Christmas & food - a Powys point of view

Christmas is almost upon us! And what is Christmas if not a festival of food (amongst the gifts, the seasonal games and festivities, the celebrations with family and friends - or not - depending on your preference or situation). The news is full of updates about what foods may or may not be available for people this year. Yet whilst most of us will not go hungry, even given a restricted choice at the supermarket or our chosen local food outlet, there will be others who will struggle to put food of any kind on the table, be it Christmas or any time of year.

For this blog post we want to explore a few of the ways we interact with food, and consider food get-togethers, at Christmas and also other times of the year. We will also touch on the support for people with eating disorders at Christmas.

Food for Life get-togethers - new Powys Food Network

In November the first Powys Food Network meeting took place, organised jointly by Powys Association of Voluntary Organisations and Cultivate. Cultivate is a cooperative based in Newtown in North Powys, run by volunteers and employees who are dedicated to supporting a resilient local food economy.

The Grow, Cook and Share in Powys Network, which is funded by the Soil Association’s Food for Life get-togethers programme, has been set up to support groups across Powys to get involved in growing, cooking and sharing activities. There are many benefits to a Food Get Together, not just the opportunity to enjoy tasty, wholesome food prepared from locally grown ingredients. The groups who attended the first network meeting in November this year reported that people enjoyed coming together - not just to eat and learn about food - but to socialise. This is a really important aspect of coming together to eat, as isolation and loneliness, which can impact hugely on mental health, are at much higher levels in our local communities since the pandemic.

At Christmas it’s important to look out for family, friends and neighbours who don’t have the opportunity to get together with others for the traditional festive meal, whilst at the same time being sensitive to the wishes of those who choose to enjoy the holiday time quietly by themselves. 

My colleague Jen, PAVO's Health & Wellbeing Information Officer, has pulled together some useful information about Powys community groups and venues offering Christmas meals and other activities over the 2021 festive period. 

You can find further details on the main PAVO website.

Meanwhile, the next meeting of the new Powys Food network will hopefully take place at Cultivate’s community gardens in Newtown in early 2022. If you’d like to find out more about the network, or even sign up, then email sue.newham@pavo.org.uk

How Christmas diet choices can affect our mental health

There is a huge amount of research now about the potential impact of our dietary choices on our mental wellbeing. According to the UK charity The Mental Health Foundation: “Eating well – which means having a balanced diet full of vegetables and nutrients – can improve your sense of wellbeing and your mood.”

The article explains the link between different foods and the impact they can have on your mental health and highlights particular foods that can lead to low mood such as those with high levels of fats, sugars and caffeine.

Festive food, of course, is full of these dietary nasties! Perhaps the best approach is one of balance at Christmas - just a few sugary treats but plenty of healthy fresh food for the most part. It’s actually amazing how wonderful fresh fruit and veg can taste when you cut down on your sugar intake. Fresh cabbage and carrots, especially those grown locally and organically, are so naturally sweet to the taste buds!

Eating disorders at Christmas

For anyone living with an eating disorder, the festive season can introduce even more challenges to daily life. Suddenly we’re not just expected to eat three square meals a day, but to snack endlessly on all the so-called Christmas edible goodies that appear in the shops and maybe even as presents from well-meaning family and friends.

Then there is the added hurdle of extra visitors who join the dinner table at festive meal times - family and friends we may not have seen for many months, and who may not understand how anxious such a setting can be for someone living with an eating disorder.

The eating disorder charity Beat has a useful web page of tips for anyone in this situation to help make it as stress free as possible:

Five questions you might have about Christmas with an eating disorder

Young Minds, the charity supporting young people with their mental wellbeing, suggests distraction techniques, adjusting expectations and being kind to yourself if thoughts of Christmas make you feel upset, angry or anxious:

Tips for coping with an eating disorder at Christmas

Beat's helpline services will be open 4pm – Midnight from 24th December to 3rd January. During this time people can call 0808 801 0433, email waleshelp@beateatingdisorders.org.uk or speak to an advisor using one-to-one webchat.

If you need urgent help outside Beat’s opening hours, then contact the Samaritans on 116 123, they are open 24 hours a day, 7 days a week.

Favourite festive local produce of our team

Locally produced food has less food miles, supports the local economy, and boosts climate change resilience. Perhaps it also has that extra feel good factor which can help us feel better about ourselves and the planet!

So, what Powys food and drink can we enjoy this Christmas? The Health & Wellbeing team at PAVO tell us about the locally grown / produced food and drink that they most like to enjoy!

