Your questions answered

FREED is a flexible evidence-based treatment approach focused on early intervention; making it much more effective than traditional treatments at reversing the changes to brain, body and behaviour caused by eating disorders. 

The FREED service was developed and tested by the South London and Maudsley NHS Trust Foundation’s Eating Disorders Unit and King’s College London. When FREED was compared with “business as usual”, FREED reduced the amount of time an eating disorder was left untreated. FREED patients waited less time for assessment and treatment and had better treatment outcomes. Most made a full recovery from their eating disorder within one year. Using the FREED service was a positive experience for patients, carers and staff.

FREED confirmed that treating people as early as possible leads to better results for eating disorder treatment.

In 2016, FREED was introduced to three new eating disorder services in the UK. In 2018, FREED was introduced to eight new services. By 2020, we hope that at least 20 services will be using FREED. FREED is also being used in South Australia under the term EmergED.

People sometimes ask why FREED is only for those aged 16 to 25 with an eating disorder of up to three years. If someone has only been unwell for a short time treatment seems to work better. This is most true during adolescence and young adulthood. People with eating disorders also experience changes to their brain, body and behaviour. In the first three years of illness these changes are more easily reversed. 

Eventually, we hope that everyone with an eating disorder will be able to access tailored, specialist treatment quickly. FREED is one step towards this goal. 

After three years, eating disorder symptoms tend to become “hard wired” in the brain. Symptoms can still be changed, but it gets harder to make changes. There may be long-lasting consequences. The sooner you get help, the easier it is to recover quickly and fully. Early intervention also means you are less likely to miss out on study, relationships and other opportunities because of your illness.

There are two key things that stop early intervention for eating disorders: difficulties spotting the illness early, and difficulties getting help. You can use our quiz “Do I have a problem” to see if you have difficulties that need help. You can use our guide to seeking help and support for assistance with getting the help you need.

The brain is made up of white and gray matter. White matter connects different parts of the brain with one another. It also sends messages between the parts. Gray matter is responsible for all the brain’s most important jobs like memory and planning.

Technology has allowed us take detailed pictures of the brain. This has allowed us to look at how the brain is influenced or changed by illnesses like anorexia nervosa. Studies have collected brain images from people with eating disorders and compared them to those of people who have never had anorexia. These studies have shown that adults with anorexia have less white and grey matter in the brain than people who have never had anorexia. This means that their brains are smaller in size. In fact, the brain of someone with anorexia can look similar to the brain of someone with dementia, a very serious disease of the brain.

We do not know exactly why the brain shrinks in anorexia. It may be due to damage caused by starvation. As the brains of young people are still developing up until the mid-20’s, their brains may be particularly affected by anorexia symptoms. In fact, we may see even more brain shrinkage in these younger people.

One very important question: Can brain shrinkage be reversed with recovery? The answer seems to be YES! A review of a number of studies showed that once people had returned to a healthy weight, there was an increase in the amount of white matter in the brain. Moreover, after staying at a healthy weight for a few years there was also improvements to grey matter. In fact, there was so much improvement that there were no longer any differences in brain size between those with anorexia and those without.

Although these findings are positive and encouraging, we still have a lot to learn. We still don’t exactly know how eating disorders affect brain shrinkage. We also don’t know if there are areas of the brain that are more affected than others. Or if some damage cannot be reversed. 

One thing we can be certain of is that the earlier we can provide help the better. The sooner you combat an eating disorder the better the outcome for the brain is likely to be.

Some of our Stories are from people who have recovered from their eating disorder without FREED treatment. They talk about how early intervention might have helped them, but also show that you can recover even after a long period of being unwell.

Before you start eating disorder treatment, you will need to be referred to an eating disorder service. In some areas, you can self-refer but most services require a GP referral. Our Help and Support guide talks more about this.

