Dr Winston, who is also Medical Director for Schoen Clinic UK (mental health), set up the country’s first clinic in 2011 for people who have diabetes and an eating disorder.
In an edition of the BMJ published in March, Dr Winston explains that diabetes professionals may not have the confidence to discuss possible eating disorders affecting the patients they see. An eating disorder may be the cause of poor diabetes control.
Eating disorders are twice as prevalent in people with diabetes as in the wider population. Around two in five men and one in five women with type 1 diabetes are believed to omit or reduce their insulin in order to try to lose weight. Among those with type 2 diabetes, up to 10 per cent are estimated to have an eating disorder (compared with around four per cent in the general population).
The problem has been termed ‘diabulimia.’ It is described as the most dangerous eating disorder because of the high risk of causing serious complications including amputations and blindness due to poor diabetes control.
The theory is that people with diabetes may be more susceptible to eating disorders because they must focus closely on their food intake; this can become confused with body image and mental health issues. People with type 1 diabetes often lose a lot of weight before diagnosis, then gain weight once they start taking insulin.
In the article, Dr Winston explains eating disorders occur to a similar extent in both type 1 and type 2 diabetes.
At Dr Winston’s NHS service in Warwick, the Aspin Clinic, they support many people with type 2 diabetes. Typically, these patients have binge eating disorder and may be severely overweight.
The clinic’s approach is based on first identifying and addressing the underlying emotional issues, then introducing a tailored weight management programme.
All specialists featured in the article agree that a multi-disciplinary approach is essential: diabetes specialists need to work together with eating disorders specialists to identify whether poor diabetes control could indicate an eating disorder and to provide effective, comprehensive support.
Four speakers from Newbridge House will deliver presentations at a prestigious international eating disorders conference this week.
The 14th London Eating Disorders Conference is taking place from March 20 to 22 at the Queen Elizabeth II Centre, featuring speakers from all over the world. The theme for this year’s conference is: putting patient and carer perspectives at the heart of everything we do.
Sessions presented by specialists from Newbridge House will showcase not only the work of the clinic, but the active, rigorous research programme to measure the effectiveness of all interventions.
Hospital Manager Rachel Matthews will present a session on the Newbridge Prognosis Score: evaluating the effectiveness of a prognosis tool based on patient and family progress. This innovative work investigates what factors assessed at admission may be used to predict likely outcomes from treatment on an individual basis.
Senior Occupational Therapist Janet Tighe will present a session on social eating and preparation and research to evaluate how effective and helpful this support is. Using a graded approach, young people begin by preparing simple meals, then progress to main meals (according to age and ability). Social eating is also supported, initially by having lunch outside the unit in a café, then may include going to a restaurant for an evening meal.
The effectiveness of this approach has now been fully audited using an Eating and Meal Preparation Skills Assessment (EMPSA) tool.
Additionally, Newbridge has recently completed a Random Controlled Trial (RCT) evaluating a manualised body image therapy: practical body image with mirror exposure which was originally developed at our unit.
The treatment uses cognitive behavioural techniques, including practical tasks and experiments, to challenge body dissatisfaction and increase acceptance of a healthy weight. Early results from the development phase showed a significant decrease in social avoidance and significant improvement in self-esteem. Full evaluation from the RCT will be presented to conference by Assistant Psychologist Hannah Biney.
Professor Hubert Lacey, Head of Research for Newbridge and Schoen Clinic UK (mental health) will lead an invited workshop session on severe and enduring anorexia.
There are also posters: self-esteem group (psychology) and relaxation group (occupational therapy).
Professor Lacey said: “Bringing three papers from a single unit to a conference of this standing is a very significant achievement. It showcases what we do and equally, the work we do to measure everything.
“This is a core principle at Newbridge: we develop and innovate and then we carefully evaluate, so we understand what works and we have an evidence base for everything.”
“Like our treatments, the research work is fully multi-disciplinary, coming from the full range of the professions: psychiatry, psychology, occupational therapy and nursing.”
Young people took part in a wide-ranging, imaginative Winter Celebration and raised money for the eating disorders charity, Beat.
This year’s Winter Celebration included young people devising and acting in famous roles from literature, many musical performances and Christmas songs in sign language.
There were also factual presentations, for example, with the key stage three Geography group showing how people around the world celebrate Christmas in different ways. Around 12 young people of different ages were involved in the range of performances.
The teachers stepped up too, performing their own rendition of the Shakin’ Stevens song ‘Merry Christmas Everyone’ and there was a Christmas quiz.
In addition to the performances, many of the young people on the unit worked hard to create a range of craft items (Christmas cards and painted candle holders) which were sold to parents and staff. A stall was set up following the performances and parents were invited to purchase items, with all profits going to Beat, the national charity supporting people with eating disorders and raising awareness. A total of £95 was raised.
