[speaker001:] Now we're not talking about diets here, we're talking about eating disorders. What they are, how they can affect people, and why? And perhaps, what we can do about them? All of us, or perhaps, not all of us, but most of us do worry about our food, we eat too much, we eat too little, we eat the wrong thing! I'd like to try and define what the difference between and eating disorder and simply wanting to to to be a different shape or a different size is? But, perhaps you could first start by answering this question, do you ever worry about what you eat? Button one for yes, and button two for no. And in this hundred... my goodness! Eighty six people said yes, fourteen no. Those eighty six, why did you say yes when yo when I er... ho how did you... interpret what I said about worrying? Yes? Yes?
[speaker002:] I was a previous anorexia sufferer
[speaker003:] Mm.
[speaker002:] I didn't have a view of what my body should be like... I, I always thought I was fat... regardless of what weight
[speaker003:] Yep.
[speaker002:] I was... and it's never gone away even though I've put my weight back on.
[speaker003:] Yes?
[speaker004:] I think there's another point around that about... erm, the image that's portrayed by the media and and to be successful in your career you must be a slim, well made up woman... erm, and thinness equates with success and an ability to get on in life.
[speaker005:] It's also true that we make moral and ethical judgements about women in particular who are overweight... even
[speaker003:] Mm.
[speaker005:] by a small amount. And studies have shown that... women and men tend to judge a women as being less intelligent and less competent... and certainly, obviously, less attractive if she is overweight.
[speaker003:] Mhm. Yes?
[speaker006:] Er... I wonder if there is in fact er... a a view that women expect men to have of them that's th... the desirable woman? And I just happen to have with me
[speaker001:] [LAUGHTER]
[speaker006:] pain painted in the turn of the century, er a Renoir
[speaker003:] Ah yes! A very famous one!
[speaker006:] in which all the women are well padded, buxom... and all enjoying food
[speaker001:] [LAUGHTER]
[speaker006:] and drink! Now, if you compare with, with today
[speaker003:] Aha.
[speaker006:] when, when the does, when the Twiggys came in and... and the, the... the angular woman er, of which I am not... I wonder if that was the male view or what is the wo, the view that women have of themselves?
[speaker007:] I think women who are overweight have to work an awful lot harder to prove that they're just as good
[speaker003:] Mhm.
[speaker007:] as somebody. And, generally speaking do... twice as much work, put in twice as much effort... and just to prove they're as good! Not better, or anything else, just as good so that I'm, all these things that fat doesn't matter! And we're constantly trying to convince ourselves that fat doesn't matter!
[speaker003:] Right, now what has this got to do with eating disorders? I mean, where do eating disorders come from? Do they come from the kind of perceptions that we're hearing or is, is it something different? Yes?
[speaker008:] I think eating disorders are very much, weight is a symptom
[speaker003:] Mm.
[speaker008:] it's not the fact. Eating disorders tend to come from childhood, or problems, or ways people have approached food in the past... and the pressure is on women to be slim to fit into these categories... are er, just more pressures that make it very difficult for somebody who has an eating disorder... to sort the problem... all these pressures just make it more difficult. It's, they are not actually responsible for it, I don't think, but something that has happened that, that has caused somebody to see food in a different manner.
[speaker003:] Would somebody with expertise here like to define for the rest of us what... what, what differentiates somebody with a,a, an eating disorder, er from someone who's er... a chronic dieter or a chronic worrier or no not a chronic dieter at all, but someone who just thinks about it a lot?
[speaker009:] When it takes over your life, you know, anything that happens to you is related back to food whether it's... you know, connected or not, that is when it becomes an eating problem. Instead of you saying, oh perhaps something's gone wrong and trying working it out, it's all reflected back yourself... with food.
[speaker003:] Right, are you ta, are you talking from er er personal experience or people you know?
[speaker009:] I'm a sufferer.
[speaker003:] A sufferer of?
[speaker009:] Anorexia.
[speaker003:] Now, anorexia is much written and talked about, but perhaps not accurately, how would you define anorexia?