Once you have been referred to an eating disorder service, the next step is an initial meeting or ‘assessment’ at the service. This appointment can last for up to 2 hours and is a chance for you to share what is difficult for you and what you would like help with. You will meet with a psychologist, doctor, nurse, therapist or other trained mental health professional who is used to seeing young people just like you. They will be interested in what you have to say and will work hard to make you feel at ease. Usually they will have some specific questions for you, including questions about eating, weight and exercise; your mood and general mental health; your physical health; and your interests, background and family. Measuring height and weight is an important part of an eating disorder assessment and sometimes blood pressure, temperature and blood tests may be arranged too. If you have any worries – ask in advance or on the day. It’s normal to feel nervous but people usually feel much better once they have attended.

After the assessment, plans will be made for your treatment. Treatment choices for eating disorders included guided self-help (working through treatment materials yourself but with support from a clinician at the eating disorder service); group treatment; individual treatment; and family treatment. Sessions with a dietitian may be available too. Group and individual treatments are usually a form of cognitive-behavioural therapy (CBT). The Maudsley Model of Anorexia Nervosa Treatment for Adults (MANTRA) may be used for anorexia nervosa. Some services offer Cognitive Analytical Therapy or compassion-focused therapy. 

Key to all eating disorder treatment is you. Your goals, needs and requirements will be taken into account and you will be an active partner in treatment.

Before talking to your friend about your concerns it may be helpful to ask yourself these questions:

“Am I the best person to approach them?”

This can be a difficult question to answer but it can make a very big difference to the person you’re worried about. You may decide that the person best placed to have the discussion with your friend is someone who they could feel more comfortable opening up to and sharing their feelings with. This could be a different friend, or someone in their family, or a teacher or work colleague. If so, consider approaching that person with your concerns instead. 

“Am I prepared?”

Prepare by learning as much as you can about eating disorders. Your friend may be feeling anxious or embarrassed. They may also become angry when asked about their eating. They may be in denial. Or they may not recognise that they have an eating problem. Importantly, these feelings do not mean that the problem doesn’t exist. In our experience, feelings of anger or hostility do not last. If you persist in a supportive way your friend is likely to appreciate your care.

“Where and when should I approach them?”

Approach your friend with compassion – sensitivity, understanding and care. It is best to speak to them where you can talk openly and calmly, without distractions or other people about. Pick a time when you aren’t likely to be interrupted or have the conversation cut short. Avoid raising your concerns at a meal time.

“What should I say?”

It’s normal to feel unsure about what to say. Take some time to work through this in advance and make a plan.

It is helpful to remember that the person you are worried about is likely to be scared of talking about their behaviours or feelings. 

Actually, they may not even talk about them straight away. The key message to share is that you care about them, that you are worried about them, and that you want to help them. It can be helpful to have some specific examples of why you are worried and for these to not all be about food. For example, “I’m worried that you seem more unhappy lately. You also seem to avoid eating lunch with us and you seem more tired than usual. Is there anything that I can do to help?”.

It can help to practice what you’re going to say with a family member or friend. You might ask them to role-play different responses. This will allow you to practice staying calm and keeping the conversation focused.

“Who will support me?”

An important part of giving the best support is taking care of yourself. It is normal to feel stressed and emotional when you are worried about someone. It’s important to ensure that these feelings don’t get in the way of helpful support or impact your own health. You may want to reach out to a health professional, connect with another family member or friend, or contact a helpline. 

There are a number of resources available on the Beat (Beating Eating Disorders) website. 

Before talking to your child about your concerns it may be helpful to ask yourself these questions:

“Am I the best person to approach them?”

This can be a difficult question to answer but it can make a very big difference to the person you’re worried about. You may decide that the person best placed to have the discussion with your child is someone who they could feel more comfortable opening up to and sharing their feelings with. This could be a different family member, or a close friend, or a teacher or work colleague or your GP. If so, consider approaching that person with your concerns instead. 

“Am I prepared?”

Prepare by learning as much as you can about eating disorders. Your child may be feeling anxious or embarrassed. They may also become angry when asked about their eating. They may be in denial. Or they may not recognise that they have an eating problem. Importantly, these feelings do not mean that the problem doesn’t exist. In our experience, feelings of anger or hostility do not last. If you persist in a supportive way your child is likely to appreciate your care.

“Where and when should I approach them?”

