Inside the Mind of an Eating Disorder Doctor
We had the privilege of sitting down with Dr Chuks, an eating disorder doctor in London to pick his brain about what he's learned and what he'd like to share with our community. We hope you'll find it insightful - we sure did!
What are the top 3 misconceptions you'd like to put right about those who suffer with eating disorders?
Ooo, great question! And interestingly, one I'm frequently asked. I'm always really encouraged when I get asked this because it means that those asking it are aware that lots of misconceptions exist about eating disorders!
There are lots. There really are. Lots of misconceptions around how to define an eating disorder, lots around the race, age and gender you have to be to have one, and many more.
I'm not sure about the top 3, but one of the main misconceptions that I think is important to talk about is the one which says that eating disorders are a choice. That the sufferer—at some stage—had the luxury of choice, and that at any point they have the ability to "just snap out of it" if they so wish (as someone described it to me once). This is not true—although it can sometimes appear that way to those observing such an individual. Through frustration, there may be the desire to tell the person to "just eat!" (again, as someone described it to me once). However, there are deeper mechanisms for such an insidious illness which often needs multidisciplinary support.
The next misconception is that eating disorders are not serious. The opposite is true! Anorexia nervosa for example—one of the many eating disorders—claims more lives than any other mental health condition. And, working as an inpatient doctor in eating disorders, I see the extent of ill health caused by eating disorders. This being said, even outside of highly-specialised eating disorder units, there are many people suffering in the community. Many in silence. Many eager to access services but some unable to because services are packed and buckling under the sheer demand. No, eating disorders are incredibly serious and it's important for us to treat them as such.
Lastly, there are misconceptions over how old people are when they're first diagnosed with an eating disorder. Many people don’t realise that the most common age of onset of an eating disorder is between 12 and 25. There are many who are diagnosed even before they've hit double figures! In general, there needs to be more awareness about how early an eating disorder can set in. This is so we can be more proactive—rather than reactive—in our care. Essentially, a focus on prevention rather than cure.
What are 3 things you've learned in your work?
Gosh, I've learnt so much! It's a job of non-stop learning. Every day there seems to be something, it really is remarkable. I think it's because every patient is so different.
Firstly, one of the things I've learnt is the importance of a good, well-informed support network—both for patients and staff! This might look different for different people. From a patient-perspective, recovery can be very challenging, and having those around you who are able to offer much-needed encouragement and accountability increases the likelihood of a positive outcome. And of course, from a staff point of view, working in mental health can be very taxing. Very emotionally demanding, and so it's essential to be able to properly reflect, offload and process. A support network can often provide an avenue for this.
Secondly, I've learnt afresh the sheer extent to which the body and mind are interlinked. Often in medicine, we have a tendency to treat the mind and body as individual entities—as mutually exclusive. We have mental health hospitals and we have general medical ones. With eating disorders, we can plainly see the link between malnutrition (which we typically think of as being an outcome of the body) and mental state (which we typically think of as being an outcome of the mind). It's fascinating. What is even more remarkable is how noticeable one's mental state can improve with treatment!
Thirdly, I've learnt that hope is never lost! Contrary to what people may see, hear or think, despite having an eating disorder for many years, there is still a chance of partial—or even full—recovery.
What are 3 things that you'd love people to know about eating disorders?
OK, this is going to be a hard one. Because there are about a million things that I'd like people to know!
But, an important point is that there can be a lot of shame attached to an eating disorder. And as a result, it can be very socially isolating. I want people to know that they don't need to suffer in silence. It's so, so, so important to reach out for help. This could come in various forms. It could mean reaching out to a friend or a family member; it could mean contacting a charity for advice; or it could even mean paying your GP a visit. Whatever it is, it's important to raise the alarm.
Another important point to mention is that there are many different types of eating disorders. For many reasons, whenever people think of eating disorders, they tend to think of anorexia nervosa and bulimia nervosa. But there are many more! Including the most common of them all—binge eating disorder—and ARFID (avoidant and restrictive intake disorder). We have got to talk about these more. It's so important that when we think about eating disorders, that we think widely. This is particularly important when it comes to the early diagnosis of an eating disorder and the subsequent intervention strategies.
And I guess lastly, given the times we're in, it would be important to mention the impact that the COVID-19 pandemic has had on those with eating disorders. To put it bluntly, it was the perfect storm. It created the "perfect" conditions for an eating disorder to thrive. So, what did the outcomes of that look like? Well, many in the community relapsed. The already overwhelmed eating disorders services nationally reached breaking point. And those of us in the field really felt it. Referrals lists were off-the-scale. I share this not to bring down spirits, but just as a reminder to everyone to support the NHS and its affiliated organisations. To back the mental health services. Because mental health is crucial to us all, and lives are being positively impacted by the work of those in the services.
Dr Chukwuemeka “Chuks” Nwuba works as an eating disorders doctor in London. He was voted on the list of Powerful Media’s Top 10 Black Future Leaders 2017-18. He is a member of the Association of Black Psychiatrists.