When I heard about the death of former Deputy Prime Minister John Prescott last week, the news instantly triggered a memory of him.
However, unlike many others, I wasn’t thinking about his two Jags or the time he punched a protester.
Instead, I recalled how he had revealed he had suffered from an eating disorder for many years. In his 2008 autobiography, Pulling No Punches, he admitted that in the 1980s he had succumbed to bulimia as a way of coping with the stress of serving in Labour’s then shadow cabinet.
He wrote of the shame and embarrassment he felt as a man suffering from an eating disorder widely perceived to be a ‘woman’s disease’.
Fearing that he would be considered unstable and too much of a risk to be a minister, he hid his problem.
Despite his bravery in going public with his battles, his revelation was met with confusion and even ridicule. How could a middle-aged man have what was then perceived as a teenage girl’s disease? And how come he was overweight? It showed how much misunderstanding there was around eating disorders. That was 16 years ago, and I’m not sure much has changed.
I used to run an eating disorder clinic and oversaw a treatment group for patients with bulimia and have, over the years, seen thousands of patients with this condition. During this time, one of the most hearbreaking things I learned is that most patients with bulimia wait over ten years before seeking help. This is because, like Lord Prescott, they feel a mixture of shame, guilt and embarrassment.
Many people with eating disorders have crushingly low self-esteem and self-worth, which makes them feel they are underserving and unworthy of help. It can also take some bulimics a long time to recognise that they have the condition in the first place. As strange as it sounds, bulimia often creeps up on them and becomes a normal part of their life. It’s often not until someone mentions it that they realise their behaviour is dangerous and an expression of mental illness.
Bulimia is a cycle of behaviour which has three core components. The first is bingeing. This often develops as a way of coping with extreme stress, or distress, or regulating emotions. People can consume vast amounts – several thousand calories – in one sitting. While bingeing the person might momentarily feel better as they feel emotional release.
John Prescott, pictured in 2008, wrote about his bulimia in his autobiography Pulling No Punches
A bulimic will then, typically, be overcome with feelings of shame and disgust which leads to the second part – purging.
They will typically make themselves vomit to get rid of the food they have eaten. Depending on the length of the binge and the amount eaten, some of the food will be absorbed, explaining why some bulimics are overweight.
The final component is that they will then punish themselves by restricing their food intake by either eating very little or nothing at all. The food deprivation results in low blood sugar levels and often, by the next day, they are so hungry that it triggers a binge and the whole awful cycle starts all over again.
Bulimia carries very serious physical health consequences, such as causing potentially deadly changes to the chemicals in the body including things like low potassium and damage to the digestive tract, throat and teeth. It is also very dangerous from a psychological perspective when sufferers fail to develop strategies for dealing with the problems in their life that led to the bingeing.
Most people will be aware of the type of bulimia I have just outlined. But there’s a second type that is more insidious and harder to spot – sufferers often don’t believe that it’s an eating disorder, at least not to start with. This is called ‘non-purging subtype’ and involves not vomiting but doing something else in order to cancel out the food they have binged. They might over exercise or obsessively calorie count, for example, in place of purging.
With over exercising, people convince themselves that they are healthy. They are often stunned when you explain they have a type of bulimia. The problems often don’t come to a doctor’s attention until for some reason the person cannot perform the compensatory ‘punishment’ behaviour.
Over the years I saw quite a few patients who were in running or cycling clubs but, as they had aged, had picked up injuries which meant they could no longer exercise as much as they did to compensate for their binges. This caused them distress on a level that is hard to describe. Beside themselves with anxiety, several attempted suicide.
I also saw quite a few younger men who, on the surface, looked healthy and buff. However, when something triggered them they’d spiral out of control and binge on what they considered ‘unhealthy’ food such as crisps, cake, biscuits and chocolate.
They’d then atone by commmiting to punishing workouts that burned off all the extra calories they’d consumed.
It was truly horrifying to listen to some of the stories. One man only sought help after he collapsed at the gym because he’d been on the running machine for six hours and worried staff had to ban him from using it.
The good news for people with bulimia, regardless of what type it is, is that specialist treatment has very good outcomes.
Seeing people who had been tormented by bulimia get better with psychotherapy was one of the reasons I loved working in the eating disorder field.
It’s important for those with eating disorders to understand that they have nothing to feel ashamed or embarrassed about – they are ill and deserve our sympathy, support and help.
Zoe’s right to put family first
Zoe Ball is stepping down from hosting the BBC Radio 2 breakfast show
Zoe Ball has announced she is quitting her Radio 2 show so that she can spend more time with her family. Many have been quick to point out that her son is 23 and daughter, 14. Surely they don’t need Mum around? I beg to differ.
Her daughter, in particular, is at a very crucial age. Yes, most 14-year-olds don’t want their mum hanging around, cramping their style. But anyone who knows teenagers will know they exist in that strange in-between age, oscillating between being adult and childlike.
There are times when they can seem very young and need Mum or Dad around for support or a cuddle. Teenagers, as they take their tentative steps out into the world, need to know someone is still there, looking out for them. Even if they pretend they don’t.
Cambridge Dictionary have named ‘manifest’ as their word of the year. This term refers to the idea that you can make something happen by simply wanting it badly enough, a Gen Z trend that is huge on social media.
It is, of course, utterly unscientific. An example of what psychologists call ‘magical thinking’ – the belief that wishing for something or performing a ritual will make it happen.
The reason I loathe the idea of manifesting is that it encourages people to be passive participants in their own lives. It denies any sense of agency and control in what happens to you, nothing more than blowing out the candles and making a wish.
Yet we have so much control over the direction of our lives and obtaining what we want in life. Rather hoping against hope you get what you want, get out and do something. Get a qualification, network, educate yourself, volunteer, get experience.
Yes, much harder than manifesting, but also much more likely to work.
Health Secretary Wes Streeting has announed a review into the deployment of 3,500 Physician Associates (or assistants as they should be called) currently working in the NHS. I hope he will stipulate that PAs must flag up to patients that they are not doctors and therefore have professional limitations.
Feel Better Live More
A patient recommended this podcast to me and I’m hooked!
Dr Rangan Chatterjee is a GP and approaches health – including mental health – from a thoughtful, compassionate and holistic stance and is full of practical advice, information and tips.