Nicola Winslow, Head of James Brindley School at Newbridge, commented: “The Winter Celebration is a longstanding tradition at Newbridge House. It is an important part of our year in the way it brings family members to Newbridge for a positive celebration and reflection.
“Some of our young people are not keen on performing in a traditional sense and we understand this but find ways to include as many people as possible in ways they feel comfortable. Many young people worked hard to create the craft items and were really pleased to raise money for Beat.
“I would like to thank our young people for all their work, enthusiasm and willingness to contribute, bringing everyone together for a great celebration of many different talents.”
Supporting a family member with an eating disorder at Christmas presents multiple and very complex challenges. It is important to prepare for this and to acknowledge how different members of the family feel about Christmas, including their fears, hopes and concerns. For the individual who is coping with anorexia at Christmas, there is likely to be raised anxiety about the super-abundance of food at this time of year and an increased pressure, compared to other times of years, to eat with other people and to eat food they might otherwise avoid.
Parents are likely to be feeling the pressure to create a happy, or even perfect day (social media can be particularly unhelpful in this respect). Parents may find themselves reflecting on how different Christmas is now the family are coping with an eating disorder, compared to previous years, when children were younger. These concerns and conflicted feelings can become an ‘elephant in the room’: parents carry on with Christmas preparations, hoping all will go well, unwilling to share anything which could be seen as ‘negative’. However, it is much better to talk through and acknowledge worries of eating disorders and Christmas at an early stage.
What preparation is helpful if you are coping with eating disorders at Christmas?
Family members should try to talk about how they are feeling about Christmas openly and honestly in advance
Try to avoid comparing this Christmas with previous years
It may be helpful to avoid or adjust social media interaction, particularly if this is something that makes you feel a pressure to have a ‘perfect’ Christmas
Emphasise your own traditions around Christmas, for example, going to get a Christmas tree and decorating it, shopping together, going for a walk or to a Christmas market. These traditions can be comforting and enjoyable and they also help to take the emphasis away from a big Christmas dinner/the consumption of food
A significant aspect of Christmas is the emphasis of getting together with relatives and friends. When someone is struggling with an eating disorder at Christmas, this presents a particular challenge. If they have not seen relatives for several months or longer, they may feel anxious simply about seeing them and particularly about comments they may make (however well meaning).
An individual with an eating disorder is likely to feel particularly anxious about eating with people who they do not share meals with on a regular basis. Who to invite, for Christmas Day or at other times, can become a significant source of conflict. The individual who is coping with anorexia at Christmas may not want relatives to visit because of the difficulties this could present. Other family members may feel anorexia or bulimia already compromises family life in many ways and for also Christmas to be changed is not acceptable. If you are caring for someone with anorexia or bulimia at Christmas, you may find yourself in the middle of this conflict.
Practical advice for Christmas and relatives when you are coping with eating disorders at Christmas:
Perhaps invite only close relatives or friends to your Christmas meal, which is likely to be a major pressure point. Consider who your child feels most comfortable with and it is worth bearing in mind, if your child has not seen a particular relative for a significant period of time, they are likely to feel anxious (will they comment on changes to their appearance?)
Consider getting together with wider family and relatives in a way in which food (particularly sitting down for a meal) is not the primary focus, for example, going for a short family walk together, or a more informal ‘drop-in’
Talk to your relatives in advance about what may help and what may not be helpful. Explain that any comments about appearance, even “you look well” could be misinterpreted by a person with an eating disorder (to suggest weight gain/fatness) and it is best to avoid any comments about appearance. It is also best to avoid any comments about anyone else’s appearance and certainly to avoid discussion about New Year diets. Comments about how much food is being eaten are also unhelpful (“I’m stuffed”/ “aren’t you doing well”)
If relatives feel worried that they might ‘say the wrong thing’, reassure them that people with eating disorders usually welcome talk during mealtimes as distraction. General talk about all subjects not related to food/body imagine/eating disorders are helpful. Straightforward statements like “I’ve been really looking forward to seeing you” are a positive way of starting conversation. Relatives may need to be aware that the young person may be less chatty than they have been on previous occasions.
The Christmas Meal
Anyone coping with anorexia or bulimia at Christmas is likely to be feeling anxious about the Christmas meal. Family members are likely to also have worries and concerns about how the meal will be; for the individual with an eating disorder at Christmas and for the family as a whole. It is very helpful to discuss and agree portions and strategies in advance. At Newbridge House, we have a Christmas meal early in December. This helps young people prepare and we also share portion sizes (weights and photographs) with the families we work with.
