August 31st 2022

Eating Disorders Victoria (EDV) is calling on the Victorian Government to take meaningful action on binge eating disorder (BED) as it maps out a state-wide eating disorder strategy alongside ongoing mental health reform. BED is the most prevalent eating disorder affecting Victorians, accounting for 47%, or 133,000, of the states increasing eating disorder cases. Despite the prevalence, only 25% of people with BED will seek help. Left untreated, BED can cause severe psychological, physical, social and economic distress.

EDV CEO Belinda Caldwell is urging the Government to make BED a priority area as work begins on the Victorian Eating Disorder Strategy.

“People with binge eating disorder don’t feel ‘seen’ in our eating disorder treatment system, let alone our broader mental health system. The fact that there are so few pathways for BED specific support in our public health system shows that this diagnosis has been largely forgotten. This is despite us knowing that more Victorians have BED than any other eating disorder. BED is debilitating and life-limiting and deserves equal recognition to other eating disorders,” Belinda said.

Lived experience advocate Sarah Bryan knows the challenges in the health system around BED firsthand.

“I was engaged in mental health services for a number of years for other things before my BED was recognised. Not only did health professionals not know the signs or the questions to ask, neither did I. I had never heard of BED before being diagnosed, I just thought the problem was me. Now I know that I had a legitimate, and treatable, eating disorder,” Sarah says.

Sarah recently led a group of Victorians with lived experience of BED to create a vision for policy makers to aspire to when re-examining eating disorders within our mental health system. The vision calls for all tiers of the mental health system to be better attuned to the signs of BED, with stepped access to BED-specific treatment and support. Key to this is weight-neutral care, which removes appearance-based prejudice that often plagues eating disorders. Eating disorders occur in people of all body sizes, with BED more likely to occur in people with higher weight.

Sarah will be speaking about this issue to MPs and other stakeholders, including the Minister for Mental Health Gabrielle Williams, at ‘Feed the Soul’’, a breakfast event at The Hotel Windsor hosted by EDV on Wednesday August 31^st.

For further information, please contact Breanna Guterres, Communications Manager on 0431 717 177 or [email protected]. Please refer to the Mindframe media guidelines when reporting on eating disorders.

VISION: All tiers of Victoria’s reformed mental health system have the knowledge and skills to respond to Binge Eating Disorder, providing stepped access to support services in a variety of forms across the spectrum of severity.

Success of this vision is predicated on recognition of the following:

➡️ Binge Eating Disorder is a debilitating and life-limiting mental illness that deserves equal recognition to other eating disorders

BED is the most prevalent eating disorder in Australia, affecting 47% of people with eating disorders. This is compared to 3% with anorexia nervosa, 12% with bulimia nervosa and 38% with other eating disorders.[1] BED has significant psychological and physical health consequences, which can include:

• Social withdrawal or isolation
• Feelings of shame, guilt and self-loathing
• Depressive or anxious symptoms and behaviours
• Extreme body dissatisfaction/distorted body image
• Self-harm or suicidality
• Cardiovascular disease
• Type 2 diabetes
• High blood pressure and/or high cholesterol leading to increased risk of stroke, diabetes and heart disease
• Osteoarthritis
• Chronic kidney problems or kidney failure[2]

Identification and treatment of BED lags behind other eating disorders partly due to its later inclusion in the DSM. BED was added as an independent eating disorder diagnosis in 2013, almost 20 years after anorexia nervosa and bulimia nervosa.

➡️ People with Binge Eating Disorder need non-discriminatory and weight neutral care.

People experiencing BED often don’t feel ‘seen’. Poor training in the healthcare system around the identification and treatment of eating disorders can result in appearance-based prejudice, where eating disorders are predominately identified in people in smaller bodies.

While BED occurs in people with diverse body sizes, research suggests that those with BED are an estimated 3–6 times more likely to be larger bodied people.[3] Larger bodied people often go undiagnosed, or when they are diagnosed, there is a lack of suitable and inclusive eating disorder services available to them. They may be incorrectly prescribed food restriction or weight loss, which perpetuates illness. Food restriction is contraindicated in eating disorders.

Weight-neutral care, whereby people are supported to enhance their physical and mental health without the intention of weight change, should be offered to people with binge eating disorder disorders to ensure the best possible recovery outcomes.

➡️ Entry to care must be accessible to account for high levels of stigma that leads to shame.

Negative attitudes and misconceptions around the causes of eating disorders, the presentation of eating disorders (e.g. age, body weight, gender, cultural background) and certain eating disorder behaviours (e.g. bingeing) results in stigma leading to shame. The shame cycle perpetuates distress and compounds illness. It prevents people from reaching out, discussing their symptoms and accessing effective treatment.

Reducing this high barrier to care is dependent on creating accessible entry points. Digital interventions that allow for less invasive and private help seeking, such as web chat, online questionnaires, or online psycho-educational programs, have been identified by people with BED as critical early components of a stepped system of care.

Reducing stigma and shame can also be supported from within the health system by training healthcare professionals to provide evidence-based and weight inclusive eating disorder information and treatment.

➡️ Peer-led Binge Eating Disorder initiatives are an essential adjunct to clinical treatment.

For those who have had the opportunity to access it, peer support has been identified as a vital component for recovery from BED. The aforementioned isolation and shame experienced by people with BED makes finding connection with others so powerful and a key motivator for recovery.

Peer support has the potential to reduce pressure on the clinical healthcare system. Offering peer support early can reduce the need for engagement in higher intervention support later on. For those already engaged in clinical treatment, peer support for eating disorders has been proven to reduce hospital readmissions, reduce eating disorder behaviours and increase quality of life.[4]

References:

[1] NEDC

[2] Sheehan DV, Herman BK. The psychological and medical factors associated with untreated binge eating disorder. Prim Care Companion CNS Disord. 2015;17(2).

[3] McCuen-Wurst C, Ruggieri M, Allison KC. Disordered eating and obesity: associations between binge-eating disorder, night-eating syndrome, and weight-related comorbidities. Ann N Y Acad Sci. 2018 Jan;1411(1):96-105

[4] Beveridge, J., Phillipou, A., Jenkins, Z. et al. Peer mentoring for eating disorders: results from the evaluation of a pilot program. J Eat Disord 7, 13 (2019).