Research and Expertise
Participating in research gives you the opportunity to have your voice heard which might help influence how support is offered to others in the future.
Research requiring you to focus on personal experience can be emotionally provoking. If you have any concerns about participating in a research study make sure you read all the information provided and contact the researcher if you need to ask further questions or discuss what support you can access if you find the experience difficult.
Completed Research and Outcomes
We are partnering with University of Nottingham, Health Humanities on a study workshop to capture opinion, feedback and existing patient experience to inform new service developments specifically form“Eating Disorders in Boys and Men”.
We invited 50 people and professionals with specific exert experience of current services from across a range of sector and settings for a full day working group event on 11th December 2019 (9:00-16:00) hosted by Health Humanities at The University of Nottingham (Lead: Dr Heike Bartel) and First Steps ED (Lead: Kevin Parkinson, CEO).
This event involved presentations by academics, practitioners and males with experience of eating disorders and compulsive exercise where participants had the opportunity to take part in a number of case study workshops, discussion panels and get involved in the development of a new UoN HELM online learning and teacher resource which First Steps ED is investing in to make available to professionals working in support services for males.
This event will help to inform new care models and future service redesign, informed by research at The University of Nottingham and intended to be adopted by First Steps ED as the East Midlands Eating Disorder charity to help reduce the stigma males experience when seeking support.
Workshop Partners:
Health E-Learning and Media (HELM) Team at University of Nottingham is based in the School of Health Sciences and aims to provide expertise and support in the development, design, evaluation and research of technical and media-based educational materials and interventions in health.
University of Nottingham School of Health Sciences provide a range of undergraduate and postgraduate courses and degrees in the fields of nursing, midwifery, physiotherapy, sport rehabilitation, and applied health professions and have an outstanding reputation for teaching and research excellence.
Health Humanities (Improving Health and Wellbeing in Contemporary Society) is a new Research Priority Area (RPA) at the University of Nottingham bringing together established and enthusiastic eminent scholars from the United Kingdom and International academics and practitioners investigating how the arts and humanities can provide new opportunities for transforming healthcare and enhance physical and mental health and well-being.
Body Image in pregnancy: a study investigating body image during and before pregnancy (retrospectively).
Rebecca Woods & Dr. Kamila Irvine // School of Psychology, University of Lincoln
Background:
Pregnancy represents a period of drastic physical changes, and people’s bodies deviate from the socio-cultural thin ideal. These changes can lead to development and/or heightening of body image concerns in pregnant people. Existing research is somewhat inconsistent; some previous studies found that body image improves during pregnancy, while some recent research suggests that social media in particular has negative influence on body image attitudes during pregnancy.
Therefore, this study investigated the body image attitudes and the influence of social media in pregnant people.
Method:
Participants (116 identified as female, 1 identified as male) were aged between 20 and 45 (average age was 30.44). The participants completed questionnaires about their body image prior to pregnancy and about current (during pregnancy) body image. They completed questionnaires about: social media usage, societal influence on body image, internalisation of societal appearance ideals, fear of negative evaluation, body appreciation, and body dissatisfaction during pregnancy.
Summary of the Findings:
- People were generally happier with their body during pregnancy compared to pre-pregnancy. In particular, people reported feeling less influenced by society, cared less about being judged, felt less pressure to look a certain way and appreciated their body more during pregnancy. This could be because pregnancy represents a period of socially accepted changes, for example weight gain is normalised, which protects people from experiencing body image concerns.
- Using social media more frequently limited the improvement in body image during pregnancy. Although people became less worried about what other people think, spending more time on social media restricted how positive people felt about their body during pregnancy. This highlights the negative effects social media may have on body image during the perinatal period.
- Body appreciation predicted decreases in body dissatisfaction during pregnancy, which indicates that having an appreciation for their pregnant body protects people from developing body image concerns. This could be due to pregnant people becoming more aware that the bodily changes have important functions in helping their unborn child to develop. Therefore, by prioritising the needs of the foetus and motherhood, pregnant people can positively cope with the physical changes and become more satisfied with their body.
