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End of the year; and considerations that nobody asked me

I know that it might be an unpopular opinion, but I absolutely love November. Of course, I am biased as it marks my birthday and the start of Christmas celebrations, which I personally start early, at around the 25th of November, so I can enjoy the lights and the silliness for over a month.


The air gets colder, and we get cozier in our homes- as we swap our summer clothes for the winter ones. I love taking out my hats, wool jumpers and coats- There is something I truly love about swapping your wardrobes around- it’s almost like going shopping! But for free- and I genuinely forget all the shit I have amassed in the years .


I went to Rome the weekend of the 21/22 of November, and when we returned to London, it was suddenly cold- like Winter arrived overnight.

The cold for me reflects the end of the year, as well as putting up Christmas decorations; and in turns I find that my mind always wonders at this time of year. Historically, New Year’s Eve was the worst for me in terms of mood- I sort of looked back at the year gone and just felt defeated and cheated out of time- there is so much to learn, and to do, and so little time to conquer it all! As much as I've tried to pack quite a bit of life in my years, I feel the the "to do" list never diminishes.

Which is why this year I’m doing my usual “let’s think about the year gone by and set some realistic goals” now- So I can act on it a bit before and feel I have achieved more. Also, I already know that I will work on the 1st of January, so it’s likely that I wouldn’t want to spend my earned off-time setting up yet some more rushed, unrealistic goals for 2022.

So while I’m sipping on a hot tea I am just thinking back at all the completely unrealistic yearly goals I have set for myself:

-one goal for 2021 was “survive ITU”- I think 2020 Alice had a hint that shit was about to hit the fan, somehow

-Quit smoking- which I thought was going to be THE absolutely most unrealistic one; and then we get to the glorious:

-“Get a body”, which I all fairness has always been part of the list, like Parmesan on any given recipe- and I’m sure I am not the only one out there that has put similar variations of it. Like-“Start going to the gym”, “start new diet”, “beach body”, “pick up CrossFit”, and so on.

I’m as guilty as anybody else (just started on a new diet, as riding the wave of “I should be able to eat whatever and never feel guilty” has led me to put on stupid weight that I didn’t need. Oh, the cross of trying to maintain an healthy weight and excessive dieting - very different things; however they can sometimes cross over.



This whole “get a body” bullshit got me thinking- in 2020 I was definitely restricting my calories, and doing keto, and intermittent fasting, as well as working 12-14 hours shift running around in full PPEs, and beware! Even running/exercising at home. It’s funny, because when I put all of this on paper and re-read through it, it is fairly obvious that:

a) I was desperately trying to control some aspects of my life; and

b)If it was my best friend doing all of this, I would have definitely cornered her for an intervention.


The equation was fairly simple: I go to work and no matter how much I try, people do not respond to therapy, and end up dying in massive numbers- whilst when I go home and restrict my diet, and exercise, I can predict how my body will react. So much so, that at this point last year I was about 8 kilos less than I am now.

Thankfully, I don’t care as much as I used to, and also I have a body frame that doesn’t show too much if I gain weight- yes jeans are tighter, my face might look puffier, but all in all it doesn’t massively show. To others. But we know our bodies quite well, having personally spent 34 years in mine, so I know I can tell the difference. It does get somewhat difficult, and lonely, having to repeat myself day in and day out, that I am indeed ok that way I am, that weight does not define me, that this body has got me through so much I should just be grateful we made it alive and in one piece. Because body acceptance is not something that’s just given to you one one mriacolous day- It’s actually hard work.

And as I said before, these feeling of not feeling worthy, of attributing so much importance to your weight, the shame for a bar of chocolate-it can be a very lonely place to be. Eating disorders, and variations of them, they are not just based on weight; that is the ultimate manifestation of an ongoing psychological issue. If it was merely a problem of weight, the solution would be to just eat differently; instead, the golden standard for treatment remains therapy.


