When she desperately needed help for an eating disorder, Sophie James got a simple, yet terrifying answer: “Your BMI is not low enough to qualify for treatment.”
Losing weight rapidly on a hugely restrictive diet – 10 fish sticks at 16 calories each plus a biscuit if she felt faint – the 29 year old had just been handed the macabre incentive to eat even less.
Although blood tests and ECG heart rhythm tests pointed to a failing body, despite her despair she fell victim to a policy that can make it difficult for anyone not in the deepest clutches of anorexia, bulimia and other eating disorders to get help.
“I felt completely invalidated and backed into a corner,” she says. “The only way I could access help was to make myself even sicker, so I made it my mission to lose more weight and get down to the required BMI.
“I was seeing a psychiatrist who was desperately worried about me and told me she was two weeks away from sectioning me to a mental health ward.”
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Sophie finally reached a BMI of 16.5 – the ideal for a woman in the UK is up to 24.9. “I remember just lying on the floor thinking I had done it – I had finally made myself ill enough,” she says. “Jon was at work and I stayed like that with our dog Blue for eight hours because I didn’t have the strength or energy to move as I was so malnourished.”
Forcing herself into this perilous state meant she could finally access regular appointments with specialist clinical and counselling staff at an NHS eating disorders clinic.
This regular support has stabilised her condition but she fears her experiences mirror those of thousands of women struggling with body image and weight.
The pressures on poorly resourced NHS units serving an estimated 1.25 million people with an eating disorder have intensified during the pandemic and the stresses on vulnerable people are about to rise as the loosening of restrictions is being accompanied by nationwide advertising blitzes for summer ‘beach bodies’.
Campaigner Hope Virgo, whose Dump the Scales campaign seeks to outlaw the practice of using BMI as an entry test for support services, believes thousands of women could be suffering similar struggles to Sophie.
“Over the last year we have seen a huge increase in people struggling with disordered eating and people coming forward to get support,” she says. “But there are tens of thousands who have not come forward but have felt stuck, suffering shame, stigma and guilt.”
Sophie’s struggles with diet and body image started in her teens when she gained weight after leaving school and stopped the exercise she got from studying PE at GCSE.
“I’ve always been very self-conscious about the way I look,” she says.
“I had really bad acne from the age of 13 until about 24 and the first time I went on a diet was when I was 17. I did a bit of yo-yo dieting and then went to one of those slimming groups which made me thoroughly miserable.
“Going once a week and justifying to a group of strangers what was on the scales was terrible. If you didn’t turn up for class you got a text message. It felt like pressure to me.”
Sophie, who is from the West Midlands, wrestled with dieting and, despite its stresses, has a good job
and is happily married to Jon, 30.
But the fragile nature of her relationship with food and her body was exposed in the first lockdown last March.
“I’m a bit of a control freak and started to wonder ‘what can I control in my life now?’. With all those years of slimming groups, I thought I could control that number on the scale. It felt perfect.
“I started with wanting to lose just a few pounds and restricted my calorie intake and the pounds started to drop off. I thought it was amazing but with every weight drop I thought I could get even lower. I exercised more, restricted more and made myself sick. I used laxatives, walked, ran, did star jumps on the spot – anything to burn calories.
“I worked out that I could survive on around 10 per cent of my daily calorie requirement. There were times I blacked out and times when I should not have been driving.”
Sophie went from size 10 down to such an emaciated state she could no longer make adult clothes fit. But she managed to keep her plummeting weight a secret from friends and family by only showing her face on calls and virtual meetings.
“I was very secretive and deceptive,” she admits. “I went to my parents’ garden when the restrictions were lifted last summer and they said, ‘Oh my God, what is going on with you?’
“They would not let me leave until I told them and I just broke down.”
Sophie was persuaded to see her GP who referred her to the mental health team and she was diagnosed with an eating disorder.
“I knew something was wrong but we thought that if we caught it early enough, I could turn things around. I was referred to an eating disorder service but they couldn’t see me for four months and when I phoned the clinic begging for a space, I was told my BMI wasn’t low enough,” says Sophie.
While this is shocking, it is far from unusual. “Unfortunately, it is not uncommon that patients are excluded from chronically underfunded services based on their BMI,” says Dr Agnes Ayton, chairwoman of the Eating Disorders faculty at the Royal College of Psychiatrists.
“BMI is not an appropriate measure for patients with eating disorders trying to access services, it’s simply a way to monitor the physical risks of this mental illness.”
This puts desperate patients in a life-threatening position to reduce more weight in order to drop below the threshold to gain help.
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“Eating disorders have the highest mortality of all mental illnesses but services just don’t have the means to provide the right treatment for adult patients. Increased funding for specialist services is needed to meet NHS guidance,” adds Dr Ayton.
Research has shown that GPs receive just two hours training in this area and that recent funding support is subject to a postcode lottery, although the Government now says it is investing in community eating disorder services and transforming mental health services with £2.3billion extra funding being provided by 2023/24.
That comes too late for Sophie. “My health and mind just deteriorated over the next four months. I couldn’t stop it even though I knew it was damaging me. Every time something went wrong and I got another health complication I thought it was a step closer to getting help. It is a very dangerous way to go.
“I shudder to think what could have happened to me and I know I’m not alone. Eating disorder services are poorly resourced and so many people are vulnerable because there is so much pressure to be slim.
“You go into a supermarket now and the seasonal aisles are full of promotions for slimming drinks, protein bars and products to get your ‘summer body’. Most people won’t give it a second thought but for so many it could trigger or exacerbate an eating disorder.”
Sophie now has twice-weekly appointments at an eating disorder clinic and her weight has stabilised. With the help of Jon, family and friends, she is building a better relationship with food and calories.
“It has been horribly tough and I’ve caused myself and those closest to me such heartache,” she says. “But I am in a good place now and, with help, others can do the same. I just want to see better services that are more accessible to people when they need it most.”