Eating disorders are complex mental illnesses affecting over 1.1 million people in Australia every year. Medical practitioners play an important role in the treatment team, and knowing where to refer patients for more intensive care is vital.
In Australia, more than 1.1 million people experience an eating disorder in any given year.
Eating disorders are complex mental illnesses that are caused by a combination of biological, psychological and sociocultural risk factors. Left unaddressed, the medical, psychological and social consequences can be serious, long-term and potentially life-threatening — eating disorders have one of the highest mortality rates of all psychiatric illnesses.
One of the challenges in identifying and supporting people with eating disorders is that less than one in three people will seek professional help, with shame and stigma leaving many struggling in silence.
Early detection and intervention is vital, but it can often be difficult for healthcare professionals to spot the signs – particularly because eating disorders are primarily psychological illnesses, and many people may feel ambivalent about recovery, experience low motivation to change, or denial of the severity of the illness. In a primary care setting, GPs can use the SCOFF questionnaire or the Eating Disorders Screen for Primary Care (ESP) to help detect and diagnose eating disorders.
Common warning signs for GPs to be aware of include:
Psychological signs: preoccupation with eating, food, body shape and weight; intense fear of weight gain; heightened anxiety or distress around food and mealtimes; extreme body dissatisfaction/negative body image; low self-esteem;
Physical warning signs: fluctuations in weight; signs of frequent vomiting (eg swollen cheeks or jawline, calluses on knuckles); sensitivity to the cold; fatigue or lethargy; cardiorespiratory complications;
Behavioural warning signs: restrictive eating behaviours including dieting, fasting, calorie counting or skipping meals; purging behaviours; compulsive or excessive exercise; secretive food behaviours; social withdrawal or isolating from friends and family.
When treatment is delivered by skilled and knowledgeable health professionals, around 72% of people can reach full recovery and a good quality of life.
It’s important for healthcare professionals to remember that eating disorders don’t have a specific ‘look’ — anyone, of any gender, age, weight or body size can be impacted. With the rise of GLP-1 medications, it’s essential that GPs address underlying weight bias and also screen people living in larger bodies for eating disorders. People living in larger bodies make up over half of all people with an eating disorder in Australia, and rates of eating disorders are increasing most in people of higher weight.
It’s important for healthcare professionals to remember that eating disorders don’t have a specific ‘look’ (Monkey Business Images / Shutterstock).
The eating disorder system of care: what works and what needs to be improved
The most effective way to treat someone with an eating disorder is person-centred, trauma-informed care, tailored to address the person’s illness, situation and needs. Australia’s stepped system of care for eating disorders recognises that people may need to access a range of services at different intensity or frequency levels throughout their illness. Treatment teams need to include, at a minimum, a medical practitioner such as a GP, along with a mental health professional such as a psychologist. Dietitians are also key in helping people develop positive relationships with food and evaluating eating disorder behaviours and nutritional status. Psychiatrists and lived experience workers (i.e. recovery coaches or peer workers) may also play a role.
Mental health and dietetic support are available via Medicare, with Eating Disorder Treatment Management Plans (EDP) providing up to 40 sessions of psychological treatment and 20 sessions with an accredited practicing dietitian.
Recovery isn’t linear, so some may experience setbacks and relapses, at which point they may need to re-enter the system of care. While recovery is absolutely possible within the community, up to 25% of people will experience a severe and long-term illness, and may need a more intensive treatment offering.
Residential facilities report positive outcomes for participants, including reduced eating disorder psychopathology, anxiety and depression, along with greater weight restoration, quality of life and cognitive functioning.
Prior to engaging with residential treatment, it can be common to experience a ‘one size fits all’ model of care delivered through hospital inpatient treatment, which some describe as restrictive and only focused on addressing the physical symptoms of an eating disorder.
In contrast, residential facilities provide treatment in a home-like environment, with care tailored to an individual’s unique attributes, experiences, personalities and needs. This can help people ‘feel safe and visible’, allowing them to unpack the underlying psychological reasons why an eating disorder can develop, and how to reach and maintain recovery.
Alongside evidence-based psychological treatments and adjunctive treatments such as equine and nature-based therapies, facilities like Wandi Nerida also heavily emphasise the power of lived experience. Peer workers who have personal experience of recovering from an eating disorder or caring for a loved one are considered a key part of the multidisciplinary treatment team, because they showcase that recovery is possible — they ‘get it’.
What needs to change
However, for many people, these facilities may be out of reach due to age, financial and geographical restrictions. Residential facilities including Newcastle’s baiyangbaiyaang, ACT’s Eating Disorders Residential Treatment Centre and Melbourne’s Ngamai Wilam, are fully funded by their state governments and offer public beds for people aged over 18, but they do not accept referrals from out of state participants.
Wandi Nerida offers publicly funded beds for QLD residents aged 15 years and above, and also accepts fee-paying private participants from interstate and overseas. Many participants access their private health insurance, and due to greater availability, those who opt for a privately funded bed are likely to spend less time on the waitlist, meaning this could be a better option for those who need care sooner.
Ultimately, to reduce the prevalence of eating disorders and ensure more people receive the care they need to recover, we need more support. Nearly two-thirds of people in Australia support additional funding being allocated by the Federal Government to prevent and treat eating disorders. Prevention and early intervention initiatives remain critically underfunded, despite the fact that this could significantly ease the burden on the healthcare system — eating disorders result in healthcare system costs of $251 million a year, and the total economic and social cost of eating disorders is estimated to be $67 billion every year — a 36% increase since 2012.
With less than one in 10 people in the general population able to recognise the signs and symptoms of eating disorders, we need greater community awareness and understanding.
If you’re supporting a patient with an eating disorder, or are unsure how to provide effective care, resources are available. The National Eating Disorder Collaboration and InsideOut Institute offer free online training for healthcare professionals, and Butterfly Foundation offers free advice on best practices and referral pathways via the Butterfly National Helpline.
Remember, eating disorders are not a choice and impact those from all walks of life. Responding to those suffering in a curious, compassionate and validating manner can make a world of difference.
Dr Carly Roukos is a clinical psychologist who completed her studies in the United States with a special interest in eating disorders and severe and enduring mental illness. She has worked at inpatient, outpatient, and day program facilities in the U.S. specialising in eating disorders. She also has experience in forensic facilities and treating those with severe and enduring mental health diagnoses. Carly is the current Clinical Lead at Wandi Nerida, which is owned and operated by the Butterfly Foundation.
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