For most people, grabbing a sandwich at a train station is a normal non-event: you are hungry, you eat.
But when Angela Whiteford unpacked her Marks & Spencer sandwich while sitting outside the station cafe last month, she felt triumphant. At the age of 51, it was the first time she had eaten in public in more than 15 years. She says: & # 39; Meals are usually not allowed. I hate the feeling of a big meal in my stomach. As soon as I get home, I just have to get rid of it. & # 39;
The mother of the two suffers from anorexia, the eating disorder with the highest death rate from a mental illness: it kills one in ten victims.
What started as a diet to lose weight after pregnancy in 1994 quickly turned into a life-threatening illness. Now, 25 years later, it has destroyed more than half of her life.
Angela Whiteford (above), a mother of two from South London, suffers from anorexia – the eating disorder with the highest death rate from a mental illness: it kills one in ten victims
& # 39; Every day is like a groundhog day – it's the same. I don't eat much during the day, maybe an apple, and then at 9 p.m. I have a cheese and tomato sandwich for dinner and maybe a yogurt or two. It is not life, it exists, & says Angela, who wears a clothing size four to six.
We often hear inspiring stories about the recovery from eating disorders, in which teenagers are often involved. But for older women, such as Angela, the story isn't that hopeful.
The heartbreaking reality is that they are probably stuck with this disease for the rest of their lives.
The South Londoner is one of a growing number of elderly patients with an eating disorder who fall through the cracks in the system, struggling in the 60s and 70s with little hope of recovery.
Last week the Royal College of Psychiatrists & # 39; reported terrible shortcomings of the NHS & # 39; in the treatment of elderly patients with eating disorders – anorexia, bulimia and binge eating disorder. Some turned out to wait three years for mental health support.
What started as a diet to lose weight after pregnancy in 1994 quickly turned into a life-threatening illness. Now, 25 years later, it has destroyed more than half of Angela & # 39; s life. (She is pictured at the age of 18 – before she got anorexia)
For many people, interventions depend on extreme weight loss, which means they have to get worse before they get the chance to get better.
Angela says: & I wish that all those years ago my doctor noticed the signs or that I had better treatment before, & # 39; she says. & # 39; Now it's so deep-rooted that I want as much as I want to recover, I just can't do it. & # 39;
In two decades of NHS treatment, Angela received only six-hour sessions of therapy for her mental illness. Treatment, on the other hand, focuses on nutrition programs in hospitals. Yet research suggests that a lack of adequate psychological treatment halves the chance of recovery in the long term.
NHS figures seen exclusively by The Mail on Sunday show that one in five patients admitted to the hospital in 2018 for eating disorders was older than 40.
Since 2012, the number of admitted patients from over 40 has doubled to almost 4,000, a much larger increase than in those under 18.
A 2017 study estimates that about three percent of Britons between the ages of 40 and 50 experience an eating disorder. It will mainly be women.
Leading mental health experts have called for an injection of NHS funding to provide specific support to these patients with serious and long-term illness.
In two decades of NHS treatment, Angela received only six-hour sessions of therapy for her mental illness. Treatment, on the other hand, focuses on nutrition programs in hospitals. Yet research suggests that a lack of adequate psychological treatment halves the chance of recovery in the long term
Professor Janet Treasure, psychiatrist and director of the eating disorders unit in South London and Maudsley Mental Health Trust, says: “We urgently need more resources and options for this group of patients. All other areas of psychiatry are well prepared for dealing with long-term illnesses other than eating disorders. It is too easy to fall through the cracks. & # 39;
I know the plight of these patients better than most. Almost five years have passed since I was hospitalized for anorexia at the age of 24. Fortunately, I had strong family support and a specialized psychological team to make me healthy again in just under a year. But a handful of my fellow patients were not so lucky.
Until well into the 50s and 60s, many had fought our shared illness for decades and had fallen ill at a time when few effective treatments were available. They dragged on and flew under the radar of health workers until an inevitable relapse landed them in the hospital. Without the hope of a different way of life, they gave up trying – just like the doctors who were used to care for them.
Although I deliberately erased most of my psychiatric treatment from my memory, the faces of those women have always kept up with me.
