Eating Disorders in the UAE with Sage Clinics

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Eating Disorders in the UAE

Speaker A:
Hello and welcome again to the JenUp podcast. If you’re struggling with an eating disorder and feeling lost, you’ve certainly come to the right place. Both Becky and I are former sufferers of eating disorders and we understand the challenges you’re facing. Join us for inspiring educational and relatable content. Whether you’re seeking support, guidance, or just someone who understands, we are here for you. We have Dr. Vicky Mountford here today. She is the lead clinical psychologist and eating disorder service lead at Sage Clinics in Dubai.

Speaker A:
She’s previously worked at the Maudsley Hospital in London. She has over 20 years of experience working with individuals with eating disorders and body image concerns with their families. She has also published widely on eating disorders and provides supervision and training for clinicians. And in 2020, she was jointly awarded the Outstanding Clinician Award by the Academy of Eating Disorders. So it’s with great pleasure to introduce Vicky. If you’d like to say hi to everyone, Vicky, that would be great.

Speaker B:
Hi, it’s such a pleasure to be here. Thanks very much for asking me to be on the podcast.

Speaker A:
Yeah, no, it’s not a problem. So how’s it working in Dubai? I’m jealous.

Speaker B:
Well, I think we’re actually in about 40 degree heat at the moment. We’re right in the middle of summer, so it is very hot and very humid. So I think you might be having a heat wave in the UK right now. But apart from the, apart from the very, very hot weather at the moment, it’s brilliant to be here. It’s a really exciting place to work and to live as well.

Speaker A:
So that’s great. Yeah, I’ve. I’ve never been to Dubai, but I’ve always wanted to go. And the heat, obviously I can take about 30, 35 degrees, but 40 is just way too much for me.

Speaker B:
We come in winter then, and we are right next to the Burj Khalifa, which is the tallest building in the world. So you’re very welcome to come and say hello to us here at the clinic.

Speaker A:
Okay. Okay. That’s cool. So in, in terms of treatment, obviously you work with eating disorders in the UAE, so are there any ways that you have to adapt treatment out there for eating disorders?

Speaker B:
So I think the UAE is a really interesting place because it’s extremely diverse and actually only about 12% of the population are Emirati. And we have around 200 different nationalities all living together in UAE. So basically we have people from all around the world. And so of course there are many different cultural beliefs around mental health, eating disorders, the role of the family or other support networks such as religion. And there’s also lots of different levels of knowledge and awareness of mental health in the first place. So when we’re working here, we really want to use a culturally informed approach. So what I will do is explore someone’s beliefs and understanding and also that of their family, because that’s often essential and trying not to make any assumptions. And then we sort of think about how the existing treatments, which have mostly been developed within the Western world, how they can be appropriately adapted.

Speaker B:
So, for example, some of the differences might be that young or unmarried adults may still be living with their family. So we might want to think a lot more about how we involve the family than, let’s say, you know, a young adult who’s living in the UK and maybe is living independently. We also know for a lot of families here, lunch will be the main meal of the day, so rather than dinner. So we kind of need to think about that. And we also need to make sure that things such as meal plans are adapted to the family’s normal cuisine and normal way of eating. And I think the other thing that I would add on is Ramadan is really important here in the UAE. It’s a very sacred time for Muslims. There’s a big emphasis on family gratitude, worship and prayer.

Speaker B:
And Ramadan involves fasting through the day and then breaking that fast at sunset at Iftar. So it’s a wonderful time for many people. But of course, it can be really challenging for someone with an eating disorder explaining this to their families. So we have to often think really hard about how we plan and support a person through this time.

Speaker A:
Yeah, I think we’ve spoken about that previously on another podcast about the fasting and how that’s quite triggering for someone with an eating disorder. I mean, it’s really good that we’ve touched. What would be your tips on that? How would you work around that especially?

Speaker B:
So it’s really tricky because a lot of the time the advice from us might be to not fast during Ramadan. And it’s absolutely appropriate to not fast if you are, if you are unwell. However, that’s also really challenging for a lot of people to think about not fasting. And sometimes people feel like they’re missing out on, you know, what is kind of the most important time of the year for them. So, you know, we work with them. If it’s someone who is severely unwell, you know, we really strongly advise that they don’t fast.

