She has a broad, beaming smile and bags of confidence – Katie Reid looks the picture of health and with a bright future ahead of her.

Recently graduated in drama and performance, her sights are currently set on pursuing her Master’s degree. She brims with enthusiasm as she explains her hope is to specialise in changing perceptions surrounding eating disorders.

The choice is one close to her heart. Not so long ago, Katie was tottering on the brink, a tiny shadow of her current self being tube-fed and battling anorexia nervosa in a Glasgow hospital ward.

“Looking back, it’s very surreal,” says the 22-year-old, who is now living in Fife. “When you lose weight like that, your neural function shuts down, nothing is really working, and the first treatment is refeeding.

“There was a lot of waiting to see how I’d respond to that. It took a while to get my head around the fact I was in hospital.

“Then I had to learn what anorexia was, and so did my family. It was a learning process for everyone.”

It’s a sharp lesson in a difficult condition that an increasing number of families are facing.

According to eating disorder specialist charity BEAT, there was a 162% jump in demand for its helpline services in Scotland between April and October compared to the same period in 2019.

Whereas normally the charity in Scotland would expect to work with about 1,000 people experiencing anorexia, bulimia or – in most cases – binge eating over the course of a year, it now expects the number to be closer to 3,000.

Anxiety, stress, isolation and depression during the pandemic have been blamed for fuelling the rise, while lockdown restrictions have also affected the way patients access support networks. Changes to treatment plans and the loss of routine have also raised the risk of relapsing.

Now, with Christmas on the horizon, there is further concern that numbers will balloon further.

In response, the charity has boosted its work in Scotland thanks in part to almost £43,000 of additional help from the Scottish Government. It has increased its helpline hours, launched a Covid-19 support group, The Sanctuary, and initiated a Christmas campaign designed to provide extra support for parents and carers.

Those are in addition to weekly support groups for people with anorexia, bulimia and binge eating disorder, and others who support them.

The leap in numbers could scarcely come at a more pertinent time: a full review of Eating Disorder Services across Scotland is under way and expected to unveil its findings next spring. It has raised hopes for the introduction of a range of new procedures to make accessing treatment easier and faster – helping to avoid horrific stories of people drifting up to 10 years before they receive help.

One of the clinicians involved, Dr Stephen Anderson, says it is an “amazing opportunity” to reflect upon current services and make recommendations for improvements.

He added: “I have lots of hopes for change from the review.

“One really important issue is education and training so that eating disorders are detected early and people referred for appropriate treatment as soon as possible.

“We know from experience and very clearly from what people have told us, that services need to work better together – with better communication and pathways of care.”

Katie recalls struggling for about two years, hiding her severe weight loss from her family until it became obvious something drastic was wrong.

“I think it started when I was about 12, I just knew something was wrong,” she says. “I knew I wasn’t eating as much, but I didn’t speak to anyone about it and it wasn’t something we were told about at school.

“It got worse and worse. There were changes in my behaviour, but my mum and dad thought my anxiety was because I was struggling to integrate into high school. Instead, it was anxiety around myself that translated to an eating disorder.”

Her changing shape was easily hidden beneath baggy clothes.

“It’s a very sneaky illness. It made me a very secretive person. I didn’t know what was going on with me.

“Looking back it was horrific; it was one of the most horrible experiences.”

There are about 1.35 million people in the UK with an eating disorder, however, it’s thought the true number is probably higher. Worryingly, 60 per cent don’t seek help, despite evidence that getting support means they are nine times more likely to recover.

And although eating disorders are generally thought of as a female problem, one in three people affected is male – earlier this year cricket star Freddie Flintoff opened up about his 20-year struggle with bulimia, while actor Christopher Ecclestone has also spoken of his anorexia battle.

According to Emma Broadhurst, National Officer of BEAT Scotland, pictured inset below, the pandemic has provided a perfect storm for people struggling with an eating disorder.

“We knew in March we would see an increase in people coming to us because they were not accessing their usual support in the usual way.

“Eating disorders thrive on isolation,” she adds. “They are sneaky, private illnesses and if you are isolating, by yourself, not going to work or not socialising in the same way you normally would, then eating disorders will thrive on this.

“Before the pandemic, these cases might not have come to fruition in the same way. Now it’s coming out.”

With Christmas around the corner she warns there are particular challenges ahead for anyone with an eating disorder and their loved ones.

“The routine is out of the window and all the focus is on food. We want people to know they have support,” she said.

“As a parent you feel powerless because you want to make them better, and you can’t. you feel powerless and very alone. It breaks your heart.”

If Christmas brings an excess of food, lockdown brought its own troubling triggers for people with eating disorders, according to Mr Anderson, who is leading the review with Dr Jacinta Tan, a consultant child and adolescent psychiatrist who led a similar review in Wales, and Charlotte Oakley, of Connect Eating Service in Glasgow.

“There were issues at the start of lockdown with people bulk buying and we know lots of people with eating disorders said they could no longer get their usual, or safe foods, which was extremely anxiety provoking,” he says.

“Gyms and other places for exercise were closed and this caused huge anxiety for a number of people.

“There have also been big changes in how services operate.”

Since the review’s launch in March, workshops have been held with people experienced in living with an eating disorder, with plans for further meetings with clinicians and representatives from paediatrics, community mental health teams, liaison psychiatry and paediatric dentistry.

It is also expected to involve Scotland’s medical colleges, including the Royal College of Psychiatrists, the Royal College of General Practitioners, the Royal College of Physicians, and the Royal College of Paediatrics and Child Health. Health boards and social care partnerships are also set to be consulted.

It’s hoped the review will lead to earlier access to treatment and better training for medical professionals.

“Sometimes when people ask for help with an eating disorder, they are told that their weight and blood tests are satisfactory, so are told that nothing is wrong,” adds Dr Anderson.

“We know doctors get on average two hours of teaching on eating disorders the whole way through medical school and postgraduate training. There is a similar lack of education and training for nurses and psychologists,” adds Mr Anderson.

“It is such an amazing opportunity that we have to review the current set up of services across all sectors and across the country, and then make recommendations about how we can improve services across the whole of Scotland.”