Why We Can’t Wait for a "Tasty Number" to Treat Eating Disorders

Written By Helen Gifford

The email was short, but it pulled on me in a way only a clinician or a carer truly recognises.

​I had spent months advocating for Tara. I spoke to GPs, social workers, and clinical leads, attempting to overcome the rigid bureaucracy of admission criteria. Tara hadn’t hit the “required” weight limit for inpatient care, yet she was crying out for help. Her food behaviours, negative thought patterns, and escalating distress pointed to a person in desperate need of a lifeline.

​But it wasn’t until her heart rate dropped and her electrolytes plummeted that the system finally “saw” her. By the time she was admitted to a facility 30 miles from home, she was medically fragile. Her subsequent email to me was steeped in loneliness. Ironically, she was now “too low” in weight to access the very counselling she needed; while she was safer medically, she had lost the psychological safety of our therapy room.

​I sighed and began typing a reply, offering reassurance while holding those dreaded, essential therapeutic boundaries. In that moment, I realised maybe I needed those boundaries just as much as she did.

For years, I sat in multiagency meetings feeling like the outlier. I’ve always felt a quiet, nagging discomfort with the way we treat eating disorders - a field governed by rigid “facts,” clinical figures, and arbitrary thresholds that supposedly apply to every body. Whilst I advocated loudly for young people, I often felt isolated in my scepticism, wondering if my resistance to these “tasty numbers” was due to a lack of speciality or a deeper intuitive truth.

Last week, I attended the VOXED Eating Disorder Conference, and for the first time, those thoughts I’d sat with in isolation were validated. I wasn’t alone. There is a growing, vocal movement of clinicians realising that our reliance on “averages” isn’t just outdated, it’s dangerous.

The Myth of the “Healthy Average”

As was discussed by peers at VOXED, the BMI (Body Mass Index) remains the standard for triage despite its shaky foundations. It was developed in the 19th century by a mathematician, not a doctor, to study populations of white European men. ( I was educated here by Kaysha Thomas.)

When we rely on these metrics to decide who “qualifies” for help, we are essentially waiting for the house to burn down before calling the fire department.

The Data Gap: Research published in the International Journal of Obesity indicates that BMI misclassifies health status for millions. Nearly half of the people labelled “overweight” are metabolically healthy, while many “normal weight” individuals are in acute medical crisis.

By focusing treatment on these averages, we systematically fail:

BIPOC Bodies: BMI lacks the nuance to account for different bone densities and muscle mass distributions across ethnicities.

Atypical Presentations: Individuals in larger bodies with restrictive disorders often face “medical gaslighting,” where their starvation is praised as “weight loss” until their vitals crash.

Eating disorders rarely exist in isolation; they are increasingly recognised as part of a complex “co-morbidity cluster” involving neurodivergent traits and hormonal sensitivities. Clinical data suggests that up to 30% of individuals with Anorexia Nervosa are also Autistic, often utilising restrictive eating as a tool for sensory management or cognitive rigidity. Similarly, those with ADHD are nearly four times more likely to experience Binge Eating Disorder due to dopaminergic pathways and impulsivity. For many, these challenges are exacerbated by Premenstrual Dysphoric Disorder (PMDD), where cyclical drops in estrogen and serotonin trigger intense “luteal phase” spikes in body dissatisfaction and binge behaviours. Recognising these intersections is vital, as treating the eating disorder without addressing the underlying neurological or hormonal “wiring” often leads to a cycle of chronic relapse.

The Allure of “Tasty Numbers”

There is amazing life-saving work happening in crisis units, and I hear amazing feedback from families about local facilities, but as resources are scarce, funding gravitates toward the “cliff’s edge.”

Crisis work produces what I call “tasty numbers” - discharge rates, percentage of BMI improvement, and survival stats. These figures look great on a funding application. But if we intervened earlier, at the point of psychological shift rather than physical collapse, the numbers would be less “dramatic.” It’s harder to quantify a crisis that was prevented, even though prevention is infinitely more humane.

The Danger of “Symptom Hopping”

This is one of the reasons I moved into private practice: to have the freedom to look past the scale. We must remember that an eating disorder is a negative coping strategy for underlying distress, much like self-harm or substance misuse.

If we focus only on “re-feeding” without exploring the root cause, we leave the door open for Symptom Hopping. Research on “Diagnostic Crossover” suggests that up to 50% of patients migrate between different types of ED symptoms (e.g., moving from restricting to purging or bingeing). Without addressing the underlying trauma, “recovery” often just looks like trading one maladaptive behaviour for another, such as addiction or self-harm, which I see regularly in the therapy room.

True therapeutic work must be split: we manage the risky symptoms to keep the client safe today, but we must do the deep, long-term work to ensure they don’t need a different “vice” tomorrow.

Closing Thought

Coming away from VOXED, I feel more certain than ever: We need to stop waiting for the body to fail before we believe the mind is hurting. A “new generation” of therapy must prioritise early, weight-neutral intervention, because a person shouldn’t have to become a statistic to deserve a seat in the therapy space.

It’s lovely to share a few quiet moments with you today.

Until next time,

💛🌿 Helen

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Author Note & Transparency: I recommend resources based on a combination of clinical experience and consideration of available evidence. These are offered for interest only and are not endorsements of scientific efficacy or clinical recommendations. Please apply your own critical judgment.

References

Helen Gifford
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