# data[].attributes.body
Last updates Dec 2020

# data[].attributes.attachment_link.readable_text
1.1.8 Assess the impact of the home, education, work and wider social environment (including the internet and social media) on each person's eating disorder. Address their emotional, education, employment and social needs throughout treatment.

1.1.9 If appropriate, encourage family members, carers, teachers, and peers of children and young people to support them during their treatment.

# data[].attributes.attachment_link.title
Eating disorders: recognition and treatment

# data[].attributes.attachment_link.description
1.9.1 Provide advice and education to women with an eating disorder who plan to conceive, to increase the likelihood of conception and to reduce the risk of miscarriage. This may include information on the importance of: maintaining good mental health and wellbeing ensuring adequate nutrient intake and a healthy body weight stopping behaviours such as binge eating, vomiting, laxatives and excessive exercise.

# data[].attributes.attachment_link.readable_text
This guideline covers identifying and caring for adults who are malnourished or at risk of malnutrition in hospital or in their own home or a care home. It offers advice on how oral, enteral tube feeding and parenteral nutrition support should be started, administered and stopped. It aims to support healthcare professionals identify malnourished people and help them to choose the most appropriate form of support.

In August 2017, we updated the links in recommendations 1.3.4 and 1.8.15. Recommendation 1.7.17 was also updated and links added to National Patient Safety Agency documents.

Recommendations

This guideline includes recommendations on:

Who is it for?

All healthcare workers in hospital and the community who are directly involved in patient care

People who are malnourished or at risk of malnutrition in hospital or in their own home or a care home and their families and carers

Is this guideline up to date?

We reviewed the evidence in July 2017. We found no new evidence that affects the recommendations in this guideline.

Guideline development process
How we develop NICE guidelines
This guideline was previously called nutrition support in adults: oral nutrition support, enteral tube feeding and parenteral nutrition.

Your responsibility

The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.

All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.

Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.

Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.

# data[].attributes.attachment_link.title
Nutrition support for adults: oral nutrition support, enteral tube feeding and parenteral nutrition

# data[].attributes.attachment_link.description
This guideline covers identifying and caring for adults who are malnourished or at risk of malnutrition in hospital or in their own home or a care home. It offers advice on how oral, enteral tube feeding and parenteral nutrition support should be started, administered and stopped.

# data[].attributes.attachment_link.readable_text
Our Helplines are open 365 days a year from 9am–midnight during the week, and 4pm–midnight on weekends and bank holidays.

Sometimes our lines are busy. If you can't get through immediately, please do try again or try our one-to-one web chat.

If you are in need of urgent help for yourself or someone else outside of our Helpline opening hours, please contact 999 or the Samaritans on 116 123 if you or someone else is in immediate danger.

If you need support outside of these hours, we encourage you to email our Helpline staff (details below).

Beat provides Helplines for people of all ages, offering support and information about eating disorders no matter where you are in your journey. These Helplines are free to call from all phones.

I've had great experiences when using Beat's Helpline services. The people I have personally spoken to have been very sympathetic with all of my needs in my loneliest moments.

Helpline User

Confidentiality

Confidentiality is fundamental to Beat’s services. However, there are some exceptional circumstances where we may pass on information, for example:

We suspect a child may be at risk from harm.

A caller is at serious risk of harm, either from themselves or others.

A caller threatens or abuses our staff.

To ensure the quality and consistency of our services, managers may listen in to calls and check emails from time to time.

How we can help

If you call our Helpline you will speak to a trained support worker experienced in listening and talking to people in a similar situation to you. We know it can be difficult to reach out for help and talk about what you are feeling and going through, but we aim to provide a supportive, non-judgemental space.

You don’t need a formal diagnosis to use our Helpline

Our eating disorder Helpline support workers are trained to:

Offer a supportive space for you to explore your feelings and thoughts around eating disorders.

Provide information about eating disorders. When we do not have the information that someone is looking for, we might be able to give you some ideas about who might be able to help.

Explore options for help with eating disorders and to enable you to come to your own decisions about what might be best for you. This might include NHS treatment, private therapy, support from charitable organisations, peer support or self-help.

I was recently discharged from inpatient treatment after suffering with anorexia, when I developed a binge/purge cycle. I felt so alone, and ashamed to tell anyone. I rang the Helpline because I was struggling so much, but the lady I spoke to was so lovely and listened to me. Without the Helpline, I wouldn't have been able to make the step to tell services and get the help I needed.

