Supporting Young People with Eating Difficulties

 
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Hampshire Specialist Eating
Disorder Team
What are Eating Disorders?
Eating disorders are serious mental illnesses
affecting people of all ages, genders, ethnicities and
backgrounds. People with eating disorders may feel
their eating difficulties are their way to cope with
difficult situations or feelings.
This behaviour can include limiting the amount of
food eaten, eating very large quantities of food at
once, getting rid of food eaten through unhealthy
means such as making themselves sick; using
laxatives; fasting or excessive exercise or
combination of these behaviours.
 
Some stats and facts
What to look for; some signs and symptoms
Next steps
Top tips on how to support a young person
Some quick Q&A
 
 
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1.6 million people in the UK are estimated to be directly affected by eating
disorders (11% male)
14-25 year olds are most affected by an eating disorder
AN ave age onset 16-17years
Ave duration of illness 7years
Approx 45% fully recover,  33% improve, 20% chronic
20% of AN die prematurely
   (physical health compromise/ suicide)
Types of Eating Disorder
Anorexia Nervosa
Orthorexia
Bulimia Nervosa
Binge Eating Disorder
OSFED- (Other Specified Feeding or Eating
Disorder)
ARFID- ( Avoidant/Restrictive Food Intake
Disorder)
 
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Symptoms and Signs- 
Psychological:
 
-preoccupation with body image, food, dieting, exercise
 
-fear of gaining weight
 
-change in mood (may be happier initially), personality change, other mental
health issues e.g. anxiety/ irritability/obsessional behaviours
 
-high interest in food preparation, calorific information of different foods
 
-poor concentration
Symptoms and Signs- 
Physical:
 
-
weight loss or lack of expected weight gain
 
-fainting or dizziness
 
-loss of energy, coldness, weakness
 
-poor sleep
 
-amenorrhoea
 
-constipation
 
-hair thinning, lanugo hair, callouses on hands
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Symptoms and Signs- 
Behavioural:
 
-
change in eating habits, secretive, hiding food, avoidance of certain foods
 
-increased exercise
 
-vomiting, use of laxatives/appetite suppressants/diuretics; often going to the
toilet
 
-school and social functioning altered
 
-wearing baggy clothes
 
-obsessional behaviours
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Speak to the school/ college/ any other agency involved in
supporting/ looking after your young person
Speak to your young person
See GP
 
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.
 
Are you concerned about your weight? Have you lost weight?
Are you trying to lose weight? What is your ideal weight?
Have you cut down on the amount you are eating? What is your typical
day’s food and fluid intake?
Are there any foods you avoid?
How much exercise do you do?
Have you tried anything else to lose weight? (laxatives, diuretics, appetite
suppressants, vomiting)
Any physical symptoms? Loss of periods?
Any self harm or thoughts of self harm or suicide?
 
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Get as much support as possible (both personal and professional)
Take things one day at a time
Try to stay calm
Be consistent, clear and boundaried in expectations
Take more active responsibility in mealtimes (e.g., menu planning, meal
preparation, serving of food)
No diet/ low fat/ fat free foods
Eat as a family where possible
Model appropriate eating behaviour (avoid dieting)
Plan non-problem focused talk
Distraction activities post meals
Try to find motivators with your young person
T
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Carer Reactions
Carer Emotions
 
https://www.bbc.co.uk/bbcthree/clip/31b6bfb9-9d64-4445-9690-c633b727cf89
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It’s not anyone’s fault; nobody has caused the eating disorder
It is an illness the same as any other illness
You/ the family are the greatest resource in recovery
Physical health recovery occurs more quickly than
psychological recovery
Psychological recovery can take a long time
Health and happiness needs to be prioritised
Prevent hospitalisation/aid YP in returning to adolescents unencumbered
by ED
Assisting parents in aiding YP’s recovery
Two Treatment Trials-Maudsley
Two Thirds recovered by end of FBT
     75%-90%-fully recovered on five year follow up
Psychological improvement
American studies showing similar results
Maudsley discharge data
First line intervention in  revised NICE 2017
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Referrals must be made by GP – Why???
Current physical health information is vital to ensure timely assessment
Knowing a physical weight is important but not the only factor – rate of weight loss, concerning
behaviours, other physical concerns
 
Weight for height (BMI)
Rate of weight loss
Pulse (awake)
Dizziness or postural drop in BP
BP < 2 centile (systolic 88-105 diastolic 40-45)
Cool peripheries and capillary refill time
QTc interval on ECG <15 years 440-460, girls >15 450-460, boys >15 430-450
Fluid restriction / dehydration
Level of Food restriction
Bingeing
Biochemical abnormalities
Syncope (collapse)
Tachycardia / bradycardia
Temperature
R
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3 hubs across Hampshire
North: covers Basingstoke and Aldershot
South: covers New Forest, Winchester & Andover, Eastleigh
South East: covers Fareham, Gosport, Havant and Petersfield
 
Multi-disciplinary Team
Nurses
Medics
Systemic Therapists
Psychologists
Occupational Therapists
Support Workers
 
 
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RESOURCES
 
https://www.beateatingdisorders.org.uk/
 
Janet Treasure
 
https://www.feast-ed.org/
 
Eva Musby – YouTube and book
 
https://hampshirecamhs.nhs.uk/
 
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Learn how to provide effective support for young individuals facing eating challenges. Insights from Hampshire Specialist Eating Disorder Team.