I always said that my love for personal styling stems from wanting to be able to help women find empowerment through fashion and style- especially women that have suffered with any mental health condition, be it depression, an eating disorder, or physiological change in our bodies that we struggle to accept.


They say a trouble shared is a trouble halved- which is why I think that to feel less lonely we need to acknowledge that we are not alone. I also strongly remain a woman of science and absolutely love to back up my arguments/topics with data- so I thought it would be interesting to have a look into eating disorders. TW: it will not be pretty, so if you are sensitive to the subject, it might be a good idea to steer away now.

Just to start off, whilst there are new terminologies out there, such as Orthorexia (an unhealthy obsession with eating “pure” food), Anorexia athletica (excessive and compulsive exercise.), the 7 eating disorders recognised in the DSM-5 are as follows:

-Anorexia Nervosa

-Bulimia Nervosa

-Binge Eating Disorder

-Other Specified Feeding or Eating Disorder (OSFED)

-Avoidant Restrictive Food Intake Disorder (AFRID)

-PICA

-Rumination Disorder


(DSM being the Diagnostic and Statistical Manual of Mental Disorders. Think it as an equation:

DSM: Mental Health Professionals = Bible : Christians)

Why is it important to know this list? Because in order to have a recognised eating disorder, you have to meet certain criteria- which scientifically makes sense. What can happen though -and we have seen it throughout the years- was that when you select very strict criteria to fit a determinate pathology into a box (especially in the mental health word), there is a risk that some population- will not be included. Which doesn’t necessarily mean that they are not suffering, it just means that they will not receive the help they need. A lot has been argued that some criteria were too strict, for example back in the days one had to have amenorrhea (complete lack of periods in women) to be diagnosed with anorexia nervosa- the DSM has now been updated and has become much more inclusive than what it used to be previously.


Even if diagnosing has been made more inclusive, according to Beat (the leading UK charity for Eating Disorders) we can only assume that around 1.25 million people in the UK have an eating disorder. While there have been some significant and well-designed studies conducted in the UK in recent years, there has not been sufficient research to draw firm conclusions about the prevalence of eating disorders in the UK. Which means that the estimate is based on research happening outside of the UK- not ideal, as Eating disorders have the highest mortality rates among psychiatric disorders. Of those surviving, 50% recover, whereas 30% improve and 20% remain chronically ill. Meaning in the UK (and again by assumption only), something like 250,000 people will remain ill throughout their lives. Only 46.9% of AN patients were classified as ‘cured.’ Early intervention results in the best possible recovery outcome(NICE). Not providing children and young people with the resources to recover means that their illness may not be cured and that they go into adulthood with enduring Anorexia Nervosa.


I still remember when working in ITU we received a patient, a young woman, who eventually died of scurvy, a form of Vitamin C deficiency. She had suffered from an Eating Disorder for a very long time, and yet the diagnosis wasn’t that- she died of scurvy, and that’s that. This episode was only a couple of years ago.


What’s interesting (“interesting” being a VERY diplomatic choice of words), is that it’s scientifically proven that eating disorders are culturally-reactive, and not culturally bound. What does this mean? It means that even a country like Japan, where the average population is petite and minute, has witnessed a soar in numbers of people with eating disorders, which is not dictated by culture, but on Westernisation and the shift in what beautiful should look like. Like Japan, also Fiji is a country that has been heavily studied due to the rise in eating disorders after the mid-1990s. Prior to the 1990s, there was only 1 documented case of an eating disorder in Fiji. Once television was introduced in the mid- 90s, rates of eating disorders in Fiji women just boomed. In Pakistan as well, where fat was historically associated with wealth, we have witnessed eating disorders surfacing- even when the poorest people were still malnourished. Without having to go all the way to Fiji, or Pakistan, even a study in South Italy has proved the same result: although southern Italians are stereotypically different from the northern Italians in terms of physical traits, historical, cultural and social backgrounds, the prevalence of eating disorders in southern Italian adolescent sample is surprisingly similar to those reported by the areas of both northern and central Italy as well as other western countries.