[speaker009:] I would say that the criteria that's that's sent out at the moment is is far too strict for the lot, a lot of women and... at the moment you're expected to be skeletal, whereas th, you can very well be thirteen stone and anorexic it's, it depends on your attitude towards food.
[speaker010:] We have to find criteria for anorexia
[speaker003:] Mhm.
[speaker010:] nervosa... which essentially means, er loss of body weight or fifteen percent your normal... preoccupation with weight, and loss of your periods for three months... and a morbid fear of gaining weight. And, why, you may argue that those criteria are too strict, those are criteria that are used in a medical sense.
[speaker003:] Well perhaps while we're doing it all, we're talking about anorexia, we should talk about the... er, the associated erm, disorder, bulimia, which is only recently become something that people are generally aware of. Wo wo would you like to offer er, a definition of of of bulimia as well?
[speaker010:] Well bulimia nervosa is a disorder of binging. Er, these binges take places regularly and they may amount to between three to five thousand calories in one binge.
[speaker003:] What does that mean, three to five thousand calories? I mean er
[speaker010:] A normal day you might eat two, three and a half thousand calories so within one... short period of eating... you would take in maybe double that. Er, associated with that are... certain behaviours, typically vomiting, laxative abuse, erm, use of diuretics which are water tablets or excessive exercising. Again, there are very many over-valued ideas about weight and what that means to the individual and a pre-occupation with weight.
[speaker001:] I believe that... the root cause of anorexia and... people who binge and... in fact, they are failed anorexics really! There's, there's,th the... the aim is the same, the aim is not to... not to gain weight... er and... the control has been lost when th when it's necessary to binge. But, I believe that the root cause of ano, is is a... is a deep-seated unhappiness in the individual.
[speaker003:] Mhm. Erm, I would agree that erm, what you saying about the anorexic thing and the fact that's it's a sort of deep-seated unhappiness, but I think that's far too general. You know, I think that... erm, this idea of... anorexics being, erm... sorry, bulimics being failed anorexics is, a wee bit kind of unfair! Erm, I think the sort of emotional erm... sort of like... characteristics of both eating disorders are very, very similar. But I think the reasons why bulimics need to binge, erm is completely different from what than, erm an emotion that an anorexic could be suffering... from. It's er more to do with the feeling of, it's like filling gaps... erm Yep. erm, emotional gaps..., boredom,go you know, just a whole sort of like range of various emotions. Erm, where possibly like the, the anorexic, well I don't know cos I'm not speaking from an anorexic point of view, but I think the, the point we're saying, emotions are there but they're dealt with in a, a different way, you know they... perhaps starve themselves erm, to sort of like, erm... you know ge, get across these emotions, to deal with these emotions. Mhm. Yes?
[speaker002:] And one of the differences that anorexia can become much more visible and identifiable, whereas those of us who have experienced bulimia, which I had for thirteen years, can be extremely secret and well disguised because we normally don't change from normal body weight.
[speaker003:] What's the difference between bulimia and compulsive eating? Is there a difference.
[speaker002:] Well, in the definition that we heard, it tends to be associated with, with trying to rid your body of the food that you've consumed during a binge. Compulsive eating normally doesn't... go to that extent.
[speaker003:] How did you stop... bu bu bulimia, I mean it was
[speaker002:] In the end it was the
[speaker003:] thirteen years of binging I mean
[speaker002:] Yeah.
[speaker003:] wha what effect does that have on you?
[speaker002:] Erm, it it, it makes it very, very difficult to imagine how you'll recover... erm, but in the end it's a personal decision to, to try to achieve self respect, to care for yourself better, to adopt good habits of nutrition and exercise, not dieting, cos diets are the biggest con trick of all... and certainly, to rid your life of people who don't respect and accept you the way you are.
[speaker003:] Can you identify why you began doing it? I mean, how old were you when you started er... binging?
[speaker002:] Fifteen. Yes.
[speaker003:] Fifteen?