Clair Swales - Head of Health & Wellbeing

WJ George Butchers, Talgarth - Turkeys

Originally established as a butcher’s over 135 years ago, W.J. (Billy) George took over ownership of W.J. George Butchers from his uncle in 1935 and it still remains in the family to this very day. It’s our Swales family tradition to buy our Christmas Turkey from here. Their meats are sourced from local farms and there is a real passion for the produce they sell.

Gareth Ratcliffe - Health Promotion Facilitator, Mid Powys

LUCKY 7 Beer

Lucky 7 is an independent brewery in Hay-on-Wye making fresh, modern, creative beers. They produce beers that highlight the quality of the ingredients. Beers that will stimulate and excite the palate. Beers that will complement a moment. They are a must for Christmas day as well as the summer BBQ.

Jackie Newey - Mental Health Information Officer

Kale Nero di Toscana - Italian kale

Straight from our organic veg garden! Perfect greens for Christmas dinner - they can survive all kinds of awful winter weather and still taste so good.

Jen Hawkins - Health & Wellbeing Information Officer

Dairy Dreams local milk

Dairy Dreams is a family run dairy farm on the Powys/Shropshire border producing fresh, pasteurised milk from their herd of free range cows. I love the 1 litre bottles that the milk comes in, reducing the amount of plastic and knowing that my milk has only travelled a few miles from farm to cereal bowl! Also love the great range of delicious ice cream they produce, current favourite is a seasonal gingerbread ice cream for Christmas.

Lucy Taylor - Startwell Development Officer

Wendy's Eco Chic pickles, chutney and oils - Builth Wells

They make such a nice present in a basket or with a festive bow.

Owen Griffkin - Mental Health Participation Officer

Hwgga Ales - microbrewery in Llandrindod Wells

Nice selection of interesting ales named after local landmarks like Lover's Leap and Shaky Bridge and a great present for family and friends from elsewhere.

Sue Newham - Engagement Officer

Richard Edwards’ squashes - Newtown

Richard is a smallholder who grows squashes that you can buy in Cultivate in Newtown. They look like small, knobbly pumpkins, but they taste glorious. I make squash soup or roast them in slices.

A peaceful Christmas and a Happy New Year to all our readers near and far

Type 2 anorexia – my experience

This week's guest post is by a young person living in Mid Powys.

Perfectionistic, body dysmorphic, obsessive and depressive are accurate words to describe anorexia. Six months in a psychiatric hospital suffering from the disease has proved this beyond question. However, the experience also revealed to me two different manifestations of the disease - characterised by varying degrees of the traits above:

Type 1, where the sufferer has a severely distorted view of their body and therefore exercises and starves themselves in the pursuit of looking ‘normal’. This is what most people perceive anorexia to be about, but I (and others in hospital) didn’t identify fully with this and hence believe there’s a second type. 

Type 2, where an obsessive routine of eating and exercise develops in order to avoid irrational consequences despite perceiving oneself as normal (perhaps slightly overweight). Here, the consequences could revolve around any aspect of your life but mainly around weight gain where the goal is to be thin - better than normal. Hence, those who identify with the second type are likely more perfectionist, academic and hardworking. However, they’re probably more at risk (due to these underlying personality traits) as it’s probably more dangerous to act on self-perfection than on self-perception.

The obsessive, perfectionistic roots of type 2 affect many aspects of the disease making it clearly distinguishable from type 1. In type 2, food itself isn’t an issue, the calories are (hence half the hospital chose to have liquid supplements and the other half had food despite being equal in calorific intake). Exercise is also more of an issue in type 2 than type 1 as it becomes built into a rigid routine and must be done to relieve anxiety (as opposed to accelerate weight loss). Type 2 anorexics are also more likely to be deceptive and compete with other sufferers to be perfect in other people’s eyes rather than just in their own to become the ‘best’ anorexic they can be. In this respect access to online material and social media create a competitiveness which likely makes many people’s condition worse. Finally, in type 2, anorexia cannot be separated as an entity from the sufferer (hence getting to draw/name it isn’t effective despite working well for type 1 anorexics). This is because for them the disease takes advantage of their personality traits and becomes an extension of them.

We should use our understanding of each type of anorexia to personalise the otherwise universal treatment plans. Personalised medicine is a hot topic in modern medicine. Gene sequencing and editing has allowed us to choose the treatments which we know will work best on patients. Why not extend this to anorexia?