Approach the conversation with compassion – sensitivity, understanding and care. It is best to speak where you can talk openly and calmly, without distractions or other people about. Pick a time when you aren’t likely to be interrupted or have the conversation cut short. Avoid raising your concerns at a meal time.

“What should I say?”

It’s normal to feel unsure about what to say. Take some time to work through this in advance and make a plan.

It is helpful to remember that the person you are worried about is likely to be scared of talking about their behaviours or feelings. Actually, they may not even talk about them straight away. The key message to share is that you care about them, that you are worried about them, and that you want to help them. It can be helpful to have some specific examples of why you are worried and for these to not all be about food. For example, “I’m worried that you seem more unhappy lately. You also seem to avoid eating dinner with us and you seem more tired than usual. Is there anything that I can do to help?”.

It can help to practice what you’re going to say with a family member or friend. You might ask them to role-play different responses. This will allow you to practice staying calm and keeping the conversation focused.

“Who will support me?”

An important part of giving the best support is taking care of yourself. It is normal to feel stressed and emotional when you are worried about someone. It’s important to ensure that these feelings don’t get in the way of helpful support or impact your own health. You may want to reach out to a health professional, connect with another family member or friend, or contact a helpline. There are a number of resources available on the Beat (Beating Eating Disorders) website. You could also look at the book “Skills-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Model” by Janet Treasure, Grainee Smith & Anne Crane.

Before talking to your brother or sister about your concerns it may be helpful to ask yourself these questions:

“Am I the best person to approach them?”

This can be a difficult question to answer but it can make a very big difference to the person you’re worried about. You may decide that the person best placed to have the discussion with your sibling is someone who they could feel more comfortable opening up to and sharing their feelings with. This could be one of your parents, a different family member, a friend, a teacher or work colleague. If so, consider approaching that person with your concerns instead. 

“Am I prepared?”

Prepare by learning as much as you can about eating disorders. Your sibling may be feeling anxious or embarrassed. They may also become angry when asked about their eating. They may be in denial. Or they may not recognise that they have an eating problem. Importantly, these feelings do not mean that the problem doesn’t exist. In our experience, feelings of anger or hostility do not last. If you persist in a supportive way your sibling is likely to appreciate your care.

“Where and when should I approach them?”

Approach your brother or sister with compassion – sensitivity, understanding and care. It is best to speak to them where you can talk openly and calmly, without distractions or other people about. Pick a time when you aren’t likely to be interrupted or have the conversation cut short. Avoid raising your concerns at a meal time.

“What should I say?”

It’s normal to feel unsure about what to say. Take some time to work through this in advance and make a plan.

It is helpful to remember that the person you are worried about is likely to be scared of talking about their behaviours or feelings. Actually, they may not even talk about them straight away. The key message to share is that you care about them, that you are worried about them, and that you want to help them. It can be helpful to have some specific examples of why you are worried and for these to not all be about food. For example, “I’m worried that you seem more unhappy lately. You also seem to avoid going out for breakfast with me like we used to do. You seem more tired than usual. Is there anything that I can do to help?”.

It can help to practice what you’re going to say with a family member or friend. You might ask them to role-play different responses. This will allow you to practice staying calm and keeping the conversation focused.

“Who will support me?”

An important part of giving the best support is taking care of yourself. It is normal to feel stressed and emotional when you are worried about someone. It’s important to ensure that these feelings don’t get in the way of helpful support or impact your own health. You may want to reach out to a health professional, connect with another family member or friend, or contact a helpline. There are a number of resources available on the Beat (Beating Eating Disorders) website. You could also look at the book “Skills-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Model” by Janet Treasure, Grainee Smith & Anne Crane.

Before talking to your partner about your concerns it may be helpful to ask yourself these questions:

“Am I the best person to approach them?”

This can be a difficult question to answer but it can make a very big difference to the person you’re worried about. You may decide that the person best placed to have the discussion with your partner is someone who they are more likely to open up to about eating or weight concerns or emotional difficulties. This could be a family member or a close friend. If so, consider approaching that person with your concerns instead. 

“Am I prepared?”

