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Eating disorders treatment – like peeling an artichoke

“Treatment for eating disorders is like peeling an artichoke; it requires peeling away each leaf, giving it attention and credence while knowing that it may be a long time until one gets to the tenderest heart. Eating artichokes requires patience just as treating eating disorders does. Recovery is a process, and it also requires patience …” (Anita Sinacrope Maier, Effective Clinical Practice in the Treatment of Eating Disorders, edited by Margo Maine, William N. Davis and Jane Shure).

I read this book several years ago which gave me a lot of guidance and comfort as a clinician, as through my 30-year career as a GP I have had to manage and continue to treat many patients with eating disorders.

An eating disorder is a general term that describes a spectrum of disordered eating which includes these conditions: Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED). For people who do not fully meet the specific criteria for these separate conditions, there is another term used by clinicians called OSFED – Other Specified Feeding and Eating Disorders.

The typical person who has an eating disorder is an adolescent girl – an Australian study has shown 8 per cent of adolescent girls meet the criteria for AN and this is the third most common chronic illness among adolescents – asthma and obesity come first and second! However, an eating disorder can become chronic, can resurface at a later stage in life, can affect children as young as 8, as well as males and people of any socio-economic and cultural demographic.

Here are some more staggering statistics: 95 per cent of those who have eating disorders are between the ages of 12 and 25; 50 per cent of girls between the ages of 11 and 13 see themselves as overweight, and 80 per cent of 13 year-olds have attempted to lose weight; males make up approximately 25 per cent of people with AN or BN and 40 per cent of people with BED; AN sufferers have a mortality rate of almost 20 per cent over 20 years!

So you can see why the quote from the psychotherapist is so powerful to me as a clinician.

I would like to share with readers whom I believe could have experienced this firsthand, either as a sufferer or having a loved one with an eating disorder. Sometimes, the outcome is good, sometimes not so, but always the condition is impactful, concerning and often chronic.

One of the things that has helped me is to read and learn about eating disorders from a sufferer’s or carer’s perspective. This has shaped my understanding of what it is like for a person suffering from these conditions and given me insights into how to help them in the course of the illness.

So many patients tell me they cannot find doctors they can trust to treat them because they have been advised by doctors to “just eat and you will be better”. Of course, if it were that simple, these patients would have been cured a long time ago and wouldn’t require treatment.

There is still a lot of research needed to understand and treat these conditions, however one thing is clear, things will only change with better resources, and I am glad to point out several places people can turn to for assistance.

One organisation is the National Eating Disorders Collaboration (NEDC). This is an eating disorders network bringing together people with expertise or interest in eating disorders. It provides opportunities for learning, contributing and engaging in project activities. As eating disorders touch all communities, the NEDC engages not only with health professionals but also schools, universities, work places and the general public. Membership is free and you can access this via www.nedc.com.au/.

The NEDC has also recently produced a set of videos that are freely accessible on their website for e-learning for health professionals, which I have found extremely helpful, and which you can point out to your GP or specialist: www.nedc.com.au/professional-development/e-learning/.

Another organisation which is situated in the Inner West is Inside Out, which also has resources available: https://insideoutinstitute.org.au/. The website provides local resources and contacts for treatment, including a useful resource for support organisations.

Sufferers, families and carers can gain a lot of advice from the Butterfly Foundation: https://thebutterflyfoundation.org.au/. It runs a hotline (1800 33 4673), webchat or email for general support and advice, including access to some support group activities.

Another incredible support is that the federal government, through the lobbying of these and other groups, has agreed to fund a new Medicare item to support eating disorders treatment which will commence on November 1, 2019.

Details are sketchy but I understand it will include: a dedicated single Medicare item number for eating disorder treatment for those with severe and complex illness, delivering up to 60 Medicare funded sessions of treatment – 40 psychotherapeutic and 20 dietetic across the range of eating disorders – AN, BN, BED and atypical presentations, through diagnosis by a GP and mental health practitioner, recognising that these psychiatric illnesses have a significant physical impact and integrated treatment is essential.

We can only hope that this will mean better access to treatment and therefore better outcomes for eating disorder patients in the future.

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