Helpline User

Interpreting service

Beat is a member of Language Line and can provide access to an interpreter for non-English speaking callers.

Other sources of support

Downloadable resources

Find treatment

Recovery stories

Beat is a member of the Helplines Partnership, the membership body for organisations that provide Helplines in the UK and internationally.

Beat’s Youthline is a member of Child Helpline International, a network of over 180 organisations supporting children via helplines in 139 countries all over the world.

Calls to this helpline are free from landlines and mobile phones within the UK and do not appear on itemised bills.

Support to those in prison

Beat offers support to those in prison via its freephone telephone Helpline and also via post.

Letters should be addressed and sent to :

FAO Helpline

Beat
Unit 1 Chalk Hill House
19 Rosary Road
Norwich
Norfolk
NR1 1SZ

It took a lot for me to call Beat; I was so nervous but I am so glad I did. The Helpline staff were amazing. They were so understanding and friendly and told me about all the services Beat offer. They also suggested that I make an appointment with my GP and talked me through what might happen and ways I could tell my doctor. They told me about the self-help and support groups that Beat run. Sitting here now knowing I am three years in recovery, I owe my life to Beat. If it wasn’t for the Helpline and making that initial call I really don’t know where I would be now.

Helpline User

Beat is a member of the Helplines Partnership, the membership body for organisations that provide Helplines in the UK and internationally.

Beat’s Youthline is a member of Child Helpline International, a network of over 180 organisations supporting children via helplines in 139 countries all over the world.

Calls to this helpline are free from landlines and mobile phones within the UK and do not appear on itemised bills.

# data[].attributes.attachment_link.description
Beat provides Helplines for people of all ages, offering support and information about eating disorders no matter where you are in your journey. These Helplines are free to call from all phones.

# data[].attributes.attachment_link.readable_text
Thank you for visiting our website. The purpose of this website is to offer parents and carers of people with eating disorders an insight into our work in carer skills interventions. The New Maudsley model is designed to equip carers with a skillset aimed at helping them deal with their stressful caring role. It focuses on communication, individual thinking styles and behaviour that may be accommodating and/or enabling the illness. It is intended to be used as an adjunct to treatment, as opposed to a treatment in its own right. Our skills training interventions are an ongoing process in the field of research and have involved carers, people with eating disorders and clinicians in all stages of the design and delivery.

The aim of the New Maudsley Model is to lower anxiety and distress in family members and to give carers communication tools, skills and techniques that help them engage their loved one to improve their self-esteem and develop the resilience to embark on change. Just as it paralyses sufferers, an eating disorder can paralyse carers and prevent them from effectively helping. The New Maudsley Model specifically focuses on carers' understanding of the psycho-social and biological impact of the eating disorder and provides a skills-based programme to help ameliorate these behaviours.

The New Maudsley Method should not be directly compared with the Maudsley Family Therapy programme, also known as Family-Based Treatment (FBT) or the Maudsley Approach. The latter is a family therapy rooted approach for the treatment of anorexia nervosa and involves three stages of weight restoration, returning control of the eating back to the adolescent and establishing healthy adolescent identity. Professor Janet Treasure, one of the authors of the New Maudsley Approach, has been working at the Maudsley Hospital in eating disorders since 1981 and was involved when the first trial of FBT was in progress. Thus, the New Maudsley Method has evolved in order to adapt to the needs of adult patients as well. Its primary aim is to reduce stress and anxiety in carers and equip them with a similar skill set to that used by clinicians in an inpatient setting.

The New Maudsley Approach is explained in detail in Janet Treasure's skills training manual and the related DVD, both of which are designed to offer carers skills and techniques to help them develop confidence and greater empowerment to support their loved one on the road to recovery. The skills training book is available from www.amazon.co.uk.

The DVD was created as a collaboration between the New Maudsley team and the SUCCEED foundation and provides a visual representation of the communication strategies presented in the manual. The DVD can be ordered from Jenny Langley at jenny@newmaudsleycarers-kent.co.uk.

A set of scales used to measure eating disorder thoughts and behaviours can be found by clicking here.

# data[].attributes.attachment_link.description
Thank you for visiting our website. The purpose of this website is to offer parents and carers of people with eating disorders an insight into our work in carer skills interventions. The New Maudsley model is designed to equip carers with a skillset aimed at helping them deal with their stressful caring role.

