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Researchers writing in the Medical Journal of Australia have highlighted the importance of person-centred care in treating eating disorders.
The importance of overcoming the stigma of eating disorders is one of the key findings of a narrative review, published today in the Medical Journal of Australia.
The review also examines recent developments in managing eating disorders, as well as the gaps that persist for clinicians and patients in managing these conditions.
It is estimated that more than one million Australians live with an eating disorder in any given year.
This includes anorexia nervosa, bulimia nervosa, binge eating disorder, avoidant/restrictive food intake disorder, and other specified feeding or eating disorders.
The article’s lead author Professor Phillipa Hay from Western Sydney University has told InSight+ that there has been a rapid growth in eating disorder research in the past decade.
“There has been an explosion of therapy trials particularly for people with anorexia nervosa,” Professor Hay said.
“There is now a strong evidence base for several forms of psychological therapies, and emergent evidence for therapy for more recently recognised disorders such as avoidant/restrictive feeding and eating disorder.”
While eating disorders have been historically associated with low body weight, this is not always accurate, and this along with other misconceptions (such as eating disorders mainly affecting women) can lead to significant treatment barriers.
“There is yet a need to reverse the perception that anorexia nervosa is a disorder of underweight and that binge eating disorder is unique to the higher weight” Professor Hay told Insight+.
“All eating disorders (excepting underweight anorexia nervosa) may be present in people of high weight.”
Person-centred care
A significant finding of the narrative review was emerging evidence around the need for more person-centred care with a focus on recovery and less restrictive treatment.
“We need to tailor therapies better to the person and the reason that people may not ‘respond’ may be not that they have failed but that the care has failed to meet their needs,” Professor Hay said.
“It is increasingly recognised that ‘one size does not fit all’ and that the majority of people with eating disorders may receive care in less restrictive care settings such as day programs or outpatient therapy and this is invariably their preference when asked.”
Positive outcomes have been found with residential-based treatments.
The first dedicated eating disorder residential facility in Australia, Wandi Nerida, opened in Queensland in 2021, and the ACT Government recently announced the establishment of its own specialist residential treatment centre for eating disorders.
“[Residential facilities] offer a similar intensity of care [as inpatient treatment] but within a more homely environment with the ability to offer a holistic experience around food and eating including food production (gardens) and meal preparation (client kitchens),” Professor Hay said.
The biology of eating disorders
As research into eating disorders continues to evolve, a new research program led by Monash University aims to investigate biological causes of eating disorders.
The Li Transformative Hub for Research in Eating Disorders (THRED) will involve researchers from Monash University’s HER centre and the Department of Neuroscience in Monash’s Central Clinical School.
Expected to commence in the second half of 2023, THRED will conduct clinical trials of new treatment approaches for eating disorders, such as brain stimulation, hormonal manipulation and novel drug therapies, as well as developing new treatments based on its own and other research findings from Australia and around the world.
HER Centre Australia Director Professor Jayashri Kulkarni AM said that as the incidence of eating disorders continued to rise in the wake of COVID-19, a new approach was needed.
“We want to provide a better understanding of why eating disorders occur and how to treat them from a biological perspective,” Professor Kulkarni said in a statement.
“We will do this by conducting clinical trials that will investigate possible treatments. These trials will be informed by investigation into the biological abnormalities that underpin eating disorders.”
Professor Kulkarni said eating disorders could develop due to biological changes related to genes, RNA and proteins, yet there has been little investment in developing treatments that target brain biology and/or biological factors. She said a holistic approach was needed.
“For too long, eating disorders have been surrounded by ignorance about their cause and stigma that often assigns blame to the person with the eating disorder,” Professor Kulkarni said.
“It’s not that simple. These are complex conditions that require multifaceted solutions. Psychotherapy is important but does not encompass the big picture, or the possibility of biological causes.
“This program won’t be a ‘silver bullet’ for eating disorders, which are notoriously difficult to treat,” Professor Kulkarni said.
“But we hope our focus on the biology will result in improved treatments that will make a real difference.”
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