Study investigating attitudinal and perceptual body image in lesbian, bisexual and heterosexual women:
Megan Whitehead & Dr. Kamila Irvine // School of Psychology, University of Lincoln
Background:
Existing research into the role of sexuality in body image suggested that “sexual minority” women, particularly stereotypically masculine women, ten to be more satisfied with their bodies. The idea is that women who reject heteronormative beauty standards in society are less concerned about their looks and create their own community. Involvement in the community has been found to be associated with increased positive body image and reduced weight concerns. However, other studies have suggested that bisexual women are at higher risk of developing an eating disorder than heterosexual and lesbian women. Other studies have also found that internalised heterosexism and pressure to conform to ideals in order to fit in or to mask one’s sexuality can act as risk factors for poor body image and/or eating disorders. As such there is no research consensus yet about the role of sexuality, and no studies have investigated the perceptual body image in the context of sexuality. Therefore, this study aimed to investigate body image body satisfaction, size estimation, body ideals, and the role of masculine/feminine identity in lesbian, bisexual, and straight women.
Method: The study was completed by 199 women, they identified their sexuality as follows: 41 lesbian, 73 bisexual, and 85 heterosexual. They completed a number of questionnaires measuring their body dissatisfaction, body appreciation, fear of negative evaluation, self-esteem, and socio-cultural attitudes towards appearance.
Participants also estimated their current body size and ideal body size using a visual task where they use a slider to change the shape/size of CGI body model (see image). They change the shape/size of the model to 1) match their own and 2) to express the shape/size they would like to be.
Findings: analyses of the questionnaire data revealed that heterosexual women were more likely to internalise media messages compared to lesbians. However, there were no other differences in attitudinal body image (body appreciation, body satisfaction, self-esteem) between the groups.
On the other hand, the results found that feminine heterosexual women were more likely use media as a source of information than androgynous heterosexual women. Also, androgynous heterosexual women showed higher internalistion of athletic-based media messages compared to feminine heterosexual women. However, there were no differences in the attitudinal body image of bisexuals or lesbians based on gender expression.
Moreover, body estimation accuracy did not differ based on sexual orientation or gender expression. All participants over-estimated their body size (i.e. when asked to adjust the CGI stimuli size to match their own) when compared to their actual body size. Also, all participants rated their ideal body size as significantly lower than their estimated body size. Interestingly, ideal body size was statistically similar to participants’ actual body size. Finally, while we found no difference between ideal body size based on sexuality, feminine bisexuals had larger body size ideals than androgynous bisexuals.
Description:
Hannah Champion recently advertised her MSc research project via First Steps, which focused on the impacts of eating disorder stereotyping among the media, the public and the health profession. The key findings were as follows:
1. Eating disorders are often associated with the stereotype of a young, white, underweight female with anorexia nervosa, which the majority of research, diagnostic criteria and media portrayals of eating disorders are based on. Individuals with a history of eating disorders and self-identified as non-stereotypical identified a range of adverse psychological, physical and social impacts this had caused.
2. Participants described being underrepresented, marginalised and misunderstood, which led to delays among both themselves and family/peers in recognising their symptomology and/or failing to take it seriously. Moreover, only extremely underweight individuals with restrictive Anorexia Nervosa were considered worthy of help those, resulting in intense feelings of shame and embarrassment for those who were aware of their eating disorder. These issues both led to delayed help-seeking and barriers to early intervention.
3. The medical profession also reinforced the higher value of the stereotype. Specifically, primary healthcare professionals were described as failing to understand heterogeneity among eating disorder presentations, which led to non-stereotypical individuals being turned away, not receiving a correct diagnosis and being exposed minimising and invalidating attitudes by their doctor because they did not reflect the expected image. NHS eating disorder support services were also criticised for being over-represented with, favouring and targeting stereotypical service users – which is perhaps unsurprising if it is mainly these types of individuals who are being referred to services in the first place. This resulted in root issues of the illness failing to be addressed and subsequent delays in recovery.
4. The role of weight and BMI was a particularly significant. Most of the participants were not clinically underweight, at least in the initial stages of their illness. However, the findings alluded to eating disorders being perceived and understood as physical illnesses rather than serious mental health problems and that weight was being used to determine the severity of eating disorders and access to support. This resulted in a number of individuals intentionally try to lose more weight solely to gain a support service referral. Moreover, eating disorder treatment was as having little focus on aspects of recovery beyond weight restoration.
5. However, several others discussed the impact of effective support systems offered by the third sector and similar services – often in lieu of support referrals offered by their GP – such as BEAT, First Steps, online platforms such as Big White Wall and university services. These organisations provided person-centred and inclusive support, which helped participants feel validated and worthy of help, which enabled their recovery.