# data[].attributes.attachment_link.readable_text
One of the basic principles of Motivational Interviewing's communication skills are OARS, active listening with open questions, affirmations (or praise), reflective listening and summarizing. These skills are used to gain more information in order to understand any ambivalence in change. Carers can then continue to help nudge their loved ones in the direction of considering change.

The use of OARS...

Ask O PEN questions - not short-answer, yes/no, or rhetorical questions

A FFIRM the person - comment positively on strengths, effort, intention

R EFLECT on what the person is saying: 'active listening'

S UMMARIZE: collecting what the person has been saying and offering it back in a basket.
for example... Open questions:
I'm confused - how can we work together to ensure that I provide you with the best support?

How do you feel about that?

Affirmations:

That must have been very difficult for you...thank you for sharing that with me.

That looks as if it has been really challenging. Your efforts are impressive.

I can see that you find this difficult and I'm so proud of you for making such an effort. However, be careful of using "I" as it can be interpreted as patronizing or of having parental overtones which may result in resistance.
Reflective listening:
If I'm hearing you right, it sounds like you're saying that you don't deserve to .........

Sounds as if going out with the family on your birthday will cause quite a bit of anxiety for you.

From what you've said, you're very frightened of going back to school/work because ......

Summarizing: "do you mind if I run that back by you, just to check on my understanding of what you've just told me......"

Reflective listening...

Carers are encouraged to use reflective listening as an implicit mark of listening which may encourage their loved one to pause for thought. Their loved one may be better able to hear what they themselves are thinking and then continue to elaborate. Reflections convey empathy. Complex reflections move the conversation forward and to direct it towards change by drawing upon emotional energy, enhance self-efficacy or emphasing effective change strategies. Think of simple and complex reflections like an iceberg. A simple reflection is limited to what shows above the water, the content that has already been expressed, whereas a complex reflection makes a guess about what lies beneath the surface.

Edi: I just feel so alone in all of this, like there's no future...no way out

Carer: You feel there's no way out right now

( Simple reflection involves repeating back, not adding much to utterance)

Carer: Sounds to me like you're feeling trapped and alone in all of this

(Complex reflection involves adding more strength, coach's interpretation of utterance)

Open and closed questioning techniques...

Closed questions which elicit monosyllabic answers should be avoided in favour of open questions which open the opportunity for the patient to speak and elaborate on how he/she is feeling. Overall questions should be limited (never more than 3 in a row), otherwise it may feel like an interrogation exercise. Voice tone is also important when working with open questions. When using motivational interviewing in a professional setting, therapists aim for a ratio of 2:1 reflections:questions.

Edi: I just feel so alone in all of this, like there's no future...no way out

Carer: Do you feel there's no way out?
(Closed question eliciting a yes/no anwer)
Carer: What makes you feel so alone and trapped?
(Open question eliciting greater elaboration)

# data[].attributes.attachment_link.description
One of the basic principles of Motivational Interviewing's communication skills are OARS, active listening with open questions, affirmations (or praise), reflective listening and summarizing. These skills are used to gain more information in order to understand any ambivalence in change. Carers can then continue to help nudge their loved ones in the direction of considering change.

# data[].attributes.attachment_link.description
Carers of people with eating disorders suffer high levels of anxiety, depression and burden. It is extremely important that carers look after their own physical and mental wellbeing. We have a saying that a distressed carer is an ineffective carer. Be kind to yourself.

# data[].attributes.attachment_link.readable_text
Bulimia Self Help - this page as PDF

Bulimia usually affects more women than men, and often starts in the late teens or early twenties following a strict diet or stressful life event. The individual most likely has a poor self-image, and places much emphasis on needing to be thin to be attractive.

In bulimia, the individual will try to control their weight by restricting their diet, but then crave food and binge eat. This is followed by vomiting, over-exercising or taking pills (laxatives, diuretics, diet), and are often of normal weight.

Binge eating can occur in the same way as bulimia, but there is no use of weight-controlling strategies such as vomiting, laxatives, over-exercise, and individuals are often over-weight. Others binge eat as a way of coping with distressing emotions: extreme "comfort eating", but binge eating ends up making them feel worse about themselves.