Planning and organising your Christmas meal when a family member is coping with an eating disorder
It may be useful to have an agreement such as: parent will plate up the meat and potatoes for the young person and perhaps do the same for others. This way, the young person has an agreed portion of protein and carbohydrate, has a choice of vegetables and is not ‘singled out’ as having their meal in a different way to others
It may be helpful for the young person to sit next to a designated supporter who they trust and knows them well. Some people find it useful to copy their supporter’s portions, which is helpful if people are serving themselves
It is often helpful to have an activity planned for after the Christmas meal as a distraction, such as a board game or watching a film
Eating disorders at Christmas: help and advice
In summary, if you have a family member who has anorexia at Christmas or bulimia, these steps may help:
Plan and prepare: think through everything, what will help and, importantly, what will be your Plan B if things go off course
Talk though your concerns and conflicts. Don’t try to carry on with your Christmas preparations in the same way as before, hoping for the best
Adjust your expectations. A smaller number of visitors, a few less activities may be helpful
Avoid social media or anything that perhaps projects the ‘perfect’ Christmas
Advice from a parent of a young person with an eating disorder
“I think it is really important to prepare and make a plan for Christmas with your loved one, then to be prepared for your plan to go off course. Try to be flexible and be aware of your own expectations; it is probably better to lower them a little. If your teenager needs some time out in their own room it may be better to allow that than to have a big fight. My daughter is in recovery from anorexia and certainly has issues with food still, but she loves Christmas. She loves the traditions and as she moves into her early twenties, she really values the time together with family and that certainly outweighs the food anxieties, even though they are still there.”
– Parent of young person who was treated for anorexia at Newbridge House
If you are struggling to cope with Christmas and want to talk to someone, we recommend you call the Beat helpline, which is open on Christmas Eve and Christmas Day. This is run by trained specialists and Beat is the national charity dedicated to supporting people with eating disorders and all those affected by them.
An audit of meal preparation and social eating sessions at Newbridge has shown a consistent improvement for participants.
The Newbridge occupational therapy (OT) team run a range of sessions to support meal preparation and social eating. Using a graded approach, young people begin by preparing simple meals, then progress to main meals (according to age and ability).
Social eating is also supported, initially by having lunch outside the unit in a café, then may include going to a restaurant for an evening meal.
Newbridge is widely recognised for its innovative and broad group programme and OT expertise focusing on the practical and behavioural aspects of treatment. All young people at Newbridge can access these groups: Breakfast Club and Snack Out (open groups) and Lunch Club and Come Dine with Me (by assessment, set duration).
An audit has been carried out to assess the effectiveness of these interventions. Eating and Meal Preparation Skills Assessment (EMPSA) tool was used, with assessments carried out before and after treatment to measure the individual’s ability and motivation for 12 aspects of meal preparation and eating, from planning and preparing food to eating out socially.
Janet Tighe, lead occupational therapist at Newbridge House, commented: “The results are extremely reassuring, with almost all young people reporting an improvement in several aspects of their ability and motivation following intervention.
“Additionally, comments from young people indicated they found the groups encouraged independence, challenged their fears and increased confidence, in addition to being reported as enjoyable by many.”
The EMPSA requires the young person to rate their ability and motivation in 12 tasks, on a 10-point scale where ‘0’ indicates no ability or motivation and ‘10’ indicates total ability or motivation.
Twenty-five individuals completed the EMPSA before and after treatment. There was a statistically significant average increase reported for both motivation and ability.
Professor Hubert Lacey, head of research at Newbridge House, commented: “We are extremely proud of the OT resource and our innovative group programme; this is one of the unique features of Newbridge.
“Equally, we are committed to the principle of auditing everything we do, so we know what works, what needs to be refined and in what way.
“The results of this audit are particularly pleasing, showing significant improvement in both ability and motivation. Young people have regularly told us that they value social eating and meal preparation groups, finding them helpful and enjoyable. Now, with this audit, we have a clear, quantitative measure of benefit.”
Newbridge staff gathered for an evening of celebration to mark the tenth year of the service and the achievement of an outstanding rating for the second time.
Earlier this month, Newbridge House achieved a rare second outstanding rating from the Care Quality Commission, which inspects and regulates all health providers.
Only four per cent of mental services in England achieve an outstanding rating, meeting the rigorous standards demanded for the highest evaluation. Newbridge House was also rated outstanding in 2016.
This very notable achievement came as Newbridge approached its 10th anniversary. The service was established in September 2008 to provide a specialist unit wholly focused on children and adolescents with eating disorders.
Members of staff who have worked for Newbridge for the whole ten years were recognised and given long service awards. They are: Jane Ford, chef team leader, Teresa Hall, chef, Carrie Taylor, staff nurse, Jennie Kenny, occupational therapy assistant and Annette Docker, house keeper. There was also a mention of thanks to Jenny Hudson, communications specialist, who has also worked for Newbridge for ten years.
The celebration took place in New Hall Hotel, the location where Newbridge House’s nationally recognised Masterclass educational seminars take place.