Speaker B:
But otherwise we’ll work with them to think about, what support do you need? You know, Iftars are often big buffets. So if you’ve been fasting all day, it’s really difficult for people who have a binge eating disorder to manage that transition. So we’ll give lots of advice about how you might space your food out, what distractions you use, who you might speak to in your family about what support they can give you.

Speaker A:
Okay, yeah, no, that’s really good advice because I assume that everyone’s different. Really just tailor it towards. Absolutely personalised approach to it. Yeah, yeah.

Speaker B:
And talking with that person about what they’re worried about, you know, what they’re looking forward to. And the other thing we do is we talk about how else can you get involved? You know, for example, through prayer, reading the Quran, making gifts. You know, all of these are part of Ramadan. So, you know, how can you do it? It doesn’t have to be that the focus is only on the eating.

Speaker A:
Okay, okay. How long is Ramadan? Sorry, I just like to know how long?

Speaker B:
Yeah, it’s about a month. So it’s a long time. And here we have reduced working hours. The schools change their hours. So it’s a really big part of culture here. You know, it’s really, really incredibly important. And then after Ramadan, we have Eid, which will be maybe four days, maybe a week. And Eid, again, is a really big time of celebration.

Speaker B:
Visiting family, you know, so often for people, it’s really challenging. And again, there is a little bit, you know, for some people, as they’re, you know, there’s a little bit of a thought of, oh, I’m going to use Ramadan to lose weight, you know, and actually, we want to get away from those kinds of thoughts because that, again, kind of, it’s a tricky thought for some people to have.

Speaker C:
Yeah, anorexia, can’t it? If especially to have that whole month’s worth of, like, being able to not eat and be able to be able to get away with it, that must be really difficult. And then also the possible, the guilt and the shame around it of not being able to participate.

Speaker B:
Absolutely. Those things are all really, really true. So. And these are all the kinds of discussions we have with patients and their families. You know, what are the risks of doing it for you, for you, of fasting at this stage in your treatment versus how we weigh that up with. Do your family understand why your doctor’s recommending this? And how can we, as I said before, you know, how do we keep you still involved even if you’re not going to be doing the fasting or even, you know, sometimes it can be more practical things like often iftars, you know, will have. They’ll be big and they’ll have many, many family members around. You know, they’ll be really joyous occasions.

Speaker B:
So maybe if someone is at a certain stage in their recovery where they are fasting, but maybe iftars are just, you know, the close family group, fewer people, so it’s less stressful. There’s lots of different ways, as you said, that we can think about it and personalise it.

Speaker A:
That’s really good to know. So thank you for that. I’m glad we touched on that. So it’s really good. I mean, are there any. I don’t know what it’s like out there, but are there any stigmas around eating disorders in the UAE?

Speaker B:
So I think stigma and lack of awareness exists anywhere. And this can also be the case in the UAE. And I think it’s often through a lack of knowledge. So, you know, sometimes behaviours such as binging and purging aren’t recognised as difficulties that could be arising from an eating disorder. You know, it’s maybe seen as a bit more normalised than that. And weight loss may be seen as a good thing. And so people can be a bit, you know, surprised when suddenly that weight loss accelerates and becomes an eating disorder and a real problem. And I think it is some, it’s hard for some people to recognise an eating disorder as a psychological disorder or a mental health problem.

Speaker B:
So, you know, there will still be some thoughts around, you know, you just need to eat. And I think, you know, one of the things in UAE is we don’t have many specialist eating disorder clinicians or intensive treatment centres that eating disorders don’t get as much as attention. And so obviously the less attention something gets, the less well known it is, the less people are likely to be able to challenge that stigma. However, there have been some really good recent developments. Dubai has just launched its mental health framework and introduced primary care screening for anxiety, depression and eating disorders. So this is great. This is really going to help to raise awareness.

Speaker B:
And we also have some great people working in the media here to raise awareness and reduce stigma. So, you know, my team and I will appear on podcasts, on the radio, in a newspaper to talk about eating disorders, you know, and where we can, we like to have someone with lived experience as a patient or a carer, because I think that really brings it home to people. And the other thing I think is we have a lot of School counsellors who are really good at picking up the signs and having those initial conversations with parents. So often it’s a school counsellor that kind of flags the concern first. So we’re working to address that stigma and raise awareness. But as you know it, it always takes time.