[speaker002:] I was certainly to do with... feeling that I would have to be a little bit slimmer, that I would have to be acceptable to other people, that I would have to change my shape... and at the same time, I could not resist consuming large amounts of food.
[speaker003:] Now, fifteen seems terribly young
[speaker002:] That's right.
[speaker003:] for a girl to start, to start worrying about that kind of thing! Is is that a societal pressure? I mean is it a... ah,th wi, is there any history of it in the family an and, what did your family, did you family know?
[speaker002:] Families don't generally know. And it, it wasn't until many years later that I told anyone at all... that's, that's the thing I was saying about bulimia, it's very secret.
[speaker003:] And in the end, did you, I mean wha, did you get the support of of professionals or or
[speaker002:] Yes. Erm, but in the end th o only one had any impact and in general,see seeing a female professional was, I have to say, a lot more helpful than seeing male professionals.
[speaker003:] Mm. Yes?
[speaker004:] Er, my experience is slightly different when erm... when I had been trying to sort of recover, I didn't, I didn't feel as if I've get any help from professionals that I... approached. And in fact, I get an awful lot of support from friends... erm, not family because my family aren't, weren't aware of it, erm but I mean, really it came from fre, really close friends that I could sit down and talk to... and that could understand me and accept me, just like what the girl said as well.
[speaker003:] Mm mm. Yes?
[speaker005:] I think my G P actually sent me further down hill into anorexia after I'd lost about, about when I was seven stone... I went to see her, I'd never seen her before and she said well you look perfectly acc, sociably acceptable to me so I went on to lose two more stone before going back to see her and was admitted to hospital as a medical emergency! And, did continue to get professional help after that, but I think she was actually one of the... factors that... sent me further down, by telling me I looked well!
[speaker003:] What age were you then?
[speaker005:] Twenty.
[speaker003:] Yeah. And can you identify why yo wa was, are yo are you now over it? Are you
[speaker005:] Yeah I would class myself as a recovered... anorexic, but as recovered as I'll ever be! I don't think I'll ever totally get over it. I've still got a very distorted body image that I have to live with. I think I'm fat!
[speaker003:] The reality of anorexia for you was what, just not eating at all?
[speaker005:] Cutting down on food, I was University missing whole meals, telling people I was training, I'm a P E teacher so sport and the perfect body was very much up front, so the more weight I lost the better I was told I looked until it became totally out of control and I was eating an apple and black coffee a day and then vomiting so that I had nothing in me. Erm... my metabolism was... out the window.
[speaker003:] Now, as a P E teacher you're working what, boys and girls?
[speaker005:] Yes.
[speaker003:] Do you see ah,th the pe, the boys and girls or the, the young people that you're working with... erm, having the same... veering towards the same kind of thing, I mean, do you see pressures on... on girls, towards achieving that perfect body in the way that you felt it yourself at one time.
[speaker005:] I see boys calling the girls fat and it makes my hair stand on end! Erm... it goes on continually and these poor girls are... oh you're fat! You've got a great big bottom! And they're not, they don't have, they're normal.
[speaker003:] I wonder what you think of what you're hearing? Yes?
[speaker006:] I just wondered how much actual help professionals are? I mean, is is there really... enough help given? I mean, we talk about eating disorders
[speaker003:] Yeah.
[speaker006:] but do they really actually dig into the... the real reasons for the eating disorders or they just try and get you back onto a stable diet?
[speaker003:] Yes?
[speaker007:] I think what put me off in th and certainly em embedded was some of the comments as around control of our lives.
[speaker003:] Mhm.
[speaker007:] And maybe hope that we as, as people as women need to do is regain control of our lives so they, they belong to us, so it doesn't matter if if... boys say we've got fat bottoms or not,yo you say my bottom's alright an and you live with that.
[speaker008:] I'd be interested to know the lady who mentioned that, er she got help from friends, what sort of help did she get from her friends? I mean, how can you help someone with a... a problem like this? How best can you help someone with a problem like this?