6. A need for change was raised, particularly in relation to increasing early intervention and recovery among stereotype-incongruent groups via better educating society and the health profession, as well as undertaking more research with samples that better reflect the heterogeneity among this population. The research also identified the importance of de-medicalising eating disorders, relaxing BMI guidelines for support referral, and emphasising holistic, individualised care.
Next steps:
Hannah is currently working with her supervisor at Swansea University to submit and publish the research in an academic journal.
Hungry for Words was an event that took place at The University of Nottingham, and it was targeted at Year 11 and 12 pupils, and their teachers.
As part of the programme, pupils were encouraged to share their experiences about their stresses, how they cope and how this impacts on their mental health and well-being. This event was part of a wider research project, which is investigating well-being, mental health and eating disorders.
First Steps’ workshop focused on some of the stigmas associated with body image in males. It aimed to get the cohort of boys talking about their bodies and looking at them in more of a positive way, rather than focusing on their flaws.
Social media was a theme throughout one of which was seen in both a positive and negative light.
Overall, the session was successful, with the boys highlighting how much it helped them to open up and have a discussion about their own body image experiences and difficulties.
Future plans:
First Steps are to be involved in ‘Hungry for Words: An interdisciplinary approach to articulating, communicating and understanding male anorexia nervosa’ as part of the Academic Health Science Networks.
Experience of parents of people with an eating disorder
Relationship between compassion and predictors of depression in parents of people with an eating disorder.
Name of researcher: Pamela Fox, Trainee Clinical Psychologist
Email: Pamela Fox at p.p.fox406@canterbury.ac.uk
What is the purpose of this research?
The purpose of this research is to explore the wellbeing of parents of a loved one with an eating disorder and see if there are certain experiences you might have as a carer that may contribute to depressed mood. This will help develop a greater understanding of the needs of carers and help develop interventions focussed on supporting carer wellbeing.
Who can take part?
You can take part in this study if you are a parent of someone with an eating disorder.
You also must be over 18 years of age and have a good understanding of written English.
What does the study involve?
The study will involve completing six questionnaires on an online platform. This will take approximately 30-35 minutes. The questionnaires will ask you about different aspects of your mood and thoughts about yourself. You will also be asked to provide some general information about yourself.
As a thank you, you will be given the opportunity to enter into a prize draw to win one of two £50 amazon vouchers.
How can you take part?
To read further information about the study please follow the link
(https://cccusocialsciences.az1.qualtrics.com/jfe/form/SV_6sPalN4b2uJOZtX)
This link will also guide you to the study page if you wish to take part.
If you have any questions about the study, please contact Pamela Fox at p.p.fox406@canterbury.ac.uk
Further Detailed Information about the research
Relationship between compassion and predictors of depression in parents of people with an eating disorder
Hello. My name is Pam and I am a trainee clinical psychologist at Canterbury Christ Church University. I would like to invite you to take part in a research study. Before you decide whether to take part, it is important that you understand why the research is being done and
what it would involve for you.
Talk to others about the study if you wish.
(Part 1 tells you the purpose of this study and what will happen to you if you take part. Part 2 gives you more detailed information about the conduct of the study).
What is the purpose of the study?
This research will be exploring your (a parent and carer of a loved one with an eating disorder) wellbeing and seeing if there are certain experiences you might have as a carer that may contribute to depressed mood. This will help develop a greater understanding of the needs of carers and help develop interventions focussed on supporting your wellbeing.
Why have I been invited?
You have been approached for this study because I am interested in understanding your experience and needs as a parent and carer of someone with an eating disorder.
Do I have to take part?
It is up to you to decide whether to join the study. If you agree to take part, I will then ask you to sign or provide electronic consent depending on how you would prefer to complete the study, on paper or online. You are free to withdraw at any time, without giving a reason.
What will happen to me if I take part?
If you agree to take part you will be asked to sign the consent form attached to this information sheet or follow the link below to be forwarded to this information online followed by a consent form.
This is to acknowledge that you have read these guidelines and understood the purpose of the study. https://cccusocialsciences.az1.qualtrics.com/jfe/form/SV_6sPalN4b2uJOZtX
There will be six questionnaires that will take you about 30-35 minutes in total to complete. You will also be asked to provide some general information about yourself. I am interested in your views so therefore it is important that you complete the research pack on your own.
At no point on any questionnaire will you be asked to provide your name or any identifiable information. The written and online consent forms will be separated from the completed questionnaires. Your responses will therefore remain anonymous.