Common thoughts, physical symptoms, emotions and behaviours are:
Thoughts

Negative self beliefs: Judge self by what I eat and look like

Strict and rigid rules about what I can can eat (impossible to stick to) - I must stick rigidly to my diet regime

Focus of attention is taken up with food and eating

What I should or shouldn't eat

Self-critical thoughts when don't keep to rules: I'm a failure, I'm useless and weak, I'm worthless

I'm unattractive and unlovable

If I start eating, I won't be able to stop - I'm out of control

If I'm not perfect, then I'm a complete failure

If I eat, I'll feel better

Physical symptoms

Weight gain - weight can vary due to alternating bingeing and dieting

Nausea, bloating, abdominal pain

Dizziness

Dry and flaky skin

Difficulty concentrating

Sleeping problems

Dehydration

Tired, weak, run-down

Damage to teeth - sensitive, discoloured.

Mouth sores

Swollen hands or feet

Sore throat, hoarse voice

Swollen cheeks

Long term: (bulimia) anaemia, kidney damage, lack of menstrual periods, cardiac failure, loss of teeth, stomach ulcers, risk of rupture of stomach and oesophagus, heart problems

Long term: (binge eating) obesity and associated health problems, including type 2 diabetes, high blood pressure, heart disease

Emotions

Behaviours

Over-eating, often in the evenings

Controlling food intake: try to stick to rigid diet, fail, then binge

Don't eat normal meals

Eat alone, perhaps at night, secretively

Attempts to control weight (bulimia): Vomiting after eating, Disguising sound (run taps, flush toilet) and smell of vomiting (air-freshener, mints, perfume, mouthwash); Using laxatives, diet or diuretic pills; Exercising too much to try to control weight gain, or crash diets

Vicious cycle of Bulimia - what keeps it going?

Vicious Cycle of Binge Eating - similar, but no purging

Before starting any self-help plan, particularly one that includes a diet and exercise plan - see your GP (or other appropriate health professional)

Doing things differently

Spend some time working out the times when you're most likely to binge - notice the thoughts that you often seem to have, the physical sensations, the emotions and how you react to them - then do something differently at those times. See this page

Do something that takes up your attention - mindful activity

Compromise - eat a small portion if you really can't resist

Get healthier food in, rather than sugar-rich foods

Drink 6 - 8 glasses of water each day

Seek help - others will support you

Keep a food diary (PDF) to assess your current intake, then...

Create a simple menu plan with a suitable health professional - and stick to it! E.g. 3 meals and 3 snacks per day

Weigh yourself no more often than weekly

Exercise contract - again, agreed with a suitable health professional. Stick to it! (Guide - 30 minutes of moderate exercise each day, include e.g. getting off the bus one stop early, taking stairs instead of lift)

Use medication appropriately and only as prescribed - avoid laxatives, diet pills, diuretics

Eat with trusted family and friends rather than isolate yourself

Don't rush food - sit down and eat slowly, enjoying the taste. Eat mindfully

Reward and treat yourself with something other than food when you've done well - something relaxing or fun

Use a Cravings Diary (PDF) to help you do things differently

Colour Breathing

Use relaxing and self help mp3s

Thinking differently

STOPP! Pause, take a breath, don't react automatically

Understanding links between thoughts, feelings and behaviours - see CBT self help courses

Positive self-talk - encourage yourself, tell yourself: I can do this, I am strong and capable - find an affirmation that works for you (even if you don't believe it at first!). Write it down and memorise it for when you need it. SeeAffirmations

Be aware of those unhelpful thinking habits, including "compare and despair" - comparing yourself to others which trigger upsetting thoughts

Ask yourself:

Am I doing that "compare and despair" thing where I compare myself to others, which makes me feel bad about myself?

Is there another way of looking at this?

Am I getting things out of proportion?

Am I underestimating my ability to cope?

Am I mind-reading what others might be thinking?

Flexible Thinking

Am I doing that black-and-white thinking? There are shades of grey! I don't have to be 100% perfect, it's ok to be just ok.

What advice would I give someone else in this situation?

Am I putting more pressure on myself, setting up expectations of myself that are almost impossible? What would be more realistic?

Just because I feel bad, doesn't mean things really are bad.

What do I want or need from this person or situation? What do they want or need from me? Is there a compromise?

What would be the consequences of responding the way I usually do?

Is there another way of dealing with this? What would be the most helpful and effective action to take? (for me, for the situation, for the other person)

Am I exaggerating the good aspects of others, and putting myself down? Or am I exaggerating the negative and minimising the positives? How would someone else see it? What's the bigger picture?

