Written by Emily Green
Treatment Barriers in Eating Disorders
Within our healthcare systems patients can face certain hurdles when seeking treatment. Barriers to accessing eating disorder treatment can include both individual characteristics like attitudes and beliefs, and system-related factors such as location, availability of services and affordability (1). We also acknowledge the additional hurdles faced by marginalised and minority groups; coping with racial or weight stigma from healthcare professionals (2), not having the time to visit the doctors due to work or childcare commitments, financial barriers to private treatments and lack of education on healthcare options can all play a role in preventing initiation of timely treatment.
The impact of stigma on treatment
It has been reported that stigma is the most impactful barrier to reaching out for support with any type of eating disorder (3). Relating to this stigma, experiencing a non-stereotypical eating disorder presentation (e.g. in a larger body) has been reported to magnify this delay in treatment (3). This shows just how crucial it is to raise awareness of eating disorders and help empower those who need help.
Setting these system-related issues aside, the nature of unhelpful thinking styles in eating disorders means our own brains can also put up resistance to seeking treatment. Making it seem unnecessary or feeling unworthy of support. We have a separate blog post all about these maladaptive thought patterns.
Barriers to Eating Disorder Recovery
Let's unpack a few common reasons why you might not feel ready to ask for help with your eating disorder and go all in for recovery.
“I’m not sick enough”
This is one of the most common barriers we see in the TCN clinic. In our opinion "sick enough" is a symptom in itself! Feeling like you aren't sick enough shows the strength of the eating disorder self. Try to recognise this critical voice as it will need to be challenged in recovery.
If an eating disorder is impacting your life in any way, that is enough of a reason to seek help. Eating disorders can manifest serious medical complications and long term side effects if left unchecked. Compensatory behaviours such as purging, whether it be self-induced vomiting, laxative abuse or excessive exercise are present in many eating disorders and can have serious implications including cardiac arrest and renal failure (4). However, even without engaging in compensatory behaviours and associated physical symptoms, the psychological and emotional toll of an eating disorder is just as debilitating.
“I’m not thin enough”
It’s estimated less than 6% of people with eating disorders are medically underweight (5). Weight is not the only concern when it comes to eating disorders as they can occur at any size and shape. Even in a larger body, the effects of restricting food intake, weight suppression and physical stress on the body can cause significant side effects. Purging can disrupt the electrolyte balance in the body and lead to cardiac complications (4). Weight suppression (even if still in a ‘technically’ healthy weight range) can cause symptoms such as fainting, feeling dizzy and heart palpitations (6) showing how truly dangerous disordered eating behaviours can be.
“I don’t have a “real” eating disorder”
Not fitting neatly into the typical eating disorder diagnoses is very common and does not negate any of the symptoms and experiences you have. OSFED is clinically recognised in the DSM-V and covers multiple atypical or subthreshold eating disorder presentations such as atypical anorexia, subthreshold binge eating disorder and purging disorder. This is actually the most commonly diagnosed eating disorder accounting for approximately 44% of all cases (7). Regardless of weight or severity, any feeding or eating difficulties that detrimentally impact your life are real, valid and deserving of treatment.
“No one will take me seriously”
If your eating disorder is negatively impacting your life in any way, you deserve to be heard by healthcare professionals and taken seriously. The best way to approach this is to go to your GP appointment armed with resources, evidence and a written list of ways the eating disorder is detrimental to your physical health, mental health, social and family life.
At the TC Nutrition clinic, we recognise that whilst weight and BMI can guide clinical assessment and treatment, it does not necessarily reflect the severity of an eating disorder. We believe in equal access to treatment regardless of weight and shape. Read our thoughts on BMI and Eating Disorders.
“What I’m eating is fine”
Even if you think the foods on your plate are fine, normal or healthy, there's a huge part of eating disorders which are not about the food. Maybe you do eat 'well' but you experience feelings of guilt and shame about what you eat, you mentally restrict (i.e. don't give yourself full permission to enjoy foods), or exhibit rigid black and white thinking around eating (8). The alternative is that what you are eating is not actually ‘fine’.
The ED self will try to convince you that you don’t need or shouldn’t have certain foods, it may induce anxiety around eating which can lead to the elimination of whole food groups or particular foods without medical or ethical reason. This poses a great risk of nutritional deficiencies and low energy availability. A healthy diet should include balanced proportions of ALL macronutrients (carbohydrates, protein and fat), micronutrients and importantly, enjoyment!
