Ruth Jackson: Obviously no two experiences of eating disorders are the same but what were some of the causes for you?
Elizabeth McNaught: The journey into an eating disorder takes place over time through multiple damaging occurrences. It was a combination of factors for me. I didn’t like the shape of my body; I always felt larger than the other girls at school. I used to do a lot of gym and my trainer said I had a stocky build. Things like that enforced that feeling of being larger and not looking right.
I moved schools at 13 and the first thing anyone said to me was: “Hello fatty”, which was the trigger to start trying to lose weight; I went on a diet which led me onto anorexia.
I think the whole way through my childhood I never felt confident in how I looked. I was born with a large birthmark on my cheek and I was very self-conscious because of that. My parents were very conscious about my birthmark and did everything they could to protect me - they would shield me from comments and hurt but obviously that couldn’t continue in the playground and so I wasn’t prepared for the comments that kids make to each other.
RJ: The charity Beat says 86 per cent of people with eating disorders report that ‘bullying’, in its broadest sense, contributed to the onset of their illness. Is there anything we can do to help children and young people build resilience?
EM: Encouraging them is really important. When I was going through a difficult time and being bullied, I was saying: “You’re never going to fit a mould; there is not one perfect mould - you are your own mould.” Part of it is learning to love yourself but the most important thing is to learn that God loves you, whatever. It’s doesn’t make a difference if you have 15 friends on Facebook or 500; it’s not going to make a difference if you look the ‘perfect’ way; it doesn’t make a difference how much you weigh. So, encourage young people to realise that God loves them. I appreciate that’s what we do a lot at church, but really encourage them to get their value from God and not from what other people think.
Also help them realise that it’s OK to hurt; it’s OK to be upset about what people say about you; it’s OK to be upset about not being invited to parties. It’s through hurting that we grow, and we can use that experience for the good.
RJ: Now that you’re a doctor, how do you feel when you see young people heading down the same path?
EM: I find it heart-breaking. It’s devastating to see young people with so much potential getting sucked into this way of life and this illness. But it also makes me passionate about improving the services for young people. I didn’t get early enough intervention. I still battle eleven years later - it doesn’t mean they should have to. If we can get good education and early intervention for these young people, we can help them.
RJ: How do we make sure we’re addressing the root causes rather than just the symptoms?
EM: Good therapy. Therapy is vital for people with eating disorders. Talking therapy, cognitive behavioural therapy (CBT) and variants of that are absolutely critical. You cannot treat anorexia by a meal plan and making them gain weight and checking their electrolytes. That is not going to make them better. That might physically make them better, it might make the doctor feel a bit better about looking at them but it’s not going to treat their underlying issues, which are the underlying thought patterns.
RJ: What impact does an eating disorder have on a family?
EM: Anorexia is not an individual disease; it doesn’t just affect the person - it has a widespread effect on all the family. But with eating disorders and with mental health problems on the whole, people don’t talk about it. So it’s very easy for families to feel like it’s just them that are being affected - you can look around church and think everyone else is fine.
Anorexia can disrupt relationships. When I was unwell my dad didn’t think there was anything wrong at the time, so then, in my illness, I took that opportunity to divide and conquer between the parents. It can put marriages at risk; it can affect other siblings because obviously the person who’s unwell gets a lot of attention.
RJ: Are there practical things we can put in place to help young people?
EM: Education is absolutely vital: for youth workers, for parents, for anyone involved with young people and people of all ages - it is important to recognise that people of all ages have eating disorders - and to identify the early risk factors, signs and symptoms, so that we can start helping them.
If an eating disorder has developed, I think a lot of encouragement and love is vital: standing by and supporting them in their journey.
In most churches we seem to love eating together - everything revolves around food. Even in a youth group it’s all about meals together, snacks, cakes - which for someone with an eating disorder can be very exclusive and can make it quite a barrier. I would encourage churches to do things that don’t involve food; let’s have social events that aren’t about food. And if there is food, let’s have food that’s applicable to people who might struggle with eating. Have options from all the food groups. Have options that are healthy, that will make someone feel more comfortable eating it - have salads and things such as couscous that are nutritious but healthy. Chatting while eating can be helpful but it can also feel quite uncomfortable. Obviously this is different for each person but if you are sat listening to a talk and eating, sometimes that can feel like people aren’t watching you as much.
If you’ve got someone in your youth group who’s got an eating disorder, talk to them about it. Ask how you can make things better for them. Tell them they’re valued as a member of the youth group.
RJ: How can we identify someone who’s struggling with these things?
EM: There are a lot of signs and symptoms; in my book there’s a whole appendix with them. Identify people who will find excuses not to eat: “I ate before”, “I don’t feel well”, or things like that. Obviously people are allowed to eat before and not feel well, but if this is happening a lot, if you’re noticing a lot of avoidance of food, excessive exercise, being very conscious of how they look and how they eat then those are key things to pick up on.
RJ: What would be the most sensitive way to speak to a young person if you’ve picked up on some of those signs?
EM: Talk to them privately about it - don’t go to the parent, talk to the child, and ask: “Is there something going on? How can I help? How do you feel about eating? Have you noticed anything?” And then share your concerns: “I feel really conscious that you’re doing this…” Eating disorders are very deceptive; people will go to all sorts of lengths to hide it from friends, family and loved ones, but they also hide it from themselves. And there is a lot of denial and difficulty in understanding when you have an eating disorder, so they might not understand it.
RJ: Is there anything we can do to help support the parents of young people who struggle with eating disorders?
EM: Something that really helped my parents was family therapy, which was an opportunity just to sit and chat. Obviously that’s meant to be done by a professional therapist and it’s got a whole structure. But I think there’s a lot of value in talking with parents and supporting them.
Life hurts: a doctor’s personal journey through anorexia is out now. For more information and helpful advice about eating disorders visit b-eat.co.uk. For their youth helpline call 0808 801 0711.