04 August 2016

Why Some with a Food Addiction Are Being Refused Outpatient Care

Addiction comes in many forms; there are the typical substance addictions that most people think of when they hear the word ‘addiction’, including alcohol and drug addiction, and then there are the compulsive behaviour disorders such as gambling, shopping, and sex addiction. However, addiction appears to be an illness that is growing, and every day, more and more people are being affected by many different kinds of illnesses that are all grouped under the heading of addiction. In fact, eating disorders such as anorexia and bulimia are a type of addiction; they are classed as a food addiction.

Who is Affected by a Food Addiction

Most people think of young teenage girls when they hear the word food addiction or eating disorder. While the majority of those with a food addiction are indeed young girls, it is an illness that can affect anyone, regardless of age, gender and background. And one does not have to be painfully thin to be anorexic.

In many cases, those who are overweight will decide to restrict their calorie intake in order to change their body image. To the outside world, they could never be classed as anorexic as they are overweight, but they have already started to display symptoms of the illness.

Early intervention is often cited as crucial in the treatment of food addiction, but as Eliza Small discovered, it’s hard to be referred for treatment if you are perceived to be ‘too heavy’.

History of Addiction

Eliza had a family history of eating disorders, meaning she was already at risk of developing one herself. When she did, in fact, start restricting her food intake, she was referred for specialist treatment. Nevertheless, because at the time her BMI (body mass index) was considered high, she was refused outpatient treatment for her disorder.

She said, ”It made me feel like I wasn’t good enough at my eating disorder. It made me feel like I would have to get better at it.”

Unfortunately, that is exactly what she did. She continued to display symptoms of anorexia; thankfully, a family member paid for private treatment. She was then diagnosed with atypical anorexia, which is a type of food addiction or eating disorder.

Too Heavy

As mentioned, Eliza was deemed too heavy to be classed as an anorexic, but Professor Tim Kendall believes this is wrong. It is his opinion that weight should not play a part when diagnosing a person with an eating disorder such as anorexia. He said, “If you leave an eating disorder until it’s got to the point where, say with anorexia, they’ve lost say a third of their body weight, that has a lot of longer-term consequences which make it very difficult to treat, so it’s wrong in my view to leave this until it’s got very bad.”

He believes that telling a person that they are not thin enough to be diagnosed with anorexia is akin to telling them to lose more weight, which will ultimately encourage the affected person to carry on with their compulsive behaviour. He added, “It’s like someone going to their GP and being told – you drink one bottle of whisky a day right now? Come back when you drink two.”

Unreliable Measure

Professor Kendall, who is the most senior mental health adviser in England, believes that when it comes to eating disorders and food addiction, ‘patient choice is important’. He does not believe that patients should be forced to accept hospital treatment, except in extreme circumstances.

In a survey of mental health trusts across England and Wales, a third of the forty-four who responded said that they use BMI when deciding eligibility for outpatient services. This is despite the fact that guidelines from NICE (National Institute for Health and Care Excellence) say that BMI is an unreliable measure of an eating disorder when used by itself.

Most of the mental health trusts stated that BMI was used in conjunction with other criteria, although four did admit to using BMI as a primary indicator. Some trusts refuse treatment services to patients that have a BMI of more than fourteen. Others accept patients with a BMI of more than 17.5.

Minimum Eligibility Criteria

As well as being too heavy to be accepted into outpatient care for a food addiction, some patients are being turned away for having a BMI that is too low. One patient, Claire, was weighed when she arrived and was told that she could not access outpatient care because her BMI was not high enough. She was told she would have to be admitted to hospital, which she did not want. She had been unhappy with a previous stay in hospital and did not want to return. She said, “Everyone’s eating-disorder experience is completely different; you can’t put everybody in the same box – you have to listen to the person, to how they are feeling.”

Unfortunately, it seems as though BMI will continue to be used as a measure for determining who is eligible for outpatient treatment for eating disorders for the time being. According to Sarah Hodge from Kent and Medway Partnership Trust, it is all to do with a lack of resources. She said, ”You can have much more success when people have a higher BMI; they’re much better able to engage with the therapy. But we just don’t have the resources.”


  1. Food Addiction and Eatign Disorders: Patients with ‘wrong weight’ refused care

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