale, asked what we are doing to work with the fashion industry, a question echoed by the noble Lord, Lord Collins, and the noble Baroness, Lady Crawley. I commend the assiduous work of the All-Party Parliamentary Group on Body Image under the expert chairmanship of Caroline Nokes. The Government's own Body Confidence campaign has made great strides over the past two years in encouraging a more open and public conversation about body image. Working with a range of representatives from health and fitness, fashion and retail, youth and education, media and advertising, and the beauty sectors, we have been active in a number of areas: research, parent education, resources for teachers, industry awards and promoting public debate.

The noble Lord, Lord Giddens, my noble friend Lord Carlile and the noble Baroness, Lady Gale, spoke powerfully on the theme of websites. I am aware of the growing evidence of pro-eating disorder websites. They attract impressionable young people and intensify weight/shape anxiety as well as, disturbingly, introducing users to new methods of losing weight, as the noble Baroness, Lady Gale, told us so graphically. What can the Government do about this? Legislation is not the answer. Many of these websites are set up by young people with an eating disorder and we would not want to criminalise an already vulnerable group, while other websites are hosted overseas. However, we are committed to joint working with charities and the internet industry to speed up the reporting of damaging web-based content and the blocking of harmful websites. In January, my honourable friend Norman Lamb hosted a round table with key stakeholders on this very issue where, encouragingly, the development of a concordat was discussed. The Government will support this joint endeavour in whatever way we can.

The noble Lord, Lord Giddens, asked whether we recognise the link between these disorders and obesity, while the noble Lord, Lord Brooke, also spoke on that theme. The answer is that we do recognise it and we are doing a whole host of things to combat obesity, some of which I have referred to in your Lordships' House before. Weight management funding will in future be addressed through the new public health system, but most data on eating disorders come from charities such as Beat, particularly in its report on the costs of eating disorders in England, as well as surveys and reports from the royal colleges and other professional bodies. The Health and Social Care Information Centre published its annual mental health bulletin last Tuesday. It provides information on eating disorders for the first time, and I commend it to noble Lords as a reference point.

The mandate to the commissioning board makes it clear that the NHS should measure and publish outcome data for all major services by 2015, broken down by local clinical commissioning groups. To support that, the Government will strengthen quality accounts, which all providers are legally required to publish.

I have a great deal more material, but signals are being sent to me that my time is running out. I would like to address all these issues in letters to noble Lords, particularly those concerning men with eating disorders; my noble friend Lord Alderdice's question on research that we are helping to fund; and the role of schools, which my noble friend Lord Carlile and the noble Baroness, Lady Gale, asked me about.

In my own researches in this area, I have been much struck how many of those affected talk about how worthless and disempowered they feel. I think it is appropriate for me to use this opportunity to send a clear message to them: you are valued, you are not invisible, and with the right, targeted support, recovery is not only possible but probable.