But Medicare disincentives and a focus on weight remain barriers to effective care.
The National Eating Disorder Collaboration has published its strategy to guide the next 10 years of eating disorder prevention and treatment, after a decade spent accumulating evidence and consulting extensively.
“The National Eating Disorders Strategy 2023–2033 encompasses a rich history of perseverance, struggle, and courageous conversations,” said Shannon Calvert, lived experience educator and advisory consultant, in her foreword. “Hope resonates throughout this document.”
The collaboration is funded by DoHAC.
Eating disorders – characterised in the strategy as “disturbances in behaviours, thoughts and feeling towards body weight and shape, and/or food and eating” – are a complex and serious group of disorders, including Australia’s most deadly mental health disorder, anorexia.
Although most prominently affecting young people and women, diagnoses are expanding and prevalence is rising globally, now affecting an estimated one million Australians. The cost was estimated at $70 billion in 2012, a number expected to be much higher now.
The “terrific” and “very digestible” – as clunkily described by Health Minister Mark Butler yesterday – strategy aims to reduce prevalence, increase quality of life, and help coordinate evidence-based care in all states/territories through 10 key principles.
“This strategy builds on the Albanese government’s $70 million investment for innovative programs to research and treat mental ill-health and eating disorders,” said Mr Butler.
“The vast bulk of people don’t receive a formal diagnosis, and even those who do are the minority. Maybe only one in five are receiving evidence-based treatment.
“I think this framework sets out all of those challenges in very clear detail, but also with [a] stepped system of care – really breaking this challenge down into a series of steps.”
The principles of the strategy, which focus on care needs and steps for their implementation – not care guidelines – incorporate understanding of lived experience and a focus on prevention and early identification to facilitate evidence-based care and equity of access.
The strategy outlines a “stepped” approach to eating disorder care – a system of hierarchical interventions matched to a person’s needs.
It also lays out an action plan for implementation and a series of minimum standards of care, heavily focused on the role of GPs and other health professionals.
Speaking to The Medical Republic, Dr Mark McGrath, a Brisbane-based GP with extensive national and international certification in eating disorders, said he hoped the strategy would help facilitate two key areas of GP education.
“Firstly, early recognition, diagnosis and treatment really improves prognosis. Particularly if eating disorders are picked up while subclinical … you’re able to subvert an eating disorder developing fully and becoming really ingrained, and treatment can be in a much more effective.”
Dr McGrath also spoke on the potentially detrimental effects that general practice’s focus on weight can have on promoting eating disorders. Dr McGrath said that although always well-meaning, weight loss advice can be “shortsighted”.
Dr McGrath hoped that the strategy would help encourage eating disorder education and that structural changes to Medicare may allow for “financially viable” support for complex needs.
According to Dr McGrath, there is currently a Medicare disincentive to spend time on complex conditions, such as eating disorders, that require longer consults to effectively manage.
“For example, my initial visit with someone presenting with an eating disorder is two hours. And there’s just no way that that I can charge a patient an adequate amount of money to make that financially viable,” he said.
Speaking on the funding of the strategy, Mr Butler acknowledged the unmet demand and necessity of reform.
“The collaboration will be funded to work in primary health network regions – so with primary care providers – to help families navigate what is a very complex system, that’s a challenge that was set out in the strategy,” he said.
“We’ve built a range of newly funded services, particularly in Medicare. There’s a very substantial entitlement to psychological and dietetic or dietitian support services that [former health minister] Greg Hunt put in place.”
Mr Butler said the government was currently evaluating the Medicare-funded program.
The strategy notes that further research is necessary to understand how the care system must adapt to meet the needs of Indigenous Australians, an area lacking in evidence-based information.
“Until this deeper understanding emerges, the implementation of any standards and actions within the National Strategy must align with principles and practices that drive access to services that are prevention- focused, strengths-based, culturally safe and responsive, equitable and free of racism,” it says.
On the overall principle of the strategy, Mr Butler said reform could not be left up to health professionals and required a cultural shift.
“We know that the causes of eating disorders are complex, they are multi-layered, but in many ways they’re rooted in deep cultures in our community, around body image and a whole range of other things.
“We have to examine ourselves as a community about what it is that is leading particularly young people into these sorts of disorders.”