When dealing with cravings or trying to break a binge:

STOPP ! Pause, take a breath

Use Mindfulness

Mindful Breathing

NOW - mindfulness for busy people

Drink a large glass of water, iced tea or vegetable juice, and pause

Write down what you eat whilst you binge

Focus your attention fully on another activity - Mindful activity

Use grounding techniques or hold a comforting object.

Engage in a hobby or other interest - if you don't have one, find one! What have you enjoyed in the past? What have you sometimes thought about doing but not got around to?

Write down your thoughts and feelings - get them out of your head

Just take one step at a time - don't plan too far ahead

Do something different (to what you normally do)

If you carry on eating, eat very slowly, and mindfully. Eat foods that take more chewing such as raw vegetables

Relaxation techniques - try lots and find one that works for you

Put on some music - sing and dance along, or just listen attentively (use music that is likely to help you feel your desired emotion - avoid sad songs if you're depressed)

Meditation or Prayer

Help others

Be with others - contact a friend, visit family

Pamper yourself - do something you really enjoy, or do something relaxing

Positive self-talk - encourage yourself, tell yourself: I can do this, I am strong and capable - find an affirmation that works for you (even if you don't believe it at first!). Write it down and memorise it for when you need it.

Do something creative - make a box of items that remind you to use the techniques that help, or put photos on paper, or write and decorate a list

Use Safe Place Imagery

Colour Breathing

Tell yourself: "This will pass, it's only temporary". "I've got through this before, I can do it now". When we're going through a tunnel and become fearful of being trapped, there's no point in stopping - we just have to carry on in order to reach the end of the tunnel. That light is there, and waiting!

Find an alternative and healthier way of dealing with distress PDF

If you have a setback and binge - tell yourself it's ok, it's only once - don't dwell on it too much (other than see what triggered it so that you can then get back onto your self help plan)

Use relaxing and self help mp3s

Learn effective skills online - The Decider Skills for Self Help online course

Bulimia Self Help - this page as PDF

Anorexia self help

Further information

Eating Disorders Self-Help Books

# data[].attributes.attachment_link.keywords[]
cognitive behavioral therapy binge eating

# data[].attributes.attachment_link.keywords[]
cognitive behavior therapy for binge eating

# data[].attributes.attachment_link.description
Bulimia Self Help - this page as PDF Bulimia usually affects more women than men, and often starts in the late teens or early twenties following a strict diet or stressful life event. The individual most likely has a poor self-image, and places much emphasis on needing to be thin to be attractive.

# data[].attributes.attachment_link.title
Eating Disorders Self-Help Resources - Information Sheets & Workbooks

# data[].attributes.attachment_link.description
Eating disorders are serious mental illnesses that are associated with potentially life-threatening physical effects. Eating disorders involve unhelpful beliefs about eating, weight and shape and unhelpful behaviours (such as binge-eating, purging, or driven exercise) that ultimately keep people stuck in their disorder. These behaviours have significant impacts on physical, psychological and social functioning.

# data[].attributes.attachment_link.readable_text
Use this form to get support for yourself or someone else with:

healthy eating

increasing physical activity

reducing alcohol

stopping and cutting down smoking

losing weight

general wellbeing

Please start by entering your address, then you'll need to tell us:

your contact details

what you'd like support with

If you need help to fill in this form, you can:

We process, analyse and use your data in a range of ways to better understand what our customers need and to improve the way in which the council delivers your services.

Information provided in this form will be shared with healthy lifestyle services provided by or commissioned by Brighton & Hove City Council in order to offer appropriate support.

Find more information about how we use your data, and the organisations we work with to offer support, in our privacy and data notice.

# data[].attributes.attachment_link.title
Sign up for support from the Healthy Lifestyles Team

# data[].attributes.attachment_link.description
Sign up for support from the Healthy Lifestyles Team

# data[].attributes.attachment_link.readable_text
Mindfulness meditation audio recordings given by Taravajra and Karunavira here.

You can listen to recorded audio of Mindfulness practices to help you with your mindfulness meditation practice.

Click on the tabs below to reveal the audio from the Mindfulness Course CDs
To listen click 'Play button icon below To download click 'download' icon below

# data[].attributes.attachment_link.title
Mindfulness Meditation Audio | Mindful Health

# data[].attributes.attachment_link.description
Mindfulness meditation audio recordings given by Taravajra and Karunavira here. You can listen to recorded audio of Mindfulness practices to help you with your mindfulness meditation practice.

