Orygen eating disorder researchers (L-R) Dr Erica Neill, Dr Stephanie Miles and Associate Professor Andrea Phillipou
People with anorexia nervosa and other eating disorders face unacceptably poor outcomes due to a lack of scientific breakthroughs and treatment innovations in the field, a new paper from global experts has argued.
The paper, led by Orygen with co-authors from Harvard Medical School and King’s College London and published today in JAMA Psychiatry, identifies two major problems hindering research innovations: siloing of eating disorders within the mental health sector and a narrow focus on weight restoration in treatment.
Lead author and Head of Eating Disorders at Orygen, Associate Professor Andrea Phillipou, said that despite the high prevalence and increasing rates of anorexia nervosa, particularly in young people, treatment options are limited – and often lack a strong evidence base.
“Despite the clear need for research and treatment innovation, anorexia nervosa remains an inadequately researched and treated illness, with one of the highest premature death rates of any mental health condition,” A/Prof Phillipou said.
“Current treatments were developed decades ago, are effective in only a minority of patients, and rely on a limited evidence base.”
The paper argues that stigma around eating disorders is holding the field back and limiting collaboration with other areas of mental health, while a narrow focus on weight restoration is hindering the effectiveness of treatment.
“While anorexia nervosa is fundamentally a psychiatric illness, it is complicated by the fact that it can have severe physical consequences,” A/Prof Phillipou said.
“We see patients battling an all-consuming and overwhelming mental illness, while also facing a barrage of serious physical complications, creating a unique challenge for many healthcare systems.
“We know that the physical symptoms of anorexia can be life-threatening, but the focus on these symptoms—to the exclusion of the psychological symptoms—can be distressing and invalidating for many people experiencing an eating disorder.
“Weight goals are seen as a primary measure of treatment success, and while weight restoration is a critical outcome we also need to be working towards a shift in psychological symptoms.”
Senior author Professor Kamryn Eddy from Harvard Medical School said that despite these frustrations, the paper signalled a way forward for the field.
“As a field, we need to shore up the foundational research to better understand the biopsychosocial mechanisms that underlie anorexia nervosa, and the complex bi-directional relationship between low-weight and psychological symptoms,” Prof. Eddy said.
“Only then can we use this knowledge to develop and test new treatments that target these mechanisms to produce better outcomes.
“We also need to break down the silos that hamper collaboration with other areas of mental health, and reduce the stigma around this incredibly serious and often misunderstood mental health condition.”
Professor Ulrike Schmidt OBE, Professor of Eating Disorders at King’s College London said, “while our article focuses on anorexia nervosa, as the most visible and alarming of eating disorders, it is a passionate call for action on improving research for all eating disorders and improving collaboration of researchers, clinicians and funders within the eating disorders field and across the wider mental health sector.”
Recommendations:
- Undertake comprehensive multidisciplinary and collaborative research across biological, psychological, and sociocultural factors involved in the development and maintenance of anorexia nervosa.
- Establish markers for early identification and treatments that focus on early intervention so anorexia nervosa does not become chronic, entrenched, and more difficult to treat.
- Ensure assessment of comprehensive physical, behavioural, cognitive, and psychological symptoms and their dynamic relationship at multiple points during and after treatment, to better inform what is working in which treatments, how, and for whom.
VIDEO: Learn more about Orygen’s Eating Disorders team