Speaker C:
It is a battle with mental health even here. It’s a massive battle. It’s lots better. But I think it is, it’s talking and having the confidence to talk and getting people to hear.

Speaker B:
Yeah, absolutely.

Speaker A:
Yeah, no, definitely. And what’s the most common type of eating disorder that you’re treating and seeing at the minute?

Speaker B:
Yeah, so I think this kind of falls into two areas and we see a lot of young people, girls and boys. So I’m seeing an increasing number of boys with anorexia. And this is probably because I said school counsellors are really skilled at picking up the signs. And we know that anorexia presents in a really dramatic way. And understandably, parents are often very worried. So that I think is one of the, that’s probably the most common eating disorder that I treat. And actually I’m seeing children getting younger and younger. So we’re seeing kids at the age of 10 with really serious eating disorders.

Speaker B:
But I think there’s a second group as well that maybe we don’t see as much because it’s under recognised. But this is adults, including men with binge eating disorders. And I think what happens is that many people actually come into treatment because they are depressed or because, you know, they come from a referral from a dietitian because the diets never seem to work. And I think, you know, in UAE there’s a lot of delicious, easily available foods. So we have a lot of drive throughs, we have a lot of takeaway and that makes it really hard for people to manage bingeing if it’s driven by hunger or emotion. So I think, you know, there’s a number of people out there with a binge eating disorder presentation who maybe aren’t recognising that it’s a psychological disorder.

Speaker A:
Okay, that’s interesting. Did you want to say anything on that, Becky, or.

Speaker C:
No, just it’s. I think it’s just knowledge, isn’t it? And that part of education and knowledge and awareness around it. And the other thought I had through my head, it’s if you’ve got lots of food that’s readily available, it’s a lot of UPF, ultra processed food. So you’re naturally going to want to eat more of it because your gut system’s not going to register it and process that you’re not full up. So it is like an awareness of choices and balance. It’s not ruling all of that out, but I think it is about more of a balance and awareness around the UPF foods.

Speaker B:
Absolutely. And we know that restaurant food or, you know, takeaway food is often a larger portion. Often, you know, there are offers to make you buy more. So all of these things lead into over ordering and then making it harder for people to understand portion sizes and control their eating.

Speaker C:
Mean.

Speaker A:
Yeah, no, it sounds it. Well, the sugar and everything. So it’s very addictive, isn’t it? So as well. So interesting that you said, like, it goes unrecognised. And also with the anorexia, how, obviously we’re seeing that here as well. Becky and I get referrals through for young people with anorexia pro from the age of 11. I’m seeing it happen younger and younger.

Speaker A:
And why do you think that is happening, especially where you are as well?

Speaker B:
Yeah, so that’s a really tricky question and I’m really going on probably gut instinct rather than science, I think. I mean, obviously COVID really disrupted things for a lot of people. I think what we find in general is, you know, young people are maturing earlier and earlier. So the things that would have bothered you at 14, you’re now very much aware of at 10 or 11. You know, we see all the young girls in Sephora trying on the makeup. You know, those beauty ideals have really kind of kept creeping down the ages. I think children are a lot more sophisticated.

Speaker B:
And while we, while I think, you know, social media is one factor among many. You know, definitely when I work with young people, it’s often about I want to look like them. So definitely those beauty standards are registering. I think the other thing that we see that’s really interesting in the UAE is young people go through a lot of transitions. So they may come from a family where they’ve moved around various different countries. Some of them are third culture kids. They exist in schools and friendships groups where often people move on quite quickly, you know, compared to, let’s say, you know, a child that grows up in a, you know, somewhere in the UK where there’s a lot more stability. And so, you know, transition can be really exciting.

Speaker B:
But we also know even positive transitions are times of stress. So, you know, if you completely move from one side of the world to the other, what’s the thing that you can control? Oh, I can. I can come down and control my food. Plus I’m now living in a very different environment. So I wonder as well if something about, you know, the number of transitions, the number of influences that are young people are now experiencing is kind of increasing that risk at an earlier age.

Speaker A:
Yeah, I think social media has definitely got a lot to answer for as I work a lot in schools here in the UK and I do see, you know, they’re on TikTok all the time, they’re on Instagram, they’re seeing this perfect life and things perfect every day. So, you know, no one’s going to post their bad day, are they? Like, you know.