“But I’m still… working, running marathons, being successful, [insert any other reason]”
The ED self will always try to persuade you that appearing successful and ‘functioning’ on the outside means nothing is wrong on the inside. Just because you’re still functioning doesn’t mean that you are thriving. Thinking about traits which can accompany eating disorders such as perfectionism and extremely high standards (8), we know even people with serious eating disorders can still perform at a high level - but it doesn’t mean you’re not unwell! The human body has had thousands of years to adapt to survival - there is a difference between surviving and thriving. Read more about Finding Your Healthy Self.
Have you recognised your own thought patterns and reasoning here?
If so, it may be time to take a look at how your eating disorder it is affecting your life. We can support you with this in the TC Nutrition clinic. Our specialist eating disorder dietitians can offer online consultations to help you recover from disordered eating, break food rules and find food freedom. We also offer some tips for approaching your GP on Instagram.
Book a free 15 minute discovery call here with one of our dietitians.
Emily Green
TCN Intern
Emily is studying MSc Clinical Nutrition, after having graduated from a degree in Nutrition & Psychology from Newcastle University. She has an interest in supporting people to overcome disordered eating, find food freedom and keep a healthy mind. You can find Emily on Instagram @nutritionupontyne and on her blog nutritionupontyne.co.uk
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Innes, N., Clough, B. and Casey, L., 2016. Assessing treatment barriers in eating disorders: A systematic review. Eating Disorders, [online] 25(1), pp.1-21. Available at: <https://www.tandfonline.com/doi/full/10.1080/10640266.2016.1207455> [Accessed 8 August 2022].
Puhl, R. and Heuer, C., 2010. Obesity Stigma: Important Considerations for Public Health. American Journal of Public Health, [online] 100(6), pp.1019-1028. Available at: <https://ajph.aphapublications.org/doi/full/10.2105/AJPH.2009.159491> [Accessed 5 August 2022].
Hamilton, A., Mitchison, D., Basten, C., Byrne, S., Goldstein, M., Hay, P., Heruc, G., Thornton, C. and Touyz, S., 2021. Understanding treatment delay: Perceived barriers preventing treatment-seeking for eating disorders. Australian & New Zealand Journal of Psychiatry, [online] 56(3), pp.248-259. Available at: <https://journals.sagepub.com/doi/10.1177/00048674211020102?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmed> [Accessed 8 August 2022].
Forney, K., Buchman-Schmitt, J., Keel, P. and Frank, G., 2016. The medical complications associated with purging. International Journal of Eating Disorders, [online] 49(3), pp.249-259. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803618/> [Accessed 5 August 2022].
Flament, M., Henderson, K., Buchholz, A., Obeid, N., Nguyen, H., Birmingham, M. and Goldfield, G., 2015. Weight Status and DSM-5 Diagnoses of Eating Disorders in Adolescents From the Community. Journal of the American Academy of Child & Adolescent Psychiatry, [online] 54(5), pp.403-411.e2. Available at: <https://www.jaacap.org/article/S0890-8567(15)00076-3/fulltext#relatedArticles> [Accessed 4 August 2022].
Sawyer, S., Whitelaw, M., Le Grange, D., Yeo, M. and Hughes, E., 2016. Physical and Psychological Morbidity in Adolescents With Atypical Anorexia Nervosa. Pediatrics, [online] 137(4). Available at: <https://publications.aap.org/pediatrics/article-abstract/137/4/e20154080/81504/Physical-and-Psychological-Morbidity-in> [Accessed 15 June 2022].
Santomauro, D., Melen, S., Mitchison, D., Vos, T., Whiteford, H. and Ferrari, A., 2021. The hidden burden of eating disorders: an extension of estimates from the Global Burden of Disease Study 2019. The Lancet Psychiatry, [online] 8(4), pp.320-328. Available at: <https://www.sciencedirect.com/science/article/pii/S2215036621000407> [Accessed 8 June 2022].
Fairburn, C., Cooper, Z. and Shafran, R., 2003. Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behaviour Research and Therapy, [online] 41(5), pp.509-528. Available at: <https://www.sciencedirect.com/science/article/pii/S0005796702000888> [Accessed 21 June 2022].
Talia Cecchele Nutrition is a team of registered dietitians that specialise in eating disorders, disordered eating, digestive issues and sports nutrition. We aim to bring balance back to nutrition, help you to break free from food rules and find food freedom. We offer virtual consultations and group programs so whether you are based in London, the United Kingdom or around the world we would love to support you. To enquire about a private consultation please fill out a contact form.
London Dietitian. London Eating Disorder Dietitian. Eating Disorder Dietitian