The Guardian

Scrap use of BMI in decisions on eating disorder support – MPs | Eating disorders

The government’s approach to tackling lockdown-exacerbated eating disorders and negative body image is dangerous, MPs have said, as they called for action on edited images in advertising.

A report highlights the impact the pandemic has had on how people view their bodies and is critical of the growing numbers of women and men in England with eating disorders being denied support because they are not considered underweight enough to warrant it.

The report says the use of body mass index (BMI) – a measure applying height and weight to calculate a healthy weight score – to determine whether someone needs help with an eating disorder should be scrapped. A normal body weight is considered to be between 18.5 and 24.9 BMI.

The MPs consider that the government’s obesity strategy failed to “promote healthy behaviours” and could be “contributing to body-image pressures”. They add that advertising using edited images should be restricted or banned.

The report, published on Friday by the Commons women and equalities committee, found that lockdown had had a “devastating” impact on those with or at high risk of developing eating disorders and intensified body image anxieties.

It comes as concern has been raised about “a state of emergency” for eating disorders, in a briefing paper shared by a leading psychiatrist and campaigners. Hospital admissions have risen fourfold in the past year, without extra investment in specialist inpatient services during this time, it said.

Caroline Nokes, the Conservative chair of the committee, said that over the past decade there “has been a wealth of research and recommendations on how to tackle negative body image” but “government action in this area is limited”.

She said the use of BMI as a measure of healthy weight had become “a kind of proxy or justification for weight shaming”. She added: “This has to stop.”

A Guardian investigation heard from women who said they were denied help because their weight was not low enough. One said she was told by her doctor that her weight needed to drop to eight stone before she could seek help.

Nokes said: “We are particularly alarmed by the rise in eating disorders and concerned that the obesity strategy and data collection of obesity levels in kids make things worse by failing to promote healthy behaviours. The government must ensure its policies are not contributing to body-image pressures.

“Advertising and social media can cause negative body image if users are bombarded by ads which lack diverse representation. It’s paramount that people are protected from viewing consistently pressurising content online and that companies advertise their products responsibly.”

The committee heard evidence that the annual cost of dealing with eating disorders is £15bn, but just 96p is spent on research into eating disorders per person experiencing them. Its report says funding for research into eating disorders should match the £9-per-person research funding for people with mental health issues.

The MPs call for an urgent review into why eating disorder rates are rising for men, women, children, ethnic minorities and older people, and to develop policy interventions to reduce these rises. They also call for work to investigate the extent and impact of weight-based discrimination for people accessing NHS services, as well as an independent review of its obesity strategy to ensure its policies are evidence-based.

The committee said it was imperative that social media companies enforce their advertising rules and community guidelines, and strong sanctions should be introduced for failing to do so, including but not limited to significant fines.

Tom Quinn, the director of external affairs at the eating disorder charity Beat, welcomed the recommendations. He said its helpline had delivered 100,000 support sessions and experienced a 302% increase in demand in the past year.

He said: “BMI should never be used as the sole factor in diagnosing eating disorders, or for determining who is ‘unwell enough’ to access treatment. This can lead to potentially dangerous delays, and can drive people deeper into eating disorders in order to be taken seriously.

“The government’s obesity strategy must be immediately reviewed, as it includes measures known to be dangerous to those unwell or vulnerable, such as listing calories on menus. We believe that none of the measures that pose risks should be implemented until this review has taken place.”

A Department of Health and Social Care spokesperson said: “We know poor body image can be a factor in disordered eating for both men and women and we are committed to improving outcomes for those with eating disorders and related mental health issues – with record funding to expand dedicated services in the community.

“Early intervention services are being launched for young people with eating disorders which could see them begin treatment within two weeks.

“With over 6 in 10 adults overweight or living with obesity it is important that we take action to help people live healthier lives, and our approach is guided by the latest research and emerging evidence. NHS England has been clear it does not support the use of BMI thresholds.”

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