[speaker004:] It was really, really difficult! Erm, she started really by, well th well there is two of them involved at the time, but they started by reading a book on the subject... and really... just talking to me about it certainly, because I mean they really didn't understand, you know... because food to them is just food, you know it was just some meal they had to eat because they were hungry and... they couldn't understand why I had got this whole thing completely distorted. Erm... there was a, I mean there was a lot of friction, I mean, I mean I'm really lucky to have the strength of a friendship that I did because... you know, if, I wouldn't have got, you know where I am, sort of without it, I think.
[speaker008:] Aye, so you related to that more than you would rela, related to a professional, a doctor or someone...
[speaker004:] Erm, when I first approached
[speaker008:] trying to help you?
[speaker004:] doctors they started putting me on anti-depressants, tranquilizers, sleeping pills... erm, and you know, they were, their whole manner was just absolutely terrible! I mean, I felt that, it made me worse as well, by going to them and I decided that I would never go back to them again, you know.
[speaker008:] That's quite interesting!
[speaker003:] Is it a, yes there?
[speaker009:] Can I just sort of say I'm I'm somebody working... on a team er, that deals with eating disorders. I think things have changed quite dramatically in the last few years certainly, we admit very few people and we see them mostly as an outpatient. I think it actually depends where you go to to seek help and who your first... erm person that you go to
[speaker003:] Mhm.
[speaker009:] I mean there is a, I don't know if anybody saw there was a... a programme on, it was actually B B C, erm, this week, it was about somebody who felt that she was very overweight and actually had her stomach stapled! And I mean, I find that really horrendous!
[speaker010:] I think your G P is maybe one of the first places to go but the trouble, I think, with people with eating problems is it's very hard to explain what the problem is.
[speaker003:] Mhm.
[speaker010:] And I think that's... what a lot of problem with condemned by the G P is is they're not able to articulate the unhappiness that's coming from the eating disorder, so they're told to go away and put on a couple of pounds... and because they haven't expressed that feeling the G P can't... or isn't... thinking enough to try and and poke into it a little bit more.
[speaker003:] So what would be better?
[speaker010:] I think, one of the most important things is finding a trusting friend or a member of family so that you can then try express some of the feelings so that you're in a better position... erm, to try and explain the problem.
[speaker001:] One of the great difficulties is that many young people find it extremely difficult to admit that they have a problem. And in fact, even with as many professionals as one would wish it's often extremely difficult to actually engage people in treatment... erm, and the whole process of getting people into treatment or into health can be very difficult, both for the young person and for the... therapist or helper involved.
[speaker003:] I don't want to give the impression that professionals are unhelpful at all. I mean Carole said earlier, it's a question of eventually making your mind up that you want to do something about it, but then... professionals are maybe there to assist. What you've described must be something that erm... that that families of people who are suffering from eating disorders must feel very much, that there's nothing that they can do... to, to to help.
[speaker001:] Families feel very rejected by professionals... erm, in my research I've found that... er, the... families of younger sufferers tend to be involved in treatment but they feel very much that they're under the microscope, that they disapprove, that they're seen as being pathological families. With older sufferers, erm, usually families are excluded from treatment, they're kept out, they're told that they're daughter erm must be seen on her own... and they feel very helpless and very unloved and unsupported by... by the professionals.
[speaker003:] Mm.
[speaker001:] Erm, in fact, I've found that the families are no different from any other families, there's no typical anorexic family.
[speaker004:] I think erm... yo e you know you asked about the support and I think having identified that there was a gap in the support in
[speaker003:] Mhm.
[speaker004:] times of... I mean, I actually think it's a... an awful lot of ask of a friendship, or of a family situation... and also, indeed, if you... I mean I think sometimes they can be very supportive but th the true understanding may not be there... and erm... I think that's what led me to start up a self- help group in Edinburgh... erm which is, has been erm... running for the last two years now. And, I think that... level of real understanding that you do get from fellow sufferers, and indeed, it's a su, it's a support for erm... families as well who are... able to come along and, and share that kind of... support.