Why were they denied the crucial treatment that saved me?
Financing for teenagers, not for adults
The recommended treatment for eating disorders involves a triple approach.
A psychiatrist performs an initial assessment and prescribes anxiety disorders if necessary.
A specialized dietitian devises a meal plan to help patients gain or maintain weight, and between 20 and 40 sessions of talk therapy such as cognitive behavioral therapy are given.
Underweight patients – with a body mass index of less than 18 – have regular medical checks, such as blood, heart and bone health tests.
Studies show that patients who have access to this treatment plan within the first three years after meals have a 60 percent chance of sustained recovery.
The most common eating disorder does not affect your weight …
Eating disorders affect around 1.25 million Britons, the most recognizable being anorexia, bulimia and binge eating.
Anorexia is characterized by restrictive eating and obsessive thoughts about food and body weight, making people underweight. But it accounts for only ten percent of all eating disorders.
Bulimia, which includes both binge eating and & # 39; purification & # 39; of food with excessive exercise, self-induced vomiting or laxatives, affects 40 percent of all people with eating disorders.
Often those with bulimia maintain a healthy weight, which means that the disease often goes unnoticed. The most common is & # 39; Eating Disorder not otherwise stated & # 39 ;, accounting for half of all eating disorders.
This includes conditions such as binge eating disorder, nocturnal eating syndrome and purification disorder.
Weight loss is not a given for these serious mental illnesses, but the health consequences – both physical and mental – can be great.
Patients with bulimia and binge eating disorder run an increased risk of sudden cardiac arrest, stroke, bone disease, muscle spasm, kidney failure and reproductive problems.
After three years this drops to 30 percent. Of those who remain sick for around ten years, only one in five will recover.
But this intensive plan has only developed over the past five to ten years. Many older adults received ineffective treatment, or none at all. & # 39; This group of patients is being neglected & # 39 ;, says Prof Treasure. & # 39; Most did not have access to treatment when they first fell ill, or it did not work, and it left them sick for a long time.
& # 39; The government focuses on early intervention for young people because it believes that this will reduce overall costs. But treating this older group will lower costs. It will avoid the repeated hospital admissions that many eventually need. & # 39;
The government's recent financial incentive for eating disorder services proves the goal of Prof. dr. Treasure. In 2014, eating disorder services for young people received £ 150 million in additional funding. This paved the way for new psychological treatments, all very effective for children and teenagers. No additional financing for adults has been provided.
Subsequently, in 2016, the government introduced waiting time targets for children and young people. All patients under the age of 18 must now see a specialist in eating disorders within one month of a GP referral. In urgent cases this is reduced to a week.
Such goals do not exist for adults.
By the time they reach the top of the waiting list, neurological changes caused by prolonged hunger mean that their disease is much harder to treat.
& # 39; We are confronted with a whole group of patients who ask: & # 39; What about us? & # 39; & # 39 ;, said Andrew Radford, head of the UK charitable organization for eating disorders, Beat.
& # 39; Older adults call our guides because they have failed because of the service. They need a more challenging treatment and the financing of the government must explain that. & # 39;
The charity campaigning for adult eating disorder services had to be addressed in the government's last ten-year plan, which was unveiled in January. But it didn't mention the problem.
Long term, it's very hard to kick
Anorexia is characterized by maintaining a low weight. The same applies to many of those with bulimia. But the effects of this prolonged hunger on the brain can be catastrophic.
Studies of malnourished men conducted in the 1940s showed that the longer participants were starving, the greater their obsession with maintaining low body weight.
Only when the skeletal subjects were fed with violence and the weight was restored, did their preoccupation diminish with limitations. In other words, if you are very thin, you want to eat less. Scientists think this happens because hunger disrupts the areas of the brain involved in appetite and eating, while overloading those responsible for punishment and reward.
Brain image studies also show reduced activation in brain areas associated with memory, learning and emotions. This cascade of cognitive damage influences the ability not only to arrive but also to fully enter therapy.
And that is not to mention the destructive effects on the body. Long-term, eating disorder patients are at risk of fractures and osteoporosis, gum disease, infertility, stroke, diabetes, sudden heart attack and early death.