# data[].attributes.attachment_link.readable_text
Masters in Mindfulness

Body Scans

3 Minute Breathing Space

Sitting Meditations

Mindful Movements

We are pleased to include here 3 yoga videos by our colleague Kate Mitcheom, senior MBSR teacher in the USA
Training for mindfulness-based teachers on guiding mindful yoga These videos are each about one hour long and may take several moments to load. The four titles are:

1. Introduction

2. Standing Yoga

3. Lying Down Yoga

4. Participant Commentary

Walking Meditations

Short Practices

Stretch and Breathe

Mixture of Separate Single Meditations

Longer Practices guided in Welsh

Workplace Mindfulness Audio Tracks

In order to save a track, right click on the track and choose "save link as"

Mindfulness in the workplace - Cymraeg/Welsh

Meditation practices to accompany the Finding Peace mindfulness course in Welsh with Bethan Roberts

# data[].attributes.attachment_link.description
Masters in Mindfulness We are pleased to include here 3 yoga videos by our colleague Kate Mitcheom, senior MBSR teacher in the USA Training for mindfulness-based teachers on guiding mindful yoga These videos are each about one hour long and may take several moments to load.

# data[].attributes.attachment_link.readable_text
Anorexia nervosa: treatment for children and young people

Family therapy

Many children and young people with anorexia find it helpful to have a talking therapy that family members or carers can take part in too. This is known as family therapy. It involves working with a practitioner (for example a therapist), and allows you to explore how anorexia has affected you and how your family can support you to get better.

You should be able to choose whether to have therapy sessions together with your family or separately (you can also have a mixture of both). Sometimes family therapy is offered together with other families.

Family therapy usually involves between 18 and 20 sessions over a year. After the first 4 weeks, your practitioner should check if you are happy with how often you have sessions and how long they last. You can make changes if you want to. Your practitioner should ask you about this every 3 months after that, to make sure the therapy suits you.

What does family therapy involve?

To start with, your practitioner will want to get to know you and your family and build up a good relationship with you all. Your therapy will involve:

Other talking therapies

If family therapy is not right for you, your practitioner might suggest cognitive behavioural therapy (CBT) or adolescent-focused psychotherapy. Ask your practitioner if you would like to know more about these.

What does cognitive behavioural therapy involve?

If you have CBT you should be offered weekly therapy sessions for up to 40 weeks (9 to 10 months). For the first 2 or 3 weeks you should be offered 2 sessions a week. You will also usually have some sessions with your parents or carers.

You will work with a practitioner (for example a therapist) to make a personal treatment plan and start making changes in your behaviour. This should involve:

You should be given simple 'homework' to help you put into practice what you have learned. You should also be taught how to monitor your own progress, and how to cope with times when you find it hard to stick to your new eating habits (this is called relapse prevention).

Adolescent-focused psychotherapy

This therapy involves up to 40 sessions with a practitioner. The sessions will be regular early on when you need the most help, and less regular when you start to feel better. You can also have some sessions with your parents or carers if you think this might help. The therapy normally lasts between 12 and 18 months. It should include:

Eating a healthy diet

Food gives you the energy and vitamins you need to grow and develop properly. This is important as you reach your teenage years when your body is changing quickly. If you have anorexia, you might not be getting everything you need from your diet, so your doctor should encourage you to take vitamins and minerals. They should also give you advice about the best foods to eat to stay healthy and grow.

If you are having therapy separately from your parents or carers, your practitioner will need to tell them about any eating plans you have agreed so that they can support you at home.

Growth and development

Anorexia has physical effects on your body and your growth. If your body weight is low for a long time it can delay your puberty (the time when your body becomes more adult-like, when you are about 13). For girls and women, it can also make your periods stop.

If your doctor thinks anorexia might be causing problems with your growth and development they might make an appointment for you to see a specialist to help with this.

Bone health

Anorexia can also interfere with building strong bones. Because of this, you may be offered a special type of X-ray called a bone density scan to check if your bones are healthy. You might be offered this if you have been underweight for a year or more, but it might be offered sooner if you have pain in your bones or have had lots of fractures (broken bones). Your doctor should talk to you about bone scans and whether having one might be useful.

Bone problems can be worse in girls and women. Because of this, you may be offered medicine to help with your body's growth if you are underweight or have bone problems.

# data[].attributes.attachment_link.title
Eating disorders: recognition and treatment

# data[].attributes.attachment_link.description
Many children and young people with anorexia find it helpful to have a talking therapy that family members or carers can take part in too. This is known as family therapy. It involves working with a practitioner (for example a therapist), and allows you to explore how anorexia has affected you and how your family can support you to get better.