Once you have completed all the questionnaires please place them in the envelope provided and seal it. If you are completing this at the carers support group please return them to me. If you are completing them at home, please return the completed research pack in the stamped addressed envelope provided. Alternatively please use the online
questionnaires as advised.
What are the possible disadvantages and risks of taking part?
It is not anticipated that any physical or psychological harm will occur from participation in this study. However, providing care can be a stressful activity and some of the questions may make you more aware of these difficulties.
What are the possible benefits of taking part?
Your views will help develop the understanding of carers’ experiences and needs. The information you provide will contribute to my research thesis. The findings will hopefully be published in an academic journal. You will be asked at the end of the study to provide your email address if you would like to receive a summary of the findings.
As a thank you, you will also have the option to enter into a prize draw to win one of two £50 Amazon vouchers for completing the research pack.
What if there is a problem?
Any complaint about the way you have been dealt with during the study or any possible harm you might suffer will be addressed. The detailed information on this is given in Part 2.
Will information from or about me from taking part in the study be kept confidential?
Yes.
Answers you provide to the questions will be kept separate from your consent and contact information if you have provided this (i.e. to receive a summary of results and/or prize draw).
Therefore, your answers will remain anonymous.
We will follow ethical and legal practice and all information about you will be handled in confidence.
This completes part 1.
If the information in Part 1 has interested you and you are considering participation, please read the additional information in Part 2 before making any decision.
Part 2 of the information sheet What will happen if I don’t want to carry on with the study?
If you withdraw from the study, we would like to use the data collected up to your withdrawal.
Complaints
If you have a concern about any aspect of this study, you should ask to speak to me and I will do my best to address your concerns. You can contact me by leaving a message on the 24-hour voicemail phone number 01227 927070. Please leave a contact number and say that the message is for me [Pam Fox] and I will get back to you as soon as possible. If you remain unhappy and wish to complain formally, you can do this by contacting The Research Director, Professor Paul Camic on 01227 927114.
Will information from or about me from taking part in the study be kept confidential?
- All information which is collected from or about you during the course of the research will be kept strictly confidential.
- All data will be stored at the University for 10 years (in locked storage if completed offline and on a password protected computer if completed online).
What will happen to the results of the research study?
It is my intention to prepare these findings to be published within an academic journal.
However, prior to this, if you have provided your email address with the intention of receiving a summary of results then these will be sent to you. If you have taken part in this study at your local support group I will send a summary results there. The results of the study will also be made available on the study website: https://cccusocialsciences.az1.qualtrics.com/jfe/form/SV_6sPalN4b2uJOZtX
Who is organising and funding the research?
This study is being funded by Canterbury Christ Church University as part of my training towards becoming a clinical psychologist.
Who has reviewed the study?
All research in the NHS is looked at by an independent group of people, called a Research Ethics Committee, to protect your interests. This study has been reviewed and given favourable opinion by The Salomons Ethics Panel, Salomons Centre for Applied Psychology, Canterbury Christ Church University.
Further information and contact details:
If you would like to speak to me and find out more about the study or have questions about it answered, you can leave a message for me on a 24-hour voicemail phone line at 01227 927070. Please say that the message is for me [Pam] and leave a contact number so that I can get back to you. Alternatively, you can email me; my email address is
p.p.fox406@canterbury.ac.uk
We’re proud to have supported Student Minds on a groundbreaking research project to understand the provision of support for students with eating disorders across the UK, with the aim to make national recommendations on what we can be doing better to support student wellbeing.
Eating disorders huge impact on a young person’s life, and for those who are impacted, it can involve a range of emotional and psychological challenges. While an eating disorder can have a severe impact on a student’s quality of life, with the right help students can and do recover from eating disorders. We’ve met hundreds of incredible students that have done just that.
Nationally, it is thought there may be gaps in specialist support for students experiencing eating disorders and reports of students being turned away from help due to increasingly limiting ‘thresholds’ for statutory NHS services. However there was not a comprehensive national view of what this looks like and we needed to undertake research and speak with students and professionals to truly understand the picture.
Which is why Student Minds, in partnership with King’s College London (KCL) and a wider coalition of additional academic and charity partners, decided to work together on new research which explores the experiences of students with eating disorders with recommendations as to what we can do together to improve their wellbeing.
Student Minds, the UK’s student mental health charity, have shared the findings in a new informative report: ‘Supporting Students with Eating Disorders‘.
