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Why it’s time to rethink treatment for eating disorders

It’s a sobering statistic: nearly one in 10 Australians battle an eating disorder at some time in their life, and the number is rising.

It’s an emotional topic and a complex mental health issue. Add in a selfie culture, and people vulnerable to developing an eating disorder can be under immense pressure.

New research has put the spotlight on treatment, highlighting that while eating disorder treatments can be effective – both in terms of health outcomes and cost – they remain under-funded.

So, is it time for a health system shake-up?

What does cost-effective treatment look like?

According to research led by Deakin University and supported by the National Health and Medical Research Council (NHMRC), psychotherapies are cost-effective treatments for eating disorders.

Long Le, lead researcher and PhD candidate within Deakin’s School of Health and Social Development, says current Australian treatment guidelines involve cognitive-behavioural therapy or family-based treatment to address patterns of thinking and behaviours.

‘We looked at both of these front-line treatments for Australians aged 11 to 18 with anorexia nervosa, and 18 to 65 with bulimia nervosa. We analysed Medicare costs, out-of-pocket expenses and time and travel,’ he said.

‘Our research found both types of treatment were effective in terms of treatment costs and health outcomes.’

But there’s still a gap in the system.

What are the problems with current funding models?

Despite the success of these treatments, unfortunately Medicare doesn’t fund enough sessions for Australian patients to experience their impact.

‘Our studies show that for treatment to be effective, 20 to 30 sessions are needed as part of a mental health treatment plan. Yet only 10 to 12 are currently being covered by public funding,’ Le says.

‘As a result, people may stop potentially lifesaving treatment because they simply can’t afford it. They stop before it’s been effective, meaning their health outcomes are compromised,’ he says. ‘What’s more, it’s not cost-effective to the health system to provide interventions, but to not provide enough of them to deliver results.’

‘Eating disorders are costing Australia more than $69 billion per year, not to mention the costs to the community of inadequately treating sufferers.’

‘With the mortality rate for eating disorders higher than for all other psychiatric illnesses, it’s vital we do more, including keeping sufferers in front-line treatments,’ Le says.

Why do eating disorders take so long to treat?

Eating disorders, including anorexia and bulimia, are widely recognised in the community, but rarely understood.

‘It’s fairly recent that eating disorders have even been recognised as mental health issues,’ Le says.

Eating disorders are difficult to treat because they are diseases of the most complex area of the body – the brain – and in many cases are associated with other mental health conditions such as anxiety or depression. There are no known ‘quick fixes’ for these conditions.

‘There is also a stigma attached to eating disorders, a view that they’re somehow a choice. In reality, they’re complex, life-threatening diseases that can be personally devastating,’ Le adds.

'Our studies show that for treatment to be effective, 20 to 30 sessions are needed as part of a mental health treatment plan. Yet only 10 to 12 are currently being covered by public funding.'

Long Le,
PhD candidate, School of Health and Social Development, Deakin University

Why do eating disorders take so long to treat?

Eating disorders, including anorexia and bulimia, are widely recognised in the community, but rarely understood.

‘It’s fairly recent that eating disorders have even been recognised as mental health issues,’ Le says.

Eating disorders are difficult to treat because they are diseases of the most complex area of the body – the brain – and in many cases are associated with other mental health conditions such as anxiety or depression. There are no known ‘quick fixes’ for these conditions.

‘There is also a stigma attached to eating disorders, a view that they’re somehow a choice. In reality, they’re complex, life-threatening diseases that can be personally devastating,’ Le adds.

What’s the role of selfies, shares and social media?

In the new world of social media and the endless search for the perfect selfie, image is everything. Likes and shares may provide a temporary ego boost, but on the flip side, social media can encourage unhealthy eating patterns and even provide an environment where eating disorder risk factors – such as online bullying – are more prevalent.

As noted by Katie Cincotta in the Sydney Morning Herald, anyone can ‘comb sites such as Instagram, Pinterest and Tumblr for hashtags such as #thinspo and #thinspiration and you’ll find thousands of gaunt, underweight victims documenting their quest to achieve their version of beauty.’

In the social media era, the case for sustained treatment for eating disorders feels more urgent than ever.

Can alternative approaches work?

The search for accessible, effective and lasting treatments for eating disorders is global and ongoing, as Anne Tonner, whose daughter was just 13 when she began her battle with anorexia, discovered.

‘I desperately hoped it was something else, or if it was anorexia it could be turned around really quickly,’ Anne told the Mamamia No Filter podcast.

After several years of treatment partly funded by Medicare and their health fund, Anne had given up work to be a full time carer. Chloe was given the all clear, then relapsed at 16.

‘She never felt she learned the tools she needed to manage the illness,’ Anne says. ‘It was like the bottom fell out of the world again.’

Chloe’s parents decided to try an alternative treatment at Sweden’s Mandometer Clinic.

‘There’s a different way of looking at this disease and a different type of treatment. The focus wasn’t on what to eat, but on how to eat. They have to learn how to reconnect with feelings of hunger, with feelings of being full,’ Anne says.

Anne says Chloe recovered and has never relapsed 11 years on.

‘It’s an incredibly expensive treatment that’s out of reach of most people,’ she says. ‘It just astounds me that there’s still no funding for this treatment in Australia.’

Can funding save lives?

If we know how much treatment needs to be funded and what sorts of treatments do work, it’s tough to see why the health system isn’t keeping pace.

Long Le emphasises the importance of treatment: ‘If someone doesn’t get the right treatment, they stay in the system and may end up being hospitalised. More sessions mean a greater likelihood of recovery and a cost-effective approach to these debilitating diseases. We know what we need to do.’

Find out more about emerging options for effective mental health management or, if you’re interested in a career in health, there’s a world of new possibilities at your fingertips.

If you need help for an eating disorder or body image concern, call the Butterfly Foundation National Helpline on 1800 334 673 (ED HOPE) or email support@thebutterflyfoundation.org.au.

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