# data[].attributes.attachment_link.readable_text
The 'readiness ruler' is a useful tool that can be used to explore readiness to change. This technique can open doors to change, particularly when combined with problem solving discussions towards a solution focused approach. People tend to act in a way that is consistent with what they have vocalized. Consequently, this technique is a useful listening device in opening the way for an exploration of ideas as it can promote 'change talk'. There are two aspects of readiness to change. The first is how important change is to the individual and the second is how confident the individual is that change can be tackled.
1. importance to change How important is it for you to change? What concerns you about your present behaviour? What are your desires, reasons and needs for change? What is the strength of your commitment to changing? What score would you give yourself out of 10?

2. confidence and ability to change How confident are you in your ability to change? Do you have the skills necessary for change to happen? What is the biggest reason for you making this change? What score would you give yourself out of 10?

Reflections

Interesting you've given yourself a '3'. Why not a '2'?

What would have to happen to give yourself a '4'?

What resources would you need for this to happen?

# data[].attributes.attachment_link.description
The 'readiness ruler' is a useful tool that can be used to explore readiness to change. This technique can open doors to change, particularly when combined with problem solving discussions towards a solution focused approach. People tend to act in a way that is consistent with what they have vocalized.

# data[].attributes.headline
Video made by students about eating disorders

# data[].attributes.subject
Video made by students about eating disorders

# data[].attributes.attachment_link.title
After anorexia: Life's too short to weigh your cornflakes | Catherine Pawley | TEDxLeamingtonSpa

# data[].attributes.headline
Guidance on Recognising and Managing Medical Emergencies in Eating Disorders 

# data[].attributes.subject
Guidance on Recognising and Managing Medical Emergencies in Eating Disorders 

# data[].attributes.body
https://www.rcpsych.ac.uk/docs/default-source/improving-care/nccmh/guidance-on-recognising-and-managing-medical-emergencies-in-eating-disorders-(replacing-marsipan-and-junior-marsipan)/guidance-on-recognising-and-managing-medical-emergencies-in-eating-disorders-(replacing-marsipan-and-junior-marsipan)---consultation-draft-july-2021.pdf?sfvrsn=2da63c5d_4

# data[].attributes.body
https://www.bbc.co.uk/news/magazine-25782294

# data[].attributes.attachment_link.readable_text
During World War Two, conscientious objectors in the US and the UK were asked to volunteer for medical research. In one project in the US, young men were starved for six months to help experts decide how to treat victims of mass starvation in Europe.

In 1944, 26-year-old Marshall Sutton was a young idealist who wanted to change the world for the better. As a conscientious objector and Quaker, he refused to fight in the war but he still craved the chance to help his country.

"I wanted to identify with the suffering in the world at that time," he says. "I wanted to do something for society. I wanted to put myself in a little danger."

That danger came, unexpectedly, in the shape of a small brochure with a picture of children on the front.

"Will you starve that they be better fed?" it asked. It was a call for volunteers to act as human guinea pigs in a medical experiment at the University of Minnesota.

All over Europe people were starving - in the Netherlands, in Greece, in eastern Europe and the Soviet Union - and the US military wanted to learn how best to re-feed them. But first they had to find healthy people willing to be starved.

Perhaps surprisingly, hundreds of conscientious objectors - or COs - applied, all eager to help. Sutton was grateful to be one of 36 young men chosen.

"I felt very useful, fulfilled," he says. "There were hundreds of people like me who didn't have that type of opportunity, and I felt very fortunate that I could be there."

The experiment started in November 1944 and for the first three months they were fed to their optimum weight and monitored. Then their rations were cut dramatically. Food quickly became an obsession.

"I ate what I had in about three minutes and got out of there - I didn't want to stay," says Sutton, remembering mealtimes in the canteen.

"There were some in the experiment who lingered over that food for 20 minutes. I couldn't take that. Some fellows were reading cook books all the time."

The men ate meals twice a day. One might be cabbage, turnips and half a glass of milk. On another day, it might be rye bread and some beans.

Like many hungry people in Europe, the men never had meat, and calories were set at 1,800 or less. But Sutton remembers one occasion when, carrying his meagre rations in a paper bag, he took his girlfriend out to dinner at the most expensive restaurant in Minneapolis.