Speaker B:
I think the other thing that I’m seeing is, you know, what we call bigorexia. But I’m getting, you know, teenage boys coming and it’s not that they want to lose weight, but they want to get a lot more muscle, a lot more lean. So, you know, they’re becoming very preoccupied with their macros, their proteins, they’re really calorie counting, they’re exercising excessively. But it is driven by, I guess, the same mechanism, thoughts around, I need to look this way. Yeah, to feel good about myself.

Speaker C:
All low self esteem, isn’t it? It’s that not being secure within your base of who you are and that trying to constantly evolve and be better, but getting it to the ultimate extreme.

Speaker B:
Yeah, absolutely. And of course, you know, one of the things we know about all the eating disorders is, you know, once you get into that cycle, it often only gets stronger and very hard to get back out of that cycle.

Speaker C:
It’s very like from my own experience, that addictive cycle of chasing and chasing and chasing and because of my ADHD brain, it’s, it’s trying to change the control and the addictive number and off I go again. And I think understanding that and knowing that I’m always going to be chasing dopamine, it’s finding instead of having unhealthy dopamine, it’s chasing. Yeah, chasing healthy dopamine now instead of the unhealthy. But it’s always that low self esteem that bubbles underneath that never really gets addressed until you get into therapy.

Speaker A:
Yeah, exactly, exactly, yeah. In terms of beauty standards, it sounds like it’s quite high out in the UAE as well as big emphasis on it as well out there.

Speaker B:
Yeah, absolutely. And I was sort of thinking about this because obviously I’ve come from the uk, I’ve come to UAE and I go back to the UK to see family and friends and I think when you are out, you do see that people have taken a lot of time, money and care with their appearance. And I think, you know, thinking about the UAE, that’s probably down to a number of different things, but a lot of the population is relatively young. A lot of people have moved to a new country, so there’s a bit of an opportunity to reinvent yourselves. And many people have more disposable income than in their home country. And I think as well, we get drawn to what’s normal in the environment that we’re living in. So, for example, we’ve got a lot of beauty salons, cosmetic surgeons here. So I think that kind of serves to normalise doing these things, increases the focus on beauty standards.

Speaker B:
And I think what’s really interesting is because we’re very multicultural, there may be many different beauty standards across the different cultures that are in UAE, and I think that can be quite confusing or challenging for young people. Kind of, you know, what is the beauty standard that I’m following? And, you know, that’s really confusing. Even though we would say as clinicians in this field that we want to move away from beauty standards altogether, there’s even confusion around the many different beauty standards that exist, you know, and I think our beauty standards come a lot from, or they’re influenced a lot by our friends, social media again, and what we see around us. So, you know, now we’re in this environment, these are the messages that we’re getting. And, you know, we know that Dubai attracts a lot of influencers. You know, there’s a lot of. I think there is a lot of emphasis in Dubai on beauty standards.

Speaker A:
Yeah. If you’re surrounded by all the time as well, you’re gonna, you know, that’s the thing, isn’t it?

Speaker B:
Absolutely. It becomes very normal and then it’s really hard. Yeah. To step out and think, I’m going to be the one that that’s different, you know, so we, we can see a lot of people around, I think, who are working towards those. Those beauty standards in terms of looking a certain way, you know, a certain way useful and so on.

Speaker A:
I guess it’s just then recognised when it gets to the point where it’s like, you know, is this taking over my life? Like, how much of this is consuming my life? Is it, you know, all that kind of stuff and, you know, what it’s affecting and what, you know, what that’s going to take away from their life as well? Yeah, absolutely.

Speaker B:
And. And I think that’s becomes really difficult, doesn’t it? Because everybody, if everybody in your social circle is kind of doing a similar thing.

Speaker A:
Yeah.

Speaker B:
It’s tricky because you get, you know, adapted to that and that becomes the new normal.

Speaker A:
Yeah. What, if you don’t mind me asking, what advice would you give for that?

