Proposal to skip past GP referrals for eating disorders

Key points:

• Approximately a third of Australian adolescents engage in disordered eating behaviours within any given year

• Eating disorder symptoms are on the rise with at least weekly binge eating increasing almost six-fold since the late 1990s and strict dieting increasing almost four-fold with parallel increases in other behavioural and cognitive eating disorder symptoms

• Of people with an eating disorder, three percent have anorexia nervosa, 12 percent have bulimia nervosa, 47 percent with binge eating disorder and 38 percent have other eating disorders

A new study has revealed why only one in four young adults seek help for disordered eating, finding self-denial was among the main barriers to people under 25 years old making use of an early intervention program for eating disorders.

The research found that young adults were hesitant to seek help even though the primary healthcare model had good results for those who sought help.

Feedback from participants in the program, offered by Sonder and Headspace in two low socio-economic areas south and north of Adelaide, included cognitive behaviour therapy sessions and follow-up consultations, found one of the first obstacles was with individuals’ denial of having an eating disorder.

“We found the main barrier identified by those surveyed to be denial or a belief that their problems are not bad enough to seek help,” College of Education, Psychology and Social Work researcher Dr Marcela Radunz said.

“In fact, based on our previous studies, we found that high eating disorder symptoms are associated with higher denial of illness and reluctance to seek help. 

“So, we propose that early intervention services for eating disorders should be placed in primary healthcare, where individuals with eating disorders are not required to seek a referral from a GP. This may promote earlier help-seeking and promote their willingness to get help.”

People who live with an eating disorder that restricts or encourages the mental suppression of physical requirements are at severe risk. Potential outcomes of anorexia nervosa may be fatal or may facilitate the onset of other conditions which pose a fatal risk to the human body, as a result of poor nutrition and biological degeneration.

In addition, adverse side-effects of starving oneself may accelerate symptoms associated with anaemia, muscle loss, cardiovascular health, organ failure and hormone balance.

Barriers to the delivery of treatment in low-socioeconomic status populations included poor nutritional or food security issues, drug or alcohol use, mental health, other illnesses and lack of support networks for young people and families.

Other conditions, such as binge eating disorder and avoidance/restrictive food intake disorder were not included in treatment programs.

“Despite these problems, the range of disorderly eating behaviours continue to rise [sic] so there is clearly an important role for more early intervention and other models in primary healthcare settings in order to support all parts of the community,” Distinguished Professor of Psychology Tracey Wade, a co-author of the study, said.

“The pandemic has further exacerbated the prevalence of eating disorders which now have the highest mortality rate of any mental illness, so early intervention programs which proactively screen, detect and provide rapid and effective treatments is critical.”

One North American study estimated that 5.7 percent of women and 2.2 percent of men live with an eating disorder, providing a ‘[…] real challenge for public health and healthcare providers’ around the world.

Professor Wade said the prevalence of eating disorders in young people has increased 15 percent since the pandemic started, resulting in a three-fold increase in demand for eating disorder treatments.

Meanwhile, in Adelaide, the Flinders University Services for Eating Disorders is trialling a single-session intervention to help overcome denial and encourage the importance of adequate nutrition, introducing skills to decrease depression and introduce a focus on emotional regulation.  

“It is really pleasing to report early results from the trial which show that 43 percent of people commencing this accessible method have reduced dietary restrictions by 30 percent or more,” Professor Wade, who also runs the Blackbird Initiative at Flinders University, said. 

“This means interventions such as this could give a person a quicker start to therapy and they may need less therapy.”

The article, ‘Addressing the gap of early intervention for eating disorders in primary health care’ by Marcela Radunz, Luke Pritchard, Eloisa Steen, Paul Williamson and Tracey D Wade has been published in Early Intervention in Psychiatry.

Although people with an eating disorder as a primary disability may not have access to National Disability Insurance Scheme-funded supports, research has suggested that over 80 percent of adults diagnosed with an eating disorder have at least one more psychiatric disorder.

If you believe that you may live with an eating disorder, please refer to the following resources:

Butterfly: 1800 33 4673

Beyond Blue: 1300 22 4636

Do you find the GP referral process to be a barrier for accessing support? Let the team at Talking Disability know and subscribe to the newsletter for more information, news and industry updates.

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