This one day symposium organised as part of the Healthier Dancer programme, by Dance UK was held at the Royal Society of Medicine at 1 Wimpole Street, London. A great venue and auditorium for this type of event. And it was really good to see so many from the dance world interested in this vitally important topic. Lots of useful information was given by the eminent presenters looking at the topic from a variety of perspectives.
I want to highlight here just some of the points raised.
Dancers telling their own stories about their experiences of having disordered eating problems highlighted the need for the right help to be available. We already knew this of course, but it is good to be reminded of it. This point was raised several times throughout the day. A key issue addressed in some depth was the matter of prevention and early intervention – a case of prevention being better than cure.
Safe and supporting
There is still relatively little literature available on dance-specific prevention and intervention work. But it is vital to create a safe and supportive environment around body weight and shape together with having early identification policies and procedures to increase the chances of picking up problems early. It was pointed out that it is one thing having the policies but it is often difficult to implement them. We were told about the importance of handling issues in a supportive manner to increase the student or dancer’s motivation to seek support and care.
Apparently the highest percentage of people diagnosed with an eating disorder are not diagnosed with anorexia or bulimia. Instead EDNOS (Eating disorder not otherwise specified) is diagnosed. So there is a lengthy continuum associated with eating disorders or disordered eating and not one or two specific conditions where everyone shows the same psychological, physical and behavioural signs.
If we take a moment to consider how the dance world has dealt with body weight and shape in the past then I am sure we all know examples of dancers and/or dance students who have experienced negative comments about this. The desire for thinness has overwhelmed in recent decades. To encourage and foster change in the dance profession needs commitment and determination. Many need to change their ideal and realise the impact of dance and dance training on the individual’s physical and psychological wellbeing. It is time that we all become more aware of the issue of eating disorders and disordered eating in dance. And this conference has helped raise awareness of many of the issues that we need to address.
Beat is the charity that offers support, information and training about eating disorders. We got a very useful overview of the importance of first contact when people initially access support about eating disorders. Reminding us that eating disorders are a serious mental illness and not simply a faddy diet or desire to be thin. This charity supports many people with or connected to someone who has an eating disorder or disordered eating. It also offers a popular, one-day, training course Understanding Eating Disorders: Prevention, Detection and Support. Professionals in education, mental health, social care, counselling, fashion, health and fitness and of course, dance have attended this training.
Role of nutrition
Different views were put forward about applied nutrition for maintaining health and ensuring performance for young dancers and the role of nutrition in dance performance. The Food Guide Pyramid developed for Swiss Athletes is a useful tool for healthy eating practices. It certainly offers much more than the food pyramid that health educators have used for many years. The Swiss pyramid has expanded the old version so that it can be used as a valuable, visual and educational tool. And you can download it from the website link given above. The difference between body weight and body composition was highlighted along with the impact of low energy intakes on metabolic rate and fat storage – all fascinating stuff that shows us how complex the issue of nutrient intake can be.
There was a lot of support for the multidisciplinary team (MDT) approach to supporting and managing dancers with eating disorders – I am not convinced that ‘managing’ is the correct word to use here. It seems rather cold as if we are discussing commodities rather than human beings. A key issue highlighted concerned who should be on the MDT. This being dependent on the size and type of organisation as well as the ideal professional or group of professionals. Issues of confidentiality and trust were discussed but I have questions about some of what was proposed – contacting the dancer’s GP by letter was put forward as one way of alerting the GP to the dancer’s need for help. This was suggested because a GP cannot discuss a patient with a third-party without consent but apparently can accept written information from a third-party about a patient. I am not sure whether I misunderstood this – I will try to follow it up as it raises ethical issues about confidentiality and possibly data protection. Questions about, the ethics of sharing health information with a third-party and how this affects trust, both with those at the dance organisation and the GP. It was said that organisations should have in their records the name of the dancer’s GP. So perhaps along with this there is an expectation of some pre-given consent for the organisation to be able to share confidential information. Although such a blanket consent raises very real ethical concerns of its own. It also raises questions about GPs accepting written information about patients from third parties and what this might mean for trust between patients and their GPs. As I say, I will try to follow-up these issues for clarity.
Attitudes and beliefs
We were reminded during this event that we are all affected by our family and historical attitudes to food. So what we learn about food and nutrition now is on top of what we learned and believed while we were growing up. I recall the days of being told to clear my plate at meals – whether I was hungry or not. And I am sure some of us remember the TV ads telling us to go to work on an egg – something which changed dramatically in the 1980s after British politician Edwina Currie, issued a warming about salmonella in British eggs.
Charateristics of different eating disorder caregivers – rhinoceros, ostrich and dolphin character types were used to describe them and there is a lot of information on the internet about using these animal types to describe various caregiver types in eating disorders – it is interesting to consider what type of caregiver we might be. A couple of examples, the rhinoceros is controlling and constantly gives advice. In contrast, the ostrich avoids emotional reaction and supports the family practically. The dolphin is the ideal caregiver type – gentle guidance, nudging and supportive. An article on Psychology Today website offers some insight into these caregiver types. And a book was recommended:- Skill-based Learning for Caring for a Loved One with an Eating Disorder.
So a great day of raising awareness about this very important topic. What matters now is what happens next.