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  1. PACE: How to Support a Young Person with an Eating Difficulty Hampshire Specialist Eating Disorder Team

  2. What are Eating Disorders? Eating disorders are serious mental illnesses affecting people of all ages, genders, ethnicities and backgrounds. People with eating disorders may feel their eating difficulties are their way to cope with difficult situations or feelings. This behaviour can include limiting the amount of food eaten, eating very large quantities of food at once, getting rid of food eaten through unhealthy means such as making themselves sick; using laxatives; fasting or excessive exercise or combination of these behaviours.

  3. Overview Some stats and facts What to look for; some signs and symptoms Next steps Top tips on how to support a young person Some quick Q&A

  4. What are Eating Disorders? 1.6 million people in the UK are estimated to be directly affected by eating disorders (11% male) 14-25 year olds are most affected by an eating disorder AN ave age onset 16-17years Ave duration of illness 7years Approx 45% fully recover, 33% improve, 20% chronic 20% of AN die prematurely (physical health compromise/ suicide)

  5. Types of Eating Disorder Anorexia Nervosa Orthorexia Bulimia Nervosa Binge Eating Disorder OSFED- (Other Specified Feeding or Eating Disorder) ARFID- ( Avoidant/Restrictive Food Intake Disorder)

  6. What to look out for Symptoms and Signs- Psychological: -preoccupation with body image, food, dieting, exercise -fear of gaining weight -change in mood (may be happier initially), personality change, other mental health issues e.g. anxiety/ irritability/obsessional behaviours -high interest in food preparation, calorific information of different foods -poor concentration

  7. What to look out for Symptoms and Signs- Physical: -weight loss or lack of expected weight gain -fainting or dizziness -loss of energy, coldness, weakness -poor sleep -amenorrhoea -constipation -hair thinning, lanugo hair, callouses on hands

  8. Identifying Eating Disorders Symptoms and Signs- Behavioural: -change in eating habits, secretive, hiding food, avoidance of certain foods -increased exercise -vomiting, use of laxatives/appetite suppressants/diuretics; often going to the toilet -school and social functioning altered -wearing baggy clothes -obsessional behaviours

  9. Next Steps Speak to the school/ college/ any other agency involved in supporting/ looking after your young person Speak to your young person See GP

  10. What to ask? Ideas ONLY You know your child and how best to approach however a calm, compassionate, curious and non judgemental approach can be beneficial. Are you concerned about your weight? Have you lost weight? Are you trying to lose weight? What is your ideal weight? Have you cut down on the amount you are eating? What is your typical day s food and fluid intake? Are there any foods you avoid? How much exercise do you do? Have you tried anything else to lose weight? (laxatives, diuretics, appetite suppressants, vomiting) Any physical symptoms? Loss of periods? Any self harm or thoughts of self harm or suicide?

  11. Top Tips Get as much support as possible (both personal and professional) Take things one day at a time Try to stay calm Be consistent, clear and boundaried in expectations Take more active responsibility in mealtimes (e.g., menu planning, meal preparation, serving of food) No diet/ low fat/ fat free foods Eat as a family where possible Model appropriate eating behaviour (avoid dieting) Plan non-problem focused talk Distraction activities post meals Try to find motivators with your young person

  12. Carer Reactions Carer Emotions

  13. Things not to say https://www.bbc.co.uk/bbcthree/clip/31b6bfb9-9d64-4445-9690-c633b727cf89

  14. Please remember It s not anyone s fault; nobody has caused the eating disorder It is an illness the same as any other illness You/ the family are the greatest resource in recovery Physical health recovery occurs more quickly than psychological recovery Psychological recovery can take a long time Health and happiness needs to be prioritised

  15. Family based intervention Prevent hospitalisation/aid YP in returning to adolescents unencumbered by ED Assisting parents in aiding YP s recovery Two Treatment Trials-Maudsley Two Thirds recovered by end of FBT 75%-90%-fully recovered on five year follow up Psychological improvement American studies showing similar results Maudsley discharge data First line intervention in revised NICE 2017

  16. Referrals Referrals must be made by GP Why??? Current physical health information is vital to ensure timely assessment Knowing a physical weight is important but not the only factor rate of weight loss, concerning behaviours, other physical concerns Weight for height (BMI) Rate of weight loss Pulse (awake) Dizziness or postural drop in BP BP < 2 centile (systolic 88-105 diastolic 40-45) Cool peripheries and capillary refill time QTc interval on ECG <15 years 440-460, girls >15 450-460, boys >15 430-450 Fluid restriction / dehydration Level of Food restriction Bingeing Biochemical abnormalities Syncope (collapse) Tachycardia / bradycardia Temperature

  17. Hampshire Eating Disorder team 3 hubs across Hampshire North: covers Basingstoke and Aldershot South: covers New Forest, Winchester & Andover, Eastleigh South East: covers Fareham, Gosport, Havant and Petersfield Multi-disciplinary Team Nurses Medics Systemic Therapists Psychologists Occupational Therapists Support Workers

  18. Hampshire Eating Disorder team The Access and Waiting Time Standard for Children and Young People with an Eating Disorder was published in 2015, and applies to children and young people up to the age of 19. The standard states that by 2020, 95% of those referred for assessment or treatment for an eating disorder should receive NICE-approved treatment within one week in urgent cases, and four weeks in routine/non-urgent cases. The ability of services to meet this standard has been monitored since 2016.

  19. Hampshire Eating Disorder team RESOURCES https://www.beateatingdisorders.org.uk/ Janet Treasure https://www.feast-ed.org/ Eva Musby YouTube and book https://hampshirecamhs.nhs.uk/

  20. Questions

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