Urban Outfitters pro- anorexia T-shirt




What do we gather from all this, then? Well, two really frightening things:


1. An adolescents-killer psychiatric disease is so under-diagnosed, that even in 2021 in a country that prides itself of being avant-garde with mental health matters such as the UK, we still don’t have data on incidence. It’s even more worrying when we think that over the past year, child and adolescent eating disorder services of the UK National Health Service have seen almost a doubling in the number of both urgent and routine referrals. From social isolation to food insecurity, and from pressures to exercise and challenges to losing weight to loss of routines and disruptions in accessing face-to-face clinical services, it is incredibly difficult to think of a scenario with so many risk factors for eating disorders. We also know that if you are normo-weight, over 30 yo, or you are a male, receiving treatment will be much harder.



2. Also: it is incredible to think that Westernisation and subsequent exportation of one image of beauty has fucked up pretty much the entire world. I have just finished watching the documentary “The Illusionist”, directed by Elena Rossini, which teases apart complex ideas about power, consumerism and beauty, explaining clearly how the fashion, beauty, food and porn industries has dictated the way beauty, and ultimately our bodies, should be.

As British psychotherapist Susie Orbach powerfully stated,


“We are losing bodies as fast as we’re losing languages. Just as English has become the lingua franca of the world, so the white, blondified, small-nosed, pert-breasted, long-legged body is coming to stand in for the great variety of human bodies that there are.”


My conclusion? We are made to feel lonely in this never-ending battle for perfection, as we are meant to see our bodies as a "project", instead of something that should just be there helping us getting through life. As long as we are insecure, beauty will always sell. Another scientifically proven thing: sad people shop more.


Which is why I will always try and help people find their own style, rather than the one dictated by big corporates trying to get to your deepest insecurities. Maybe it should really come the time where bodies stop disappearing, and we truly enjoy the way we are? Hard work, I know.



....Few of the references here:


1.Beat website, available on: https://www.beateatingdisorders.org.uk/get-information-and-support/about-eating-disorders/how-many-people-eating-disorder-uk/


2.https://www.anorexiabulimiacare.org.uk/about/statistics


3.Joint Commissioning Panel For Mental Health (www.jcpmh.info/wp-content/uploads/10keymsgs-eatingdisorders.pdf)


4.The Diagnostic and Statistical Manual of Mental Disorders (www.dsm5.org)


5.Arcelus J, Mitchell AJ, Wales J. et al, "Mortality Rates in Patients with Anorexia Nervosa and Other Eating Disorders: A Meta Analysis of 36 Studies." Arch Gen Psychiatry 2011, 68: 724-31. Sonnenville K, Micali N et al., "Common Eating Disorders Predictive of Adverse Outcomes are Missed by the DSM-IV and DSM-5 Classifications." Paediatrics 2012; 130:e289-95


6.Steinhausen, H.C. (2002). "The Outcome of Anorexia Nervosa in the 20th Century." American Journal of Psychiatry, 159, 1284-1293


7.NICE Guidelines 2004 page 7. "Eating Disorders Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa, and Related Eating Disorders"


8.Eating attitudes and prevalence of eating disorders: a survey in secondary schools in Lecce, southern Italy

R Dalle Grave 1, L De Luca, M Oliosi


9.COVID-19 and eating disorders in young people

Francesca Solmi, James L Downs, Dasha E Nicholls

Published:May, 2021DOI:https://doi.org/10.1016/S2352-4642(21)00094-8


10.Doctors warn of ‘tsunami’ of pandemic eating disorders.

The Guardian, Feb 11, 2021

https://www.theguardian.com/society/2021/feb/11/doctors-warn-of-tsunami-of-pandemic-eating-disorders


11.Indirect acute effects of the COVID-19 pandemic on physical and mental health in the UK: a population-based study.

Lancet Digit Health. 2021; 3: e217-e230


12.Early intervention in eating disorders: a parent group approach.

Early Interv Psychiatry. 2012; 6: 357-367


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