The report interweaves findings from an audit into the lived experiences of students accessing eating disorders support, with testimony from a panel of subject experts and the existing evidence base. It is now available to read on their website, where you can find out more about the challenges facing students with eating disorders at university, and importantly what we can do to help them. The report also discusses the role of health inequalities in this context and how the Covid-19 pandemic may impact these students.
The First Steps ED’s Skills for Carers team and parents supported this research and report published by Cambridge University Press on behalf of the Royal College of Psychiatrists. The paper captures their reflections and experiences, with the hope that it may contribute to future changes and improved care for families in a similar position to themselves in future.
To read the full report, click here.
Parents of a loved one with an eating disorder report high levels of unmet needs. Research is needed to understand whether clinical guidance designed to improve the experience of parents has been effective.
Aims
To establish parents’ experiential perspectives of eating disorder care in the UK, compared with guidance published by Beat, a UK eating disorders charity, and Academy for Eating Disorders, the leading international eating disorders professional association.
Method
A total of six focus groups (one online and five face-to-face) were held throughout the UK. A total of 32 parents attended. All par- ticipants were parents of a loved one with a diagnosis of anorexia nervosa or atypical anorexia nervosa (mean age 22 years; mean duration of illness 4.4 years). Focus groups were transcribed, and the text was analysed with an inductive approach, to identify emerging themes.
Results
Four key themes were identified: (a) impact of eating disorder on one’s life, (b) current service provisions, (c) navigating the tran- sition process and (d) suggestions for improvement.
Conclusions
Current experiences of parents in the UK do not align with the guidelines published by Beat and Academy of Eating Disorders. Parents identified a number of changes that healthcare providers could make, including improved information and support for parents, enhanced training of professionals, consistent care across all UK service providers, policy changes and greater involvement of families in their loved one’s care. Findings from this project informed the design of a national web-survey on loved ones’ experience of care in eating disorders.
DATA ANALYSIS PENDING.
Thank you to everyone who supported a new experiment being conducted at the University of Oxford, designed to learn more about the roles reading can play in eating disorders and recovery. It involved reading a book about anorexia recovery (pre-publication) or a book about an unrelated topic, depending on which group you’re randomly allocated to, over a 2-week period. Participants’ responses will guide publication decisions for the anorexia book, called The Hungry Anorexic, including potential edits and whether it gets published at all.
You can find out more by clicking here.
Exploring the perceptions of social media through the eyes of those with and without eating disorders (2017)
Description: Selina Hussain recently involved First Steps in her research project. Selina’s work highlighted the following:
- Extensive amount of research has found social media to have a negative influence on an individual’s mental wellbeing through negative self-evaluation.
- Results found that there were 7 fundamental factors influencing one’s self-perception and mental wellbeing: Social Media Interactions, Emotional Responses Associated with Social Media, Media Portrayal, Life Experiences, Understanding Eating Disorder Symptomology, Personal Experiences of Eating Disorders and Identified Personality Attributes.
- The study supported that of previous studies which demonstrated that social media has a negative impact on one’s self-perception and mental-wellbeing, contributing to the development and maintenance of eating disordered behaviour.
Patient and Public Involvement work to develop research questions relevant to individuals with mild to moderate eating disorders (2017)
Description: Recently, we had the privilege of supporting student Justin Tetlow with his research project. Some of our service users and workers were involved in the work. Justin is able to now report his key findings, which are:
- There is a perception that there is a lack of GP knowledge of Eating Disorders. Therefore an education package may need to be developed for either medical students or GP Trainees.
- For mild to moderate EDs, BMI is often not relevant. An alternative diagnostic criterion may be useful perhaps based on ED behaviours.
- Continuity of Care was a priority for many EDI’s and carers. This may be crucial in the management of mild to moderate ED in primary care.
- Questions for GPs to screen patients for EDs were summarised during the PPI events and future research could validate these.
The most practically useful thing to come out of the project is the potential to replace SCOFF.
Would you like us to share or promote any upcoming research or support a dissertation?
We are happy to support relevant research opportunities and dissertations here at First Steps ED. If you would like to feature here, please send in your information via our ‘Research Request Form’ below!
Research Request Form
If you would like to feature on the First Steps ED website, please send us your information making sure to attach your Ethics Sign Off and any other flyer or leaflet you’d like to share. Submit your research request using the form below or email naomi@firststepsed.co.uk. Please be aware response times may be longer than usual and projects are not guaranteed to be supported.
