Should NG Tubes Be Used In The Treatment Of People With Eating Disorders?

When it comes to treatment for people with eating disorders there are many different options and interventions to be explored, various therapies, meal plans, pieces of group work and even hypnotism. However, alongside all the perhaps more psychological treatments, there are other more invasive practical treatments that can be used such as the NG tube (a tube that is inserted through the nose and into the stomach to feed a patient who is unable to consume food orally themselves), and this is something I never had much of an opinion on before it happened to me recently for several weeks of my admission to hospital. It may seem silly or odd to be bringing this up now as my tube came out over 8 weeks ago so surely I should be over it and not thinking about it anymore, but I have to say that even though it has been a while since its removal, the method of being NG fed still affects me to this day, is a fairly traumatic thing for people to go through, and it has made me wonder whether or not NG feeding should actually be used in eating disorder treatment full stop. 

Obviously if I am going to open up a debate in this blog about whether or not NG tubes should ever be used I am going to have to say that aside from all the ethical, psychological, long term effect complicated sides to the issue, bluntly yes NG tubes should be available as a way to treat people with eating disorders. Despite their perhaps negative side effects down the line, it makes no sense to rule them out completely (unfortunately…I really hate admitting this…excuse me whilst I go away and grumble). 

Sometimes, whether we like it or not, NG tubes are life saving necessary pieces of treatment and there are people out there who arguably would have died without them. If a person is unable to nourish themselves adequately and becomes seriously medically compromised, sometimes the only option is to NG feed them as a matter of saving a life and I know that, as much as I disagree with the methods used on me and wish more than anything it hadn’t happened, that that is the argument doctors and nurses have had with me in defending that method of treatment. 

Aside from life saving serious stuff, NG tubes can also be positively used not just for getting nutrition into people but for providing a motivation to eat orally despite the screaming eating disorder wailing in their head like a banshee who just stubbed her toe on a particularly sharp piece of lego. 

When someone is struggling to eat because of an eating disorder it is often made harder by the fact that eating always feels like a choice, an option you actively choose to partake in, and who would choose to torture themselves by forcing themselves to eat when they knew their brain would go off screaming at 90 miles per hour? With an NG tube in place however, the act of getting nutrition is no longer an option or a choice, it is going to happen one way or another and with this choice of whether or not the food will go in eventually being taken away, sometimes eating becomes easier. 

Personally I can at least admit and testify to the fact that I found the NG tube helpful in the sense that it did motivate me to eat because the choice was taken away. No longer did I have the raging debate of “do I eat or don’t I”, it was just a matter of how it was going to go in/happen (“up the nose or down the throat” as I used to think). It also gave me encouragement to eat in a way because there were times when I knew that if I didn’t consume what was in front of me orally, I would get an increased number of calories down the tube and that certainly served as some motivation! 

Indeed at my unit there was a rule that I was presented with a meal and if I were not to complete it, the entire meal would be started again via the feed. Therefore if halfway through a meal I was struggling and really wanted to give up, having the tube there motivated me to carry on as I knew that were I to stop, we would have to start all over again and I would essentially end up having to go through the same meal twice. NG tubes can also be helpful in the sense that they offer a way for medication to go into a patient when a patient is unable to take a medication themselves (another thing which I hated and disagreed with personally but can understand is necessary in some circumstances.) 

As I said at the beginning of this debate however, alongside these positives there are a lot of negatives and it is the effect of these long lasting negatives that I am still feeling today. You see, when you have an NG tube, it takes responsibility for eating away, and whilst this is a good thing when a person is unable to eat by themselves, it is a bad thing because in learning to eat again or going through the re-feeding process they are not actually learning how to do it for themselves. Indeed, people go from needing the tube in an emergency situation to becoming dependant on it and that is what happened to me. For the first few months of re-feeding I was going through the motions but psychologically was making no progress and then when it came out I didn’t know how to eat. Without the tube, suddenly the guilt became much worse because eating went from being the lesser of two evils with the tube in to simply “evil”. 

Another negative from using an NG tube and perhaps the one I am struggling the most with today is that of rapid weight gain. When you are on the tube it is possible to gain a lot of weight very quickly that mentally you are not ready or prepared for and although it can again be life saving and good treatment medically, it can be an incredibly traumatic experience. Similarly, now I have been left at a weight far higher than I am comfortable with because of the tube and because I reached this stage far quicker than I would have done without it, I am still struggling with the repercussions and am feeling overwhelmed. 

In terms of trauma it can also be a traumatic experience to be restrained for feeds and when this happens it can damage the patient vs treatment team relationship. For example I used to trust my treatment team and even get along with a lot of them, but if I am honest, now I resent them all and want to be discharged from the entire service because the act of having something so traumatic being done to me has led me to dislike and mistrust them all. Having something like an NG feed physically done to you whilst you are held down means being treated as an object not a person, there is no therapeutic benefit, you are just a thing being pumped full of stuff you are terrified of with no chance to work through it or figure out a long term solution at home. It is a temporary fix and though you can force feed someone food, you cannot force feed them long term recovery, so in a sense the NG tube method is unhelpful long term. Then again that is just my experience and I know that for other people actually starting with an NG as a temporary measure can help long term as it gets enough nutrition for their brain to work and allow recovery long term afterwards so it really is all down to personal experience. 

