One Parent's View of Eating Disorders in Two Health Systems

I was in London earlier this month for the Eating Disorders International Conference held by b-eat, the largest eating disorders charity in the UK. The event gave me the opportunity to see eating disorder treatment from two perspectives: my own, and the one faced by families in England. I came away feeling the chasm between science and practice is just as deep on both sides of the pond, but the content is different.

Infinite Options for Eating Disorder Care on One Side, Universal Coverage on the Other

In the U.S. I see families struggle to choose between what seems like infinite options for care: outpatient, inpatient, residential, individual therapy, family therapy, group therapy. So many choices, but only if they have money or excellent insurance coverage. Without available funds or generous insurance coverage, families often choose between doing nothing and the emergency room.

In the U.K., treatment of anorexia and bulimia is not a financial issue, for the most part. It is a matter of availability of any specialized services and very little in the way of choices.

Parent Attitude About Healthcare Providers

I'm an American and tend to be be more direct - and rude - than my English friends. I live in an environment where assertiveness is valued and expected in many environments, though difficult. I question my elders and expect to be able to disagree with my doctors. If I am offended or feel mistreated, I go to another healthcare and mental health provider. It is not my impression that my UK friends are quite as comfortable with this attitude and being part of a National Health System they actually don't have the same choice. Whether the UK has a healthcare system because of that orientation or having an NHS nurtures that orientation I do not know. Maybe both.

What I do know is that these differences matter. I have to be cautious about exhorting English friends to rise up in protest and I have to take into account our different orientations when ranting about the agony of being in charge of a loved one's healthcare.

Evidence-Based Treatments for Eating Disorders

In the U.S. families can find as many philosophical approaches as there are clinicians, but less commonly encounter evidence-based treatments that have been researched and established as effective. U.K. families can only, theoretically, get treatment that has been approved.

Eating disorders are, of course, the same illness on either side of the Atlantic. Unfortunately, the illness gets defined differently and, in my opinion, equally wrongly on either end. In the U.K., the standard for hospitalization is an absurdly low BMI and leaves out bulimia almost entirely. In the U.S., eating disorder medical care is dependent on finances and focuses on forms of talk therapy with little evidence for efficacy.

Families are ill-served in both situations, I'm afraid. Eating disorders are a treatable illness, but the research indicates that both medical and psychological interventions must be assertive, evidence-based and urgent.