"I wanted to take her to a restaurant just to enjoy seeing her eat... but when the waiter came up with the food she just couldn't do it. I was a bit disturbed by it, I'd spent all that money on a big meal and she just couldn't eat it."

The regime was tough - during the six months they were being starved, the men were expected to walk or run 22 miles (36 kilometres) every week, expending over 1,000 calories more than they consumed each day.

Their walks took them past bakeries and other temptations - and it was all too much for some participants. Three pulled out of the experiment.

Those that remained lost about 25% of their weight and many experienced anaemia and swollen ankles, as well as apathy and exhaustion. Their ribs stuck out through their skin - their legs were as thin as their arms used to be. And there were psychological effects as well.

"After you've not had food for a while your state of being is just numb," says Sutton. "I didn't have any pain. I was just very weak. One's sexual desires disappeared."

The men grew anxious and depressed.

"When something good happened, we would explode with joy and when we were pessimistic we were very depressed," Sutton recalls.

"I had a very close friend there and often I'd speak sharply to him and I'd find myself going to him almost every night and apologising."

The men coped in different ways. One man managed to study for a law degree. Sutton read philosophy and theology, and drew comfort from Quaker friends and the church.

Others struggled, occasionally eating illicit food before becoming despondent with guilt. One man even cut off a finger while chopping wood and couldn't explain how or why.

The experiment is still cited as a source of reference by academics studying nutrition and eating disorders, and it raised many questions about how far psychological problems can be treated if the subject is still starving.

But in some ways the project came too late. Even as the experiment continued, one Nazi concentration camp was liberated, then another - and the full horror of starvation became apparent.

BBC correspondent Edward Ward entered the Buchenwald concentration camp in April 1945, seven days after it was liberated.

"A hollow-eyed emaciated German Jew hobbled across to me," he reported. The man opened the door of a large cupboard. Inside there were about 20 corpses piled high.

"'Last night's crop,' said the man, almost casually. 'It'll be the same tomorrow, and the next day, and the next day.' The wretched inmates have been freed from their Nazi tormenters, but they've not yet been freed from slow starvation."

But while the results may have come too late for many of World War Two's victims, they still could help others.

In 1946, the researchers released a guide book for aid workers - Men and Hunger.

Show no partiality, and refrain from arguments; the starving are ready to argue on little provocation, but they usually regret it immediately

Informing the group what is being done, and why, is just as important as getting things done - billboards are the easiest way

Starvation increases the need for privacy and quiet - noise of all kinds seems to be very bothersome and especially so during mealtimes

Energy is a commodity to be hoarded - living and eating quarters should be arranged conveniently

A thoughtful worker will make use of the fact that the starving are emotionally affected by the weather -some special and cheerful activities might be saved for bad days

In the last months, the Minnesota men were fed back to health. Different groups got different foods and calorie allowances. But it was months, even years - long after the men had returned home - before they had all fully recovered.

On the day Marshall Sutton left Minnesota, he took a bus to Chicago.

"Every time the bus stopped I had a couple of [milk-]shakes and the world was a wonderful place," he says.

"I had a wonderful sense of having all the food I wanted, but I didn't have the strength - I was so happy and I was eating, but I wasn't normal."

Sutton, like most of the volunteers, went on to lead a healthy and successful life. He worked in Gaza with starving refugees in 1949 then took part in Quaker projects in the US. Now 95, he lives in a Quaker Community in Baltimore.

Seventy years on, he is still glad he took part in the experiment. His friends were risking their lives in the South Pacific, he says, and it was an honour to make a sacrifice himself.

Janet Ball's Witness is broadcast on the BBC World Service on January 20 from 08:50 GMT. Listen via BBC iPlayer Radio or browse the Witness podcast archive.

# data[].attributes.attachment_link.description
During World War Two, conscientious objectors in the US and the UK were asked to volunteer for medical research. In one project in the US, young men were starved for six months to help experts decide how to treat victims of mass starvation in Europe.

# data[].attributes.body
https://www.sussexpartnership.nhs.uk/condition-eating-disorder

# data[].attributes.attachment_link.description
We provide NHS care and treatment for people living in south east England. Our vision: outstanding care and treatment you can be confident in.

# data[].attributes.attachment_link.title
Understanding Anorexia (Anorexia Nervosa Explained Clearly)

# data[].attributes.attachment_link.title
Understanding Bulimia (Bulimia Nervosa Explained Clearly)