Overall then, should NG tubes be used to treat people with eating disorders? Well, I don’t know is the honest answer, it is a tricky one because I think the answer will be different for different people. For some people using the NG tube is not a matter of something to be debated but a necessary life saving act of treatment and sometimes it can even help long term recovery by motivating someone to eat orally by taking away the choice. Also the more nutrition someone gets the more likely it is that their brain will be receptive to treatment but then again there are the negatives of cases like mine where I have been fed up to an unbearable weight via physical methods without going through the proper therapeutic work, meaning that I am now stuck unable to deal with it and thus struggling with relapse. I don’t think when it comes to this question there will ever be an answer for everyone but it is certainly a controversial topic that I think we need to keep working on and talking about. 

Take care everyone x 

NGdebate

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10 thoughts on “Should NG Tubes Be Used In The Treatment Of People With Eating Disorders?

  1. I’m sorry my dear but I find this particular subject a lil triggering so I will not read it. I hope you can understand.
    Love you to the moon and back
    Kisses from Portugal ❤
    P.S. Turns out I'm not going to London after all 😦 but I am going to Dublin this Thursday! I'm really excited!

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    • Of course I understand silly! I am sorry to have talked about a topic that triggered you honestly I never would have done such a thing had I known! I will be more mindful in future and I hope you can forgive me on this occasion for posting about it. Love you all around the universe and back again, kisses from England xxx P.s sucks that you aren’t going to London but going to Dublin is awesome and still means you will be closer to me than you are in Portugal which is always a good thing! I hope you have a fabulous time beautiful xx

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  2. I wrote out a WHOLE comment and it didn’t send! 😦

    Okay, I’ll start at the very beginning… i can’t imagine how traumatic that was, with the physical restraint. the part you said about trust really struck me. I know that, when i was IP, trust was a huge factor. I can’t relate to your personal situation, but I remember when it came to my diabetes there were huge trust issues.

    Especially at the start of both admissions, my blood sugars would go sky-high and the nurses wouldn’t let me take more insulin until a doctor came. I was literally begging them and they said no. In hindsight, one of them said they were “in the wrong” and that impacted my trust for the rest of the admission. It also made it difficult for me to agree to the second admission, as i didn’t know if i could go through that again. I’m not saying it even comes close to what you went through, but i wanted to try and empathise with that trust factor. I also guess it helps me somehow ‘understand’ (if i possibly can) how you must feel with regard to those relationships.

    All i can say is that, as physically horrific as it was, it wasn’t done against Katie. It was trying to target anorexia, to restrain anorexia FROM Katie. They were trying to help and i know it seems like the opposite. At the start of this post, you were able to look from the outside and consider the logical reasons an NG is used. i was so proud of you for doing this, as it shows KATIE’s voice is there. Imagine i was in that position, or anyone else in treatment you cared about. You wouldn’t want anorexia to hurt them, or risk their life. The nurses didn’t want that for you.They aren’t the enemy and i hope that, in time, you can find a way to reconcile things.

    If i can ever do anything to offer support, whether it be a text or a coffee/tea in costa or waterstones, you need only say. KATIE matters xxxx

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    • Sophie, this comment is so unbelievably kind and thoughtful. I sincerely think we need a cup of tea pronto because you always know what to say to make me feel better and having someone to empathise with on the trust issue has really touched me (I am so sorry you can relate though). Also it is so good to be reminded of the fact I often forget which is that the doctors and nurses were acting to try and help me and not be against me however much it felt like it. Gah this topic is such a mind mess up, like I said, I think we need tea pronto. Thank you for typing all that comment out, trust me it really helped. Thank you for reminding me of things I often forget, much love xxxxx

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  3. I definitely get where you’re coming from, and I can only imagine how traumatising and invalidating what you experienced must have felt. However, I often see people say that they ended up at a higher weight they weren’t psychologically ‘ready’ for, and it makes me wonder… are we ever actually psychologically ready to be heavier? I sure as hell wasn’t! I think to a certain extent you kind of have to gain to a place you’re uncomfortable with in order to BECOME comfortable with it, y’know? Otherwise you just keep waiting for it to become ‘okay’ and it never does. It’s definitely hard!

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    • I have to say that as much as I hate to admit it I probably agree with you on that one there! I don’t think any of us are ever ready for weight gain no matter how much we pretend there is a time and place which will make it less scary…VERY GOOD POINT WELL MADE GOOD SIR

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  4. I’m fairly sure having an NG tube saved my life. I was at the point where I could no longer eat anything and I don’t see how that would have changed. I looked at the time I spent being NG fed as a ‘break from eating’ and all the stress that goes with it. After the break I felt refreshed and much more able to eat.

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    • To be perfectly honest I can admit that having an NG tube saved my life too…it is just so hard to see that because of all the negative outcomes that have also come with it but I do have to admit that at the time it did have a place whether I agree with it or not. Definitely agree with you when it comes from the break from eating with the NG tube though, you are a very wise bean xxxx

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