Anientxia, who was diagnosed at the age of 12, has seen her fair share of haphazard treatment. She says: & I spent most of my adolescence in psychiatric departments, with a tube and reluctant without psychological help. As soon as I turned 18, I was no longer considered a child, so I was fired without support. & # 39;
The teenager from Edinburgh did a year & # 39; OK & # 39 ;, studied part-time at a college and studied a handful of GCSE & # 39; s.
& # 39; But then I was institutionalized and stuck in my distorted eating habits, & # 39; she says.
She soon developed a diet pill addiction and stopped eating solid food. Her weight plummeted to a dangerously low level and landed her back in a London hospital. & # 39; The consultant said as long as I could get my weight safe enough to keep me out of the hospital, that was enough. That was as good as it would be. I felt completely given up. & # 39;
Three months later, when she had achieved a BMI of only 15, she was fired. Only at the age of 27, after a new relapse, did she get a & # 39; good & # 39; psychotherapy course. But at this point Ellen was locked up in her & # 39; rigid ways of thinking & # 39 ;.
She says: & # 39; The therapy could not reverse twenty years of illness. & # 39;
Recent intriguing research can explain Ellen's self-destructive thinking patterns. In 2015, Columbia University psychiatrists performed brain scans on 21 anorexia patients and 21 healthy women who made decisions about food.
While healthy women showed moderate activation in brain areas associated with reward – the ventral striatum – the anorexia women showed high-level activation in an unusual area, the dorsal striatum.
This part of the brain is involved in normal thoughts and behaviors, such as biting your nails.
This suggests that anorexia food choices are automatic and based on past experiences, as opposed to weighing pros and cons or seeking pleasure. Study author professor Timothy Walsh concluded that the longer the disease rages on, the greater the role of the dorsal striatum in food decisions.
A sign of hope that contains no weight gain
Angela and Ellen are now reluctant to participate in the intensive treatment for teenagers. Not surprisingly, the focus on weight gain turns them off. So what should be done for these patients?
Prof Treasure has a possible solution and it does not necessarily mean gaining weight. Her team is testing a program in a small group of elderly patients that focuses on practical improvements, not the number on the scales.
& # 39; By enabling patients to achieve practical goals, their attention shifts to connections with other people. Their habits are coming loose, & says Prof Treasure.
During weekly sessions with a mental health nurse or a psychologist, patients plan small, tangible goals to reintegrate them into social groups – for example, a meal with friends. As a by-product, there will be weight gain.
Prof Treasure says: & # 39; We have improved recovery speed and reduced hospital admissions. & # 39; She adds: & # 39; Although the initial results of this approach are promising, the team will have to wait two to three years for a full result. & # 39;
Angela has been registered with the intervention for the past 18 months and maintains her current weight. Her psychologist, Caroline Norton, is enthusiastic about her progress. She says: & # 39; When I met Angela, she was barely able to leave the house. This year she went to the bachelor party of her daughter-in-law for the weekend and also ate out. It is a huge achievement. & # 39;
Giving priority to weight gain can be harmful, says Norton.
& # 39; Many simply refuse to arrive. If everything you've known for 40 years is anorexia, what is left? They cling to it because it is the only life they know. We must improve the quality of life as well as possible. Maybe they want to go to town to drink coffee or go on vacation. We can help them with that.
& # 39; But the NHS cannot graph these successes in the same way as you can with weight gain, so they are not considered valuable. How do you quantify a meal or the first bus ride in 20 years? It is much harder to prove success. & # 39;
I was always convinced that the goal of every eating disorder patient should be a complete and sustainable recovery. Weight gain and all that. I was wrong. My case was typical and easy to deal with. Unfortunately, the same cannot be said for thousands of others.
& # 39; The fact is that some people will die from the disease. Even with the best help, some people don't get better, & Caroline says.
As long as science does not discover a cure, we can do the least to make life worthwhile. As Angela says: & # 39; I never thought I could leave and eat out this weekend. But Caroline believed I could do it. I had one of the best weekends of my life. & # 39;
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