Rachel Matthews, hospital manager, said: “I would like to thank every single member of staff: you have all played a very important part in making Newbridge what it is today and achieving an outstanding rating for the second consecutive time.
“Our strength lies in our people. From the moment visitors arrive in reception, our staff make them welcome and fill them with confidence about the care and treatment we provide. This continues through every stage in the journey, including all the work we do to support each young person’s discharge and transition home.
“The pride you take in our service, the commitment you have to every young person we work with, is evident in the outcomes we achieve for our patients and the national recognition we have for the quality of our service.”
We have been rated outstanding for the second time following an inspection by the Care Quality Commission (CQC) in June this year.
Newbridge House was already one of a very small number of services rated as outstanding, received an outstanding rating in 2016. Only 2.7 per cent of mental health services inspected by the CQC achieved this highest evaluation.
Professor Janet Treasure led a ‘tour de force’ 11th Newbridge Masterclass for delegates from eating disorders services across the UK and Ireland.
The focus of the Masterclass was on collaborative care, exploring the formulation of eating disorders and carer self-management approaches.
Professor Treasure is internationally recognised for her work at the Maudsley Hospital and King’s College, London and her extensive research, having authored more than 600 scientific articles.
“Janet is a prime example of someone who brings science and clinical work together because this is where her work is based,” said Professor Hubert Lacey, Director of Research at Newbridge House.
“She has trained a generation of psychologists and psychiatrists and, as well as formal research programmes, Janet has worked with carers to co-produce innovative self-help interventions.”
The Masterclass, which took place on July 17 at New Hall Hotel, Sutton Coldfield, commenced with a session considering the formulation of eating disorders. Professor Treasure said although some models emphasise solutions over cause, she believes it is critical to establish a clear and detailed formulation.
“I do believe this is important, so everyone – the team, the individual and their carers – can have a shared understanding of cause and knowledge of where we are going with treatment.”
Janet introduce a formulation based on: predisposing, precipitating and maintaining factors to build a cognitive interpersonal model for the individual. This included understanding of what is currently known about heritability and genetic correlations and how personality traits such as rigidity can act as both precipitating and maintaining factors.
The second session considered the profound and multiple interpersonal effects of eating disorders and how these can either act as maintaining factors or support recovery. There was discussion of the different approaches carers take and how they may perceive themselves as taking a nurturing, caring stance, but in fact have become coerced into maintaining the condition.
Splitting (between parents, between treatment team and family) was widely explored.
Carer self-management is essential. “There is no right or wrong and carers won’t be perfect; they need to avoid being caught up by a need for perfection,” said Professor Treasure. “We encourage carers to consider their own support network. Often, they are caring all of the time but demonstrating self-care is a very important skill to show the child.
One practical technique is to ask carers to write down three people within their support network and how specifically they can provide support.
There was exploration of the critical but challenging skills carers need to employ: advanced communication, high levels of empathy and conflict avoidance.
“We want carers to be able to facilitate conversation and to support them to have high levels of self-awareness. We say to carers – you can’t control your child, only yourself, but through the changes you make, you can positively improve the interpersonal environment.”
Concluding the day, Professor Lacey said: “This has been a most memorable Masterclass; a true tour de force.
“What has come across to me is your warmth and humanity, your unique ability to synthesise down and to use analogy to imprint so much detail on our collective memories.”
Professor Janet Treasure will lead the 11th Newbridge House Masterclass on July 17, with a day focused on collaborative care in eating disorders.
Internationally recognised and widely published, Professor Treasure has authored more than 600 scientific articles and in 2012, was awarded an OBE for her work.
Her Masterclass programme will begin by examining social factors as part of the formulation of eating disorders, then considering maintaining social factors (the impact eating disorders have on personal relationships and whether they can inadvertently sustain the disorder, or become a resource for recovery).
Professor Treasure, who is known for her work with carers, will consider how best to address the social and personal impact of eating disorders, including education, strategies to reduce unhelpful emotionally driven behaviours and how social support can facilitate change and recovery.
The afternoon sessions will focus on carer self-management approaches, which have been widely applied and tested, for people who form the support network, including parents, partners and siblings. The essence is to promote a collaborative approach to providing social support and steps to recovery, with teaching through personal example (patients and carers who have lived experience of eating disorders).
Professor Hubert Lacey, director of research at Newbridge House who developed the original concept of the Masterclass series, said: “We are absolutely delighted that Professor Janet Treasure will be joining our programme.
“The principle of the Masterclass has always been to deliver a really high quality educative experience and as such, Professor Treasure is a sought-after speaker whose work is internationally admired and respected.
“We have had a high number of applications for the Masterclass and as always, we will offer places to ensure there is a broad, multi-disciplinary range of professionals, designations and eating disorders services represented.”