[speaker003:] Mhm. After my own experiences I wo... I wouldn't advice someone not to go to their G P, but firstly, I would advice them to contact the Eating Disorders Association... er, because they are very helpful and they're more supportive than any G P I've ever come across. Okay. Yes?
[speaker002:] You mentioned er, earlier about yo, the fact that you were surprised that it was fifteen year olds, and that was quite young
[speaker003:] Yeah.
[speaker002:] and yet, in fact, that's the time when you're most vulnerable... yo, it's time of puberty, your
[speaker003:] Mhm.
[speaker002:] interested in fashion, your interested in the opposite sex and th... the ages between fifteen and eighteen teenagers ar, tend to be faddy, if it's not... er, their body shape th th, it's vegetari, vegetarianism.
[speaker004:] I think there's a third fact that you touched on earlier that I think it's just worth mentioning... and that is that we know it's also a genetic... pre-disposition to anorexia nervosa, in other words, we know that in certain families it is a disorder that will run from one generation to another.
[speaker003:] Na, yes?
[speaker005:] Erm, I'd consider myself to have an eating disorder but I don't have anorexia or bulimia. And er, I first started feeling I was overweight when I fourteen and I was, I was twelve stone... and I went to the doctor... and got black capsules to take... which had me as high as a kite... for a long time! And then there were the... the dose was reduced and then I had to come off them altogether... and after twenty nine years of dieting unsuccessfully... I gave up dieting and I haven't put on any weight since I gave up dieting!
[speaker003:] And, and what sto, why did you stop?
[speaker005:] Erm, a friend started a... a self-help group which I went to. And I realised, well I had realised for a long time that dieting wasn't the answer for me. And erm
[speaker003:] Oh so, over twenty nine years you're saying that food was controlling your life, in a way?
[speaker005:] Oh yes! Very much so!
[speaker003:] I mean that was, that was the dominant thing, was wha what you
[speaker005:] I could have told you every single item of food I had in the cupboard... every, down to the last bean! And now I don't know. I have sweets lying on the counter, I don't have to take them if I don't want to. I'm not controlled by food any more, and I don't feel guilty any more.
[speaker006:] I think the lady who said earlier when you go to your G P you can't express yourself
[speaker003:] Mm.
[speaker006:] I went to my G P, having avoided her for fifteen years, having getting... the old story every time you went... well you must go on a diet! I had been on diets... and to put it in context, over twenty years I've lost a hundred and twenty stone!
[speaker001:] [LAUGHTER]
[speaker006:] Which if you break it down is only about a pound and three quarters a week
[speaker001:] [LAUGHTER]
[speaker006:] and I think a lot of people are like that. But, when you look at it in that context it becomes very much... erm, part of your life, and it takes an awful lot to break that habit... and there's no help.
[speaker003:] Up there.
[speaker007:] I think it's very easy to fall into the trap of feeling guilty.
[speaker003:] Mm.
[speaker007:] Erm, I went on a diet last year, to one of these... clubs... and, within record time got to the weight I was supposed to be, calorie counting... and then I had to come off... and I found for weeks after... feelings of terrible guilt if I ate
[speaker003:] Mm.
[speaker007:] a chocolate biscuit! I was mentally calorie counting every time, it took me ages to get back to a sort of normal life.
[speaker003:] Can you identify th that the point at which... worrying about food, we've all agreed we shouldn't be, but there it is we do, er... pitches you into eating disorder and er... I know ca, is is there preventive action to be taken apart from changing society completely? Yes?
[speaker008:] I think it's when you become inappropriately absorbed around the areas of food... I think, too, because I work with teenagers
[speaker003:] Mm.
[speaker008:] that early intervention... is... the best way of coping with it, and certainly it demands that parents and friends and teachers, and people concerned... are aware of any change which is sustained over a period... because by early intervention then you're probably coping with the problem rather than the eating disorder, because the problem is there before the eating disorder.
[speaker003:] Erm, can intervention, as you call it, be effective do you think?
[speaker008:] Very! If it's early, before the pattern's... really entrenched.