Speaker B:
Oh, that’s a really good question. I guess it’s about what, I guess what I always talk about is what are your values? So how do we. Because it’s, you know, it’s, it’s understandable that people are aware of beauty standards, whether you’re in the UAE, whether in the UK, you know, we’re all aware of beauty standards. But it’s, do I base my whole life and my worth on whether I fit this beauty standard or not? So I think it’s really normal and it’s healthy to kind of, you know, want to make the best of what we have. And, you know, if we’re going out on a Saturday night, we want to make an effort look good, but it’s when does it begin to take over your life and compete with all your other values? So that’s the balance that we need to find. And that’s a tricky one for some people, I think.

Speaker B:
And, you know, it’s interesting. I also. Quite a lot of people with body dysmorphic disorder here, so. Yeah, so we see that body image is a big thing. And I think, you know, as Becky was saying earlier, if you’re not feeling so good about yourself in other ways, your body image often feels like something that you can fix quite quickly. And, you know, if you can fix that through cosmetic surgery or weight loss drugs or something that feels like a quick fix, then that’s understandably going to be appealing.

Speaker A:
Yeah.

Speaker B:
Yeah. So I, I think so I went off the point a little bit, but I think, you know, my voice, my advice would be how do you connect with your, your bigger values and how do you, you know, focus more on the bits that you like rather than the bits that you consider aren’t good enough.

Speaker A:
Yeah.

Speaker B:
And again, I guess it’s up to the individual to think how much do they want to do, you know, how far do they want to go in terms of meeting those beauty standards? Because everybody’s different. Yeah, but it, but it’s how do I balance that with my.

Speaker C:
Sense of self and mental health balance, isn’t it? I think. And also the psychological side of it, because if you, you’re not liking you deep down, that wholesomeness, you can constantly be chasing this, this dream of idolisation and also, like, just something else that my, where my thoughts went is where I like with my ADHD, I distort images. Like, that’s just how my brain processes. So if you’re not aware of that, that will also fuel that constantly. So, like, I know that if I’m having a distorted day, maybe because I’m tired or I miss misfiring in my brain, I can’t be looking at things. I’ve got to come away from it all. And I think they all interlink with that body dysmorphia.

Speaker B:
Yeah, absolutely. And, you know, and even things like mood or what you’ve eaten can really affect those things as well. You know, someone may make a fairly innocent comment, but for you, that’s kind of really triggered off some thoughts. So, yeah, I think you’re right. Our body image can really fluctuate as well. And one of the things I work with with my patients is, you know, that kind of body neutrality. So I don’t have to love my body, but how do I, you know, see my body as something that gets me from A to B, Something that I, you know, look after all of these things, rather than it being something that I’m constantly kind of beating myself up for.

Speaker A:
No, I love that. I think it’s appreciating what your body can do for you on a daily basis. Because I know that I didn’t do. Because I suffered like with a lot of injuries just due to my past, and I took that for granted. And now I just appreciate the small things, really. So, yeah, just, you know, kind of being able to like, go for a run or something or like, you know, all that kind of stuff. So I just appreciate that because I’ve, you know, and when, when you, you don’t.

Speaker A:
Once you’ve, you know, you can lose it before you start to appreciate, you know. Right. That’s the thing. But you don’t want to get to.

Speaker B:
That point, you know, and it’s so important, isn’t it? All those little things that you can appreciate rather than this kind of constant nagging sense that you’re not good enough because of your weight or some other aspect of your appearance.

Speaker A:
Yeah, no, definitely no. Thank you so much for that. I think it’s so important to touch on that because I think a lot of young people do struggle with that also. I think hormones play a big part as well. They can like, have massive. I know I struggle with that. Massive, like, bodily changes, stuff going on. Your body, your body doesn’t, can’t look perfect every day. It can’t look the same every day. It’s realistic. Get that out your head.

Speaker B:
I completely agree with you. And I think often quite some people are quite shocked when you say that to them. That hasn’t occurred to them that maybe it’s impossible to look your best every day, but also maybe this feeling will pass. And I think, you know, that’s the other thing that I say to people about body images. It’s okay to have a bad body image day. That doesn’t mean you’ve progressed or that you’re, you know, you haven’t been successful in working on your eating disorder. That’s something all of us go through. And just recognising it, looking after yourself and knowing that it’ll go, it’s really, really important.