Of course, the line between the two groups is blurred, but there are many instances where placing me into one of these groups would’ve helped mine and other sufferers’ recovery. Catching it early will inevitably reduce the likelihood of the disease worsening but recognising when further intervention (from Child & Adolescent Mental Health Services to psychiatric hospitals) is necessary is just as important. Taking away the choice by involving professionals is often the only way people too far into the disease can recover and increase their weight enough to correct the depression and distorted thinking associated with anorexia. 

Also, the incentives for recovery are blocked by body image or compulsions for type 1 and 2 respectively. We could therefore target these blocks differently for each type. Classical conditioning is used to treat Obsessive Compulsive Disorder (OCD) and involves patients doing what it is that causes anxiety (or not doing it in the case of a ritual). After being in a better mentality to do so, I decided to try it. I went home over a weekend and didn’t sneak off and exercise at all. That weekend was the only time my weight dropped during my whole recovery. My anxieties were practically gone from this point onwards. 

Finally, the qualities associated with type 2 sufferers can be redirected from weight loss to something beneficial. For me, I became very academic which allowed me to preoccupy myself and give enough incentive to remain fully recovered. Incentive is the key to the cure. Access to mental health services is the key to prevention.

After sharing my thoughts on service provision I’d like to talk about what it’s like to have been a male anorexic. I imagine that you’ve pictured a female through reading this blog and hope that you’re somewhat surprised that the author, the sufferer, is male. I wasn’t at all surprised to be told I had anorexia - I knew about the disease and could tell things weren’t right especially after comments from almost everyone I knew expressing their concern. I have a female twin and understandably my mother has since admitted she was always conscious of the fact that she could become anorexic. These were probably unconscious thoughts felt by everyone around me - I wasn’t expected to become anorexic and hence I was allowed to get progressively worse without it crossing anyone’s mind. I’m sure that this allowed my mind set to change and my weight to drop enough that the anorexia had developed into something that couldn’t be solved without professional help.

Unfortunately, I was taken to the GP surgery twice and both times was told that my weight wasn’t low enough to cause major concern. I was, however, referred to CAMHS on the second occasion. To an anorexic this was like being told you’re not thin enough. Furthermore, the naivety of the doctors to accept all that I said (that I eat lunch and have snacks, only exercise every couple of days and am still sociable and happy) prevented them from assessing me on anything bar the weight-age percentile I was in.

As a boy my original motives were also different to those of girls. At 7 and a half stone, I was plump and had innocent comment from friends and family saying the same. I thought I should try and lose some weight and gain some muscle (as mentioned, the muscle gain I wanted was impossible for a 12 year old). I started with cutting out food and exercising more and liked the results so continued doing this to greater and greater extents. The weight loss and routine consumed me - I lost friends and my confidence, my work suffered, my hair began falling out, my skin flaked away, I was constantly cold and remember dreading the thought of standing or walking because of how faint they made me feel - this is certainly a mental and physical disease. 

Waiting almost a month for an appointment with CAMHS gave me the time to rapidly worsen. I was lucky to have an exceptional psychiatrist - the best of many I’ve had since. However, weekly appointments with her were of little benefit and my weight continued to drop. A paper cut in class one day caused me to faint and have a small seizure which prompted my removal from school and a two week bed rest. Another month of this saw little improvement - I didn’t want to get better. My family and I were becoming more and more depressed and with all of us finding life unbearable, I was taken to a psychiatric hospital where I was the only boy. 

By removing the choice of recovery, my weight rapidly gained and I began to see more clearly - food really is the ultimate medicine and choice is its antagonist. After six months I returned to school where everyone supported me through my last steps. It took almost a year of going at my own pace before simply wanting to be normal gave me the incentive to recover - I came off my meal plan, started socialising, working hard and enjoying life again. Once in the healthcare system being male didn’t affect anything, however - expect a man as you would a woman to develop an eating disorder and don’t shy away from talking to them about it. 

There’s a reason anorexia in males is becoming more common. Social media has recently become inundated with pictures and quotes encouraging men to love women with curves and promoting curves by redesigning children's characters (particularly Disney princesses and Barbie) to reflect more realistic figures. Unfortunately, there is no male equivalent. All I ever see are pictures of ripped and good-looking men, one even quoting “women like butts too”. This sends the message out that men must love overweight women but that men must have a knife-sharp jawline, a sculpted body and of course, a peachy bum to be considered equally attractive. Its reasons like this that Body Dysmorphic Disorder is becoming worryingly common especially in males. 

We need equality to favour all genders - encourage everyone to be happy with how they look as long it’s healthy. I’ve gained so much from my experiences and have helped many to overcome their problems but the horror of anorexia and how much of life it affects is only known by sufferers and their families. It’s not a route that social media should inadvertently encourage people to go down  - we’ve ensured this with women but I feel men are increasingly led along this path due to the lack of society expecting them to do so.

