Here’s some great news for people in Melbourne and beyond who suffer from anorexia, bulimia and other eating disorders.
From November 2019, eligible patients can take advantage of a new and improved eating disorder plan. The plan is subsidised through the Medicare Benefits Scheme, dramatically improving the affordability of in-depth treatment.
Central to the treatment are extensive visits to your doctor, psychologists, psychiatrists, dietitians and, for younger patients, paediatricians.
The GP-managed plan will help the estimated one million Australians with eating disorders access the care they need. More families will be able to get back to normal and many lives will be saved.
I’m not exaggerating when I say this is a mini-revolution for mental health in Australia!
In the following, I’ll look at:
- What’s involved in the new eating disorder plan?
- What’s an eating disorder?
- Can an eating disorder be cured?
- Causes and symptoms of disordered eating
- Treatments for eating disorders
The New Eating Disorder Treatment Plan
Patients can receive Medicare rebates for:
- an eating disorder plan prepared by a GP, psychiatrist or paediatrician,
- up to 40 sessions of psychological treatment (over 12 months) with a psychologist, GP or specially trained mental health practitioner,
- up to 20 visits to a dietitian over 12 months,
- regular GP reviews of their progress against the treatment plan, and
- a formal specialist review by a psychiatrist or paediatrician.
Previously, patients could only access up to 10 Medicare-subsidised sessions of psychological treatment. Mental health experts and GPs felt this wasn’t nearly enough to treat complex eating disorders.
Eating disorder therapists, paediatricians and dietitians don’t come cheap – especially when a patient requires months or years of care. Research conducted by the Butterfly Foundation found that people experiencing eating disorders often go into debt due to the cost of treatment. Many cut treatment short due to the expense.
This new rebated plan relieves much of the financial pressure. It also keeps patients in care for longer, giving them a much better chance of recovery.
What’s an Eating Disorder?
Eating disorders are a range of mental health conditions characterised by an unhealthy relationship with food, and often a fear of being ‘fat’. They can cause considerable damage to a patient’s physical and emotional health, as well as impact family and relationships.
The majority of sufferers are females aged between 15 and 34, yet boys and men can also be affected.
Four common eating disorders are:
A person with diagnosed anorexia will usually have a distorted body image perception and an irrational fear of gaining weight. They’ll often limit the amount of food they eat, fearing the smallest morsel with make them gain weight.
The effect anorexia has on the body can be significant. It can take a huge toll on a patient’s physical health. Thinning hair, diarrhoea and constipation, muscle weakness and kidney failure are but a few symptoms.
Of all mental illnesses, anorexia claims the most lives.1 We estimate 4% of sufferers will die from complications associated with the condition.2
Bulimia patients will typically eat lots of high-calorie food over a short period of time. During this time, they’ll be awash with a sense of lost control. This is usually followed by a compensation episode involving induced vomiting, fasting, laxatives or excessive exercise.
Those affected can find themselves in a seemingly endless cycle of over-eating and over-compensating. The illness comes with a great deal of shame and guilt. Around 94% of sufferers don’t seek treatment.3
Many people with bulimia are of average weight, making it difficult for family and friends to recognise their eating disorder.
BED is the most common eating disorder, affecting around 3% of adults.4 It’s a physiological condition that inflicts men and women in equal numbers. Many people with this disordered eating problem are obese. It’s tough for them to reach or maintain a healthy weight.
Unlike bulimia, patients don’t compensate for overeating. However, intense feelings of disgust and self-hatred usually follow a binge-eating episode.
People with BED may experience lots of nasty symptoms. Examples include bowel problems, heartburn and reflux, and gum disease.
This category of eating disorders seeks to identify conditions we can’t classify into the above three. Someone with an OSFED may have symptoms of anorexia, bulimia or BED, yet can’t be diagnosed as having either disorder.
As an example, a patient may exhibit anorexic behaviours, such as severely limiting their food intake, yet manage to maintain a normal weight.
This classification doesn’t indicate their eating disorder is any less dangerous. A person with an OSFED needs immediate help. Your GP is a great place to start.
The National Eating Disorders Collaboration (NEDC) estimates that one in five obese people also exhibit behaviours associated with disorder eating that require medical attention.5 Obesity and overeating can play havoc with a person’s mental and physical health. These patients can also access the eating disorder plan, so long as they meet eligibility criteria.
Can an Eating Disorder be Cured?
Yes, eating disorders can be cured.
With the right treatment, family support and a good dose of patience, most people can fully recover with symptoms never returning. Healthy relationships with food can return, as too a positive body image.
A vital step towards a cure is developing coping skills for dealing with stress and anxiety – both common psychological triggers for disordered eating.
One of the patient benefits of the eating disorder plan is getting access to the right psychological treatment. Mental health practitioners experienced in the field teach patients to channel negative feelings away from damaging eating behaviours.
Causes and Symptoms of Disordered Eating
The exact causes of eating disorders are largely unknown as it varies dramatically from person to person. However, we do know psychological, biological and environmental factors play a role.
Psychological factors include low self-esteem and pre-existing mental health issues. Researchers estimate that almost 90% of adolescents living with bulimia have had at least one psychiatric condition throughout their lives.6
Genetics and irregular hormone activity are examples of biological factors. Environmental factors may involve dysfunctional relationships, stressful life changes and peer group pressure.
There are many symptoms indicating a loved one may have an eating disorder, even if they’re not aware of the problem. Much of the time they exhibit multiple symptoms at once, such as:
- a recent obsession with calorie counting, as well as fat and sugar content in food,
- weight fluctuations,
- obsessive use of bathroom scales,
- lethargy and depression,
- turning vegetarian or vegan seemingly overnight,
- excessive exercise,
- social withdrawal,
- abrasions on knuckles and hands from induced vomiting, and
- regularly leaving meals to use the bathroom.
People with eating disorders can be very crafty at hiding their condition. This makes spotting tell-tale signs challenging.
Eating Disorder Treatments
With eating disorders being such complex mental and physical health conditions, a team approach to treatment is the way to go.
This team can include a GP, mental health practitioner, dietitian and paediatrician. All involved must have experience with eating disorders.
Considerations guiding a course of treatment vary with a patient’s particular eating disorder and its severity, their age and background, as well as whether they have any other medical conditions.
Broadly speaking, treating eating disorders may involve a combination of:
- nutritional management and structured diet planning,
- psychotherapy and counselling, and
Hospital visits are also common, especially for anorexic patients who are prone to malnutrition. Such is the frequency of hospitalisation that many hospitals have a dedicated eating disorder unit.
Do You or a Loved One Need Help?
Get in touch with the clinic if you’d like to know more about the new eating disorder plan.
There are also loads of resources available for people who need help or would like to look into eating disorders themselves. The helpline offered by the Butterfly Foundation is free and confidential. You can contact them on 1800 ED HOPE (1800 33 4673).
Here are some other online resources:
- Sullivan, P. (1995). American Journal of Psychiatry, 152 (7), 10731074.
- Crow, S.J., Peterson, C.B., Swanson, S.A., Raymond, N.C., Specker, S., Eckert, E.D., Mitchell, J.E. (2009) Increased mortality in bulimia nervosa and other eating disorders. American Journal of Psychiatry 166, 1342-1346.
- The National Institute of Mental Health: Eating Disorders: Facts About Eating Disorders and the Search for Solutions. Pub No. 01-4901.
- Hudson JI, Hiripi E, Pope HG, Kessler RC. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biological Psychiatry. 2007; 61:348-58.