Speaker A:
Yeah, no, definitely no. Thank you so much for that. I’m sure everyone will find that useful, listening to that. And I think it’ll be good to touch on a bit of a different topic. But I wanted to touch on it before we finish off. It’s quite a big topic in the UK and I hear it is out in the UAE as well, the weight loss drug Ozempic. So just going to touch on it. Why, why do you think this drug use has gone up, especially within the UAE as well?

Speaker B:
Yeah, well, I think it’s become popular because people are suddenly aware of it. You know, we’ve had lots of celebrities and A listers suddenly looking very different and many people on social media praising it and showing off their weight loss, weight loss transformations, you know, and I can see even just in Facebook groups, people saying, where can I get this from? You know, so people are really, really aware of it now. And of course a lot of the people who’ve been using it have been losing lots of weight and that kind of puts us back to a time where we’re really idealising thinness and reinforcing weight stigma. I don’t think we have a lot of data exactly on who is using Ozempic, particularly because maybe some people are using it without prescription. And I wanted to say I think there is a role for WeGovy, which is the version licensed for weight loss, but only if that’s done under strict medical supervision. What I am noticing in my clinic is that patients with eating disorders who are within the healthy range, healthy weight range, or even at the lower end of the healthy weight range are using Ozempic. And this is really concerning because I think it’s, it’s really feeding into the eating disorder. So it’s feeding that desire for thinness, you know, keeping the eating disorder going.

Speaker B:
And we know that Ozempic is going to disrupt the process of regular eating, it’s going to disrupt your appetite cues and so on. So it’s really interfering with some of the things that we’re trying to do in treatment about helping people to understand their bodies more. And we really don’t know yet the long term effects of these drugs. So you know, when I, when people do come to my clinic and they’re on Ozempic, we’re really working with them to think about, to explore it and to think about how we can stop it. But yeah, it really concerns me and I think we’re likely to see some quite big problems in the future coming from those who had an eating disorder and got caught up using Ozempic.

Speaker A:
Yeah, no, thank you for that. I’ve just seen a lot in the news about it, especially here in the UK, a lot of people using it. And as you said, the biggest takeaway from that is that you don’t know the long term side effect. We don’t know. Are you willing to risk that?

Speaker B:
Yeah, exactly. And you know, and some of the early stuff that’s coming out is worrying. And again I think what we’re hearing as well is, you know, possibly this might be a drug that you need to be on for life. You know, it’s difficult for people to sustain the weight loss, particularly if they don’t make sustainable lifestyle changes while they’re taking it.

Speaker C:
Okay, isn’t it? Because you’re then going round in that I’m not good enough phase and cycle.

Speaker A:
Yeah, absolutely, yeah, that’s not good. Anything else do you want to ask on that Becky, before we finish up?

Speaker C:
No, I think you’ve just covered it. It’s not sustainable. It’s making those undercurrent changes that would be triggering all of that in the first place. And I think it is the, the quick fix. Everybody wants it now and it hits that button for the now. But actually in the long term, if the psychological side around food is not met or those beliefs from how you’ve been brought up or where, where those thoughts. Is it like a neurodiversity thought process that goes on? They’re all interlinked. If these things are not addressed, then you sort of set up to fail on the drug and the financial part of that as well.

Speaker C:
That must just cost so much money.

Speaker B:
Absolutely, yeah, definitely.

Speaker A:
Oh well, thank you so much for coming on. It’s been great to have you on, Vicky, and some great topics and I’m sure everyone’s gonna listen to this. Hopefully going to find some useful information especially about body image. Some tips around that respect your body daily. Treat it with care and love. I posted about that recently on my Instagram. Just I think it’s really important. But Becky’s gonna finish off the podcast and say bye to everyone.

Speaker B:
Well, thank you so much for having me on the pleasure to talk to you both.

Speaker C:
It’s been lovely to meet you. Thank you so much for listening to JenUp Podcast. Please subscribe and share this podcast so others can benefit. You can find us on Facebook and Instagram @AskJenUp on Jenny’s website at JenUp.com. If you visit the website and you find lots of different resources available there, please like, share and subscribe.

Speaker A:
Thanks guys. Take care.

How to get help?

Jenny Tomei is a Nutritional Therapist and Eating Disorder coach. See all her credentials on her About Jen page and then should you need help then make contact with her today. Your road to recovery can start now!