Prepare by learning as much as you can about eating disorders. Your partner may be feeling anxious or embarrassed. They may also become angry when asked about their eating. They may be in denial. Or they may not recognise that they have an eating problem. Importantly, these feelings do not mean that the problem doesn’t exist. In our experience, feelings of anger or hostility do not last. If you persist in a supportive way your partner is likely to appreciate your care.

“Where and when should I approach them?”

Approach the conversation with compassion – sensitivity, understanding and care. It is best to speak where you can talk openly and calmly, without distractions or other people about. Pick a time when you aren’t likely to be interrupted or have the conversation cut short. Avoid raising your concerns at a meal time.

“What should I say?”

It’s normal to feel unsure about what to say. Take some time to work through this in advance and make a plan.

It is helpful to remember that the person you are worried about is likely to be scared of talking about their behaviours or feelings. Actually, they may not even talk about them straight away. The key message to share is that you care about them, that you are worried about them, and that you want to help them. It can be helpful to have some specific examples of why you are worried and for these to not all be about food. For example, “I’m worried that you seem more unhappy lately and are less interested in doing things as a couple. You also seem to avoid eating with me and you seem more tired than usual. Is there anything that I can do to help?”.

It can help to practice what you’re going to say with a family member or friend. You might ask them to role-play different responses. This will allow you to practice staying calm and keeping the conversation focused.

“Who will support me?”

An important part of giving the best support is taking care of yourself. It is normal to feel stressed and emotional when you are worried about someone. It’s important to ensure that these feelings don’t get in the way of helpful support or impact your own health. You may want to reach out to a health professional, connect with another family member or friend, or contact a helpline. There are a number of resources available on the Beat (Beating Eating Disorders) website. You could also look at the book “Skills-based Learning for Caring for a Loved One with an Eating Disorder: The New Maudsley Model” by Janet Treasure, Grainee Smith & Anne Crane.

Before talking to the student you are worried about, it may be helpful to ask yourself these questions:

“Am I the best person to approach them?”

This can be a difficult question to answer but it can make a very big difference to the person you’re worried about. You may decide that the person best placed to have the discussion with the student is a different teacher, their parent/s or another family member, or one of their friends. If so, consider approaching that person with your concerns instead. 

If can be difficult to contact a parent to say that you’re concerned about their child’s eating. However, parents are usually very grateful when teachers make contact. Often they are worried too and hearing from the school gives them the confidence they need to take action. 

“Am I prepared?”

Prepare by learning as much as you can about eating disorders. The student may be feeling anxious or embarrassed. They may also become angry when asked about their eating. They may be in denial. Or they may not recognise that they have an eating problem. Importantly, these feelings do not mean that the problem doesn’t exist. In our experience, feelings of anger or hostility do not last. If you persist in a supportive way, the young person is likely to appreciate your care.

“Where and when should I approach them?”

Approach the conversation with compassion – sensitivity, understanding and care. It is best to speak to them where you can talk openly and calmly, without distractions or other people about. Pick a time when you aren’t likely to be interrupted or have the conversation cut short. Avoid raising your concerns at a meal time.

“What should I say?”

It’s normal to feel unsure about what to say. Take some time to work through this in advance and make a plan.

It is helpful to remember that the person you are worried about is likely to be scared of talking about their behaviours or feelings. Actually, they may not even talk about them straight away. The key message to share is that you care about them, that you are worried about them, and that you want to help them. It can be helpful to have some specific examples of why you are worried and for these to not all be about food. For example, “I’m worried that you seem more unhappy lately and you’re doing less well in class. You seem more tired than usual and I’ve noticed you’re often in the library at lunchtime instead of eating with your friends. Is there anything that I can do to help?”.

It can help to practice what you’re going to say with another teacher or friend. You might ask them to role-play different responses. This will allow you to practice staying calm and keeping the conversation focused.

“Who will support me?”

An important part of giving the best support is taking care of yourself. It is normal to feel stressed and emotional when you are worried about someone. Your school will have policies or systems to help you manage concerns about student wellbeing, so use these for your own support as well as the students. There are also a number of resources available on the Beat (Beating Eating Disorders) website. 

Seek support yourself if you need to, from a friend, family member or a health professional.