Postscript from our guest author:

On the last day of an eventful year, I need to say this. The expectation of men to be strong and brave - to be masculine - is quite literally killing people. It's this expectation that allowed me to fly under the radar when my mental health suffered and it's this expectation that has killed four silently suffering but definitely loved friends in the last month alone. We need to be so much more aware of the hurt that people around us are feeling and not hesitate to talk to them about it. It really can be just a few words, a quick check up or a smile that can break that depression and give someone reason to think about the future which is otherwise non existent in the mind of a depressive. Please, have a Happy New Year and make this your resolution so that in 2017, good people aren't hurt by their mental health.

Many thanks to our guest author for sharing his experiences of anorexia. There are several charities specialising in providing support for people with eating disorders. These include:

B-eat - the UK's eating disorder charity

Anorexia & Bulimia Care

Seed - eating disorder support service

Men get eating disorders too

If you know of others, let us know in the comments box below.

Do we need a change for treatment into Eating Disorders?

By guest author Helen Missen, from North Powys

Recently I have been in an NHS system that works incredibly effectively - is a gold standard as far as the way it runs - and is evidence based.

9 weeks ago Breast Test Wales called me for a routine mammogram (I'm 50 at the end of the year). Within that time frame I have had two biopsies, many explanatory leaflets and a number of incredibly supportive phone calls. I have had consistency of care, from what I suspect are the team who will, in the event of a dodgy result, care for me long term. I have a sketchy and limited knowledge of breast cancer, one borne from a nursing career and a lot of media input. I shall, of course, read extensively and take advice from others if all goes tits up. I know, without a shadow of a doubt, that I will have evidence based, effective treatment. After all breast cancer can be a killer.

Six years ago my knowledge of anorexia was as my knowledge of breast cancer is now. I had nursed eating disorder patients during my training as a nurse on the psychiatric ward, and had heard everything that the media had falsely 'fed' me. Evidence for the treatment of anorexia was sketchy and not effective. Parents were still blamed for their child's illness.

Six years ago our family were beginning the journey with my daughter, who was then 15, down the slippery slope of anorexia nervosa.

I learned that anorexia remains the most deadly of all mental health/psychiatric disorders, killing either through malnutrition which leads to heart failure, or suicide.

I learned that neither my daughter nor we were to be blamed for her illness; this was neither a choice, nor anything we had done to cause it.

I learned that even though my daughter is a high achieving perfectionist, a good girl, those very strengths of character were her downfall, but are also her strength.

I was scared, we were scared. Seeing our daughter taken over by an illness that seemed to be killing her in front of our very eyes. As with many mental health disorders the sufferer fights a daily mental battle against their own brain which tells them that eating will do them serious harm. The trouble is when it's a fear of eating, one cannot be encouraged to 'give up' something or have a 12 step model to follow.

Anorexia is now widely acknowledged to be a biological brain disorder with genetic components to it.

The treatment is now evidence based: early intervention is key to a good recovery and full life. The medicine is food. Alongside therapy to learn strategies and tools to deal with emotions that fuel and nourish this terrible illness, there are some useful drugs.

As the brain starves the thought processing is out of control. Once full nutrition is in place the starved brain can once again function and process information through some therapies. There are many co-morbidities that go alongside anorexia, that may have some respite once the starved brain is re-fed.

We became the primary care givers, not because of the advice of the professionals assigned her at the time, but by researching the latest evidence, which is now the norm for treatment of anorexia in children: Family Based Therapy (FBT). We supported refeeding our daughter. Encouraged full nutrition of a variety of foods, and challenged the fears associated with food. Plus we worked alongside therapists and our daughter. Research is currently being carried out by The Maudsley Hospital in London (SLAM) to the effectiveness of a version of FBT in adults, with promising results.

Our daughter felt in control at the beginning of this journey, but quickly realised that she is out of control in an illness that once entrenched, is tough to fight.

There is every confidence that someone with anorexia and breast cancer, can and will recover from the devastation it wreaks on families and individuals. Anorexia and many eating disorders may lead to hospitalisation and intense treatment. Uncomfortable and distressing as it is, this treatment will lead to recovery for the majority. Chemotherapy is, I understand, distressing and uncomfortable in the side effects it induces, but necessary for full health.

With breast cancer, there are regular check ups. Watching for signs of the disease returning is the norm. The care is by a team of highly trained specialists, a breast surgeon if required, and a team of nurses, radiographers and radiologists who specialise in breast disease.