[speaker003:] Yes?
[speaker009:] I think it's wrong to underestimate... erm i i it's particularly initially, how, how positively reinforced it can, it can be around you... erm, just this... the idea of losing weight... and that er... you know, people will be... wha, for whatever reasons are, either envious or they want to know how you can do it, they want to know, and particularly if it's linked with exercise then it's all very good things to do and... you know, the media's telling you and... a, everyone's telling that this healthy lifestyle that actually then goes out of control through... being so controlled... erm e e, there's a, well there's a thin line between it, being a very positive experience, and you're suddenly buying smaller jeans and erm... you know, it's just... everything is is feeding, if that's the right word, this idea that it, that that it's tremendous to be
[speaker003:] Mm.
[speaker009:] losing weight, to realising that you can't do anything about it.
[speaker010:] I think the advice I would give any mother of an anorexic is to tell them how awful they look! I wish I'd been told early on... what I looked like... and what I was doing to my body. Nobody... wanted to be cruel enough to hurt me because they thought I was so vulnerable at that time... and I really wish I'd been told that I looked disgusting!
[speaker001:] But at another level, if we could show love, respect and acceptance for each other in the magnificent diversity that that we show as women, instead of patronising and attacking each other on the basis of our body shapes, that would be a great step forward!
[speaker003:] Hooray! Yes? I'd like, I'd just say that I the the are professionals now that do know more about eating disorders and I do think there are clinics being set up. Erm, we do know quite a lot about... erm, why it is that when you diet you start to think about food all the time, and why it is that certain things happen, and I think that there's more and more information and knowledge being gathered... and yes, the... na, the desire to change has to come from the individual but perhaps, having clinics available where people can go when they're ready to change or where they can get help. I think very often you do need professional help and it isn't possible to do it with family and friends because of the interaction that actually makes it worse. So there's a practical suggestion and I, I like, I like Carole's philosophical suggestion that we could start celebrating the diversity of human kind. I mean, that's the kind of thing one often hears on this programme, is it wishful thinking or d'you think we could actually achieve it? Oh! Wahey!
[speaker001:] [LAUGHTER]
[speaker003:] Yes?
[speaker002:] I think the media have an awful lot to answer for!
[speaker003:] Yeah.
[speaker002:] I run one of the self-help groups that one of the ladies mentioned and we looked at an outsize catalogue recently and it went up to size twenty six and in some cases up to a size thirty... and the ladies who modelled the clothes were no bigger than a twelve, possibly a fourteen, but a very shapely fourteen!
[speaker003:] Mm. Mm.
[speaker002:] So the media, even when anything you do depends on your size,yo your image is all for a woman, your brain or your ability really comes way down the line! You have to look good first... before anyone listens to your other abilities!
[speaker003:] But looking big and good are not incompatible are they?
[speaker004:] I was just gonna say, I I think we should possibly stop blaming the media or whatever actually happens and perhaps echo what the... the lady earlier said, I think that it's in our hands, we're the women... [LAUGHTER] that could make this happen []!
[speaker003:] Yes?
[speaker005:] Well I
[speaker006:] I was just si Oh sorry!
[speaker005:] I'm sorry!
[speaker003:] One at a time! [LAUGHTER] []!
[speaker006:] I was just sitting here wondering why men don't have this image problem? Because there are an awful lot of overweight men and I don't see any problem with them at all!
[speaker003:] [LAUGHTER]
[speaker006:] They don't seem to have any problems between each other either!
[speaker005:] I'm quite concerned that my four year old daughter is after a Sindy doll... and wondering whether perhaps Sindy dolls shouldn't be produced... in erm... such diverse figures as real life?
[speaker003:] Well there's an
[speaker005:] Are we, are we providing
[speaker003:] an interesting idea!
[speaker005:] our future generation with women with an ideological... figure such as Sindy.
[speaker003:] A lot of ideas and certainly worth talking about it. It's something I hope we'll talk about again. I hope you've learnt something and I know that I have! Thanks very much for joining us. [closing music]