DR. MAX PEMBERTON: I have treated THOUSANDS of patients with bulimia – and like John Prescott, many suffered from terrible shame. But there’s another form of bulimia that YOU could have without even realizing it…
When I heard about the death of former Deputy Prime Minister John Prescott last week, the news immediately brought back memories of him.
But unlike many others, I wasn’t thinking about his two Jags or the time he punched a protester.
Instead, I remembered how he had revealed that he had been suffering from an eating disorder for years. In his 2008 autobiography Pulling No Punches, he admitted to succumbing to bulimia in the 1980s as a way to cope with the stress of serving in Labour’s then shadow cabinet.
He wrote about the shame and embarrassment he felt as a man suffering from an eating disorder that was widely seen as a “women’s disease.”
Fearing that he would be seen as unstable and too much of a risk to be a minister, he hid his problem.
Despite his courage in making his battles public, his revelation was met with confusion and even ridicule. How could a middle-aged man develop a disease that was considered a teenage girl’s disease at the time? 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 supervised a treatment group for patients with bulimia. Over the years I have seen thousands of patients with this condition. One of the most shocking things I learned during this time is that most patients with bulimia wait more than a decade before seeking help. This is because, like Lord Prescott, they feel a mixture of shame, guilt and shame.
Many people with eating disorders have crushingly low self-esteem and self-worth, leaving them feeling under-paid and unworthy of help. It can also take some bulimic patients a long time to recognize that they have the condition in the first place. As strange as it sounds, bulimia often sneaks up on them and becomes a normal part of their lives. Often only when someone says it does he realize that his behavior is dangerous and an expression of a mental illness.
Bulimia is a behavioral cycle consisting of three core components. The first is binge eating. This often develops as a way to cope with extreme stress or anxiety, or to regulate emotions. People can consume enormous amounts – several thousand calories – in one sitting. During binge eating, the person may temporarily feel better because he/she experiences emotional release.
John Prescott, pictured in 2008, wrote about his bulimia in his autobiography Pulling No Punches
A bulimia patient is then usually overcome by feelings of shame and disgust, which leads to the second part: purification.
They usually make themselves vomit to get rid of the food they have eaten. Depending on the duration of the binge and the amount eaten, some of the food will be absorbed, which explains why some bulimics are overweight.
The final part is that they will then punish themselves by limiting their food intake by eating very little or nothing at all. The lack of food results in low blood sugar and often they are so hungry the next day that it triggers a binge and the whole horrible cycle starts again.
Bulimia has very serious physical health consequences, such as causing potentially fatal changes in the chemicals in the body, including things like low potassium and damage to the digestive tract, throat and teeth. From a psychological perspective, it is also very dangerous when patients fail to develop strategies for dealing with the problems in their lives that led to the binge eating.
Most people will be aware of the type of bulimia I just outlined. But there’s a second type that’s more insidious and harder to spot: Patients often don’t believe it’s an eating disorder, at least not to begin with. This is called the ‘non-purging subtype’ and involves no vomiting, but something else being done to cancel out the food they have eaten. For example, they may overexercise or obsessively count calories instead of purging.
By exercising too much, people convince themselves that they are healthy. They are often baffled when you explain that they have a form of bulimia. The problems often do not come to a doctor’s attention until the person is unable to perform the compensatory “punishment” behavior for some reason.
Over the years I have seen quite a few patients who were members of running or cycling clubs, but as they got older, they had suffered injuries that prevented them from exercising as much as they could to compensate for their binge eating. This caused them suffering on a level that is difficult to describe. Bewildered with fear, several attempted suicide.
I also saw quite a few younger men who at first glance looked healthy and pale. However, when something triggered them, they would spiral out of control and indulge in what they considered ‘unhealthy’ foods such as chips, cake, cookies and chocolate.
They would then pay by committing to punishing workouts that burned off all the extra calories they consumed.
It was really horrible to listen to some of the stories. One man only sought help after collapsing in the gym because he had already been on the running machine for six hours and concerned staff had to ban him from using it.
The good news for people with bulimia, regardless of the type, is that specialist treatment produces very good results.
Seeing people tormented by bulimia improve through psychotherapy was one of the reasons I enjoyed working in the eating disorder field.
It is important that people with eating disorders understand that they have nothing to be ashamed of; they are sick and deserve our sympathy, support and help.
Zoe is right to put family first
Zoe Ball is quitting as host of BBC Radio 2’s breakfast show
Zoe Ball has announced she is quitting her Radio 2 show so she can spend more time with her family. Many have been quick to point out that her son is 23 and daughter is 14. Surely they don’t need mommy? I beg to differ.
Her daughter in particular is at a very crucial age. Yes, most 14 year olds don’t want their mom hanging around and hindering their style. But anyone who knows teenagers knows that they exist in that strange in-between phase, torn between adult and childish.
There are times when they may seem very young and need mom or dad for support or cuddles. As they take their tentative steps into the world, teens need to know that someone else is watching out for them. Even if they pretend it isn’t.
Cambridge Dictionary has named ‘manifesto’ its word of the year. This term refers to the idea that you can make something happen simply by wanting it bad enough, a Gen Z trend that is huge on social media.
It is, of course, completely 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 despise 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 over 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 getting what we want in life. Rather hope against hope that you get what you want, go out and do something. Get a qualification, network, develop yourself, volunteer, gain experience.
Yes, much harder than manifesting, but it’s also much more likely to work.
Health Minister Wes Streeting has announced an investigation into the use of 3,500 Physician Associates (or assistants as they should be called) currently working in the NHS. I hope he will rule that PAs must make it clear to patients that they are not physicians and therefore have professional limitations.
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Dr. Rangan Chatterjee is a GP who approaches health – including mental health – from a thoughtful, compassionate and holistic attitude and is packed with practical advice, information and tips.