Sadly the follow up, and in fact the treatment for anorexia and many eating disorders, remains sketchy.

The fact that someone is suffering from a killer illness doesn't necessarily mean that treatment will be continuous or under the care of a specialist professional with years of experience in the field of eating disorders. Generally, for an adult, a six week course of treatment with a psychologist, perhaps a GP but seldom a highly trained specialist psychiatrist or dieticians in the field of Eating Disorders, is the norm.

Passed from pillar to post many adults are consigned to treatment that is in a grey area. Not sick enough to be hospitalised, generally suffering with the inability to realise how ill they are, and regularly not challenged to put on the weight their brain needs to sufficiently function to make a full recovery. Throw in a change of address, say to university, and the treatment becomes even more difficult. Outdated beliefs by professionals still falling short of the evidence that is readily available, shortened therapies and no continuity by expert therapists.

This is a relapsing illness which needs strong people, alongside the sufferer, to see them through what may, and generally is, a long recovery process. There are triggers that can cause a trip up in recovery.

Families, and indeed sufferers, become demoralised and tired. They need consistent and trusting expert therapists to stand alongside, firm in both the belief that recovery is possible and that the person suffering with this horrific illness can and will make it through.

We live in a forward thinking, scientific world, with resources and evidence to show that early intervention is the key to treatment. Sufficient support and encouragement, plus working to full nutrition to a point whereby a brain can sufficiently heal, (not a lesser 'number' for the purpose of professional targets), takes time and energy from all parties.

Thankfully, in the past six years, treatment in Wales for young people and children with anorexia is beginning to be treated effectively with pockets of incredible expertise. Indeed, the Welsh Assembly has one of the most thorough Frameworks for Eating Disorders, and is about to refresh it to include thoughts/actions from both sufferers and carers. A child diagnosed with anorexia now may have access to the treatment and care to see them out of the darkness and into a life fulfilled and lived. Adult care is also overseen by the framework and in some geographical areas there is occasional expertise. Unfortunately, though, many sufferers are still consigned to little or no expert help.

The media are beginning to realise that this is a treatable illness, not necessarily characterised by the photographs of immensely thin people or a set of scales.

As a mother of a daughter still suffering from anorexia I continue to fight the illness, support my daughter, and try to illicit the best possible care for her. Thankfully she has reached recovery on a number of occasions. Sadly, those occasions have generally brought around a 'backing off' of professional care, and thus a relapse. I also encourage other families starting out on the journey, signposting them to expert advice and evidence based treatment. I help to change policies and teach both professionals and families alike. I badger parliament both in Wales and in England, and I hope and pray for my daughter’s total recovery, for a breakthrough for her, and others in the same place as she is.

A gold standard NHS treatment for Eating Disorders is still not in place, but within the next few years I hope it will be. Certainly for my grandchildren the care and understanding for people with anorexia will be far more hopeful with new therapies, drugs and research already making great strides. I hope too for a new batch of GPs, medical students and indeed the public to have a greater awareness and teaching about eating disorders, especially anorexia.

For the time being I am pleased to say that the results from Breast Test Wales have been that I need no treatment and have the all clear. 

Helen’s recommended resources

F.E.A.S.T. – Families Empowered and Supporting Treatment of Eating Disorders

Anorexia & bulimia care

Beat – the UK’s eating disorder charity

Family Based Therapy – the Maudsley Approach

The New Maudsley Approach – for professionals and carers of people with eating disorders

Books to read

How to Help your Teenager Beat an Eating Disorder, by James Locke and Daniel Le Grange

Skills based Learning for Caring for a Loved One with an Eating Disorder – the New Maudsley Method by Janet Treasure

Anorexia Nervosa by Janet Treasure and June Alexander

Anorexia Nervosa: a Survival Guide for Families, Friends and Sufferers by Janet Treasure

The staggering cost of eating disorders in England

A newly released report carried out for Beat by a volunteer economist from the charity Pro Bono Economics (PBE) has found an overall estimated cost of £1.26billion per year to the English economy from eating disorders – and could be much higher.

The report sought to form a comprehensive view of the overall costs to society of eating disorders in England, especially amongst young people, and the costs to the NHS, employers and employees.

The report, by economist John Henderson volunteering with PBE, reveals overall healthcare costs estimated at £80-£100m, costs of reduced  GDP up to £2.9bn, and costs of reduced length of life and health up to £6.6bn.

With mental ill health representing up to 23% of the total burden of ill health in the UK, and estimated to double over the next 20 years, the findings of the report demonstrate the severity of the impact of eating disorders on society at large.

For full story see Beat website