Introduction: 

Welcome to the twenty-ninth edition of the NEDC e-Bulletin. In this edition of the e-Bulletin we're highlighting some core information around late onset of eating disorders.

If you are interested in getting more involved in the NEDC we encourage you to join the collaboration and become an NEDC member.

Contents

1. Feature article: Late onset of eating disorders

2. New report: Investing in Need

3. At Home with Eating Disorders Conference

4. New Resource: Eating Disorders Myths...Busted.

Late-onset refers to first diagnosis of an eating disorder given in post-puberty stages of life. Eating disorders have traditionally been regarded as illnesses which primarily affect adolescents. While it’s true that adolescence represents a peak period of onset, anyone of any age, cultural background or gender, may experience an eating disorder.

Research indicates an increasing numbers of middle-aged and post-menopausal women in industrialised countries practice disordered eating behaviours. (Slevec & Tiggemann, 2011). It is estimated that 4.5 percent of women above the age of 45 are practicing disordered eating habits. (Keel et al 2009).

Furthermore, one study in Western Australia found that 25% of patients from a community sample experienced onset of their eating disorder after the age of 30 (Fursland, Allen, Watson, & Byrne, 2010).

This would suggest a number of factors contributing to this stage of onset. Where disordered eating patterns occur in this cohort, there is significant evidence of associated risk factors and co-morbid health characteristics such as depression and anxiety, and a decreasing activity and physical health status and changes in quality of life health risks relating to ageing. (Lapid, Prom et al, 2010). (Fairweather-Schmidt et al. 2014).

While there is a growing awareness that maladaptive eating attitudes and behaviours are common in women of various ages and stages of development, research into late onset of eating disorders in general remains limited and is particularly true of males with late onset of eating disorders. There have been recorded cases of delayed onset of eating disorders in men after age 40 (McCormack, Lewis et al. 2014), within the limited body of research into males with eating disorders, but typically studies tend to focus on younger males and frequently rely on comparisons with females (Striegel-Moore et al., 2009).

Research has highlighted stressful changes in mid-life such as marriage, pregnancy, menopause and divorce as potential triggers for older woman (Drobnjak et al. 2014; Bueno et al. 2014; Fairweather-Schmidt et al. 2014). While studies have identified gender-specific risks for men which include involvement in sport (Bratland-Sanda & Sundgot-Borgen, 2013) and pre-morbid obesity (Crosscope-Happel et al., 2000;) , certainly very little research has been conducted into specific risk factors for males in midlife.

Older people with persistent eating disorder symptoms require a different approach and a different environment to engage with treatment. At present specialist treatment services and community based recovery support programs for people with late onset or enduring illnesses are limited.

Over the last decade a greater understanding of eating disorders and disordered eating as issues that affect older adults has begun to emerge. Yet there is much to learn about this phase of eating disorder development, particularly in the following areas:

1. What are some typical stages of life where eating disorders may appear later in life?
2. What are the characteristics of late onset ED, are they any different to eating disorders which present in the ‘typical’ stages of life such as puberty or middle adolescence?
3. Have those with late onset been misdiagnosed previously?
4. What are some potential contributing factors to the growing prevalence of late onset eating disorders and are they the same as those contributing to the growth in pre-adolescence onset of eating disorders?

With the average age in our population increasing, further studies into vulnerable segments of middle aged individuals are important. Research into these areas would help to develop prevention and treatment strategies as well as offer support to improve quality of life and mental health concerns.

References

Bratland-Sanda S, Sundgot-Borgen J (2013) Eating disorders in athletes: overview of prevalence, risk factors and recommendations for prevention and treatment. Eur J Sport Sci 2013, 13(5):499-508.

Bueno, B., Kung, I., Bulik, C.M., Jim´enez-Murcia, S., Granero, R., Thornton, L., Penelo, E., Mench, J.M., S´anchez, I.,Tinahones, Fern ´andez-Aranda, F.J (2014) Late Onset Eating Disorders in Spain: Clinical Characteristics and Therapeutic Implications. Journal of Clinical Psychology, Vol. 70(1), 1 – 17.

Burger, K.S & Stice, E (2011) Relation of dietary restraint scores to activation of reward-related brain regions in response to food intake, anticipated intake, and food pictures. Neuroimage, 55:233–239.

Carter, O., Byrne, S., Allen, K & Fursland, A (2014) Readiness and motivation to change in the treatment of adults with anorexia nervosa: a case series. University of Western Australia, Perth, Australia; Centre for Clinical Interventions.

Cumella, E.J & Kally, Z (2008a.) Comparison of middle-age and young women inpatients with eating disorders. Eat Weight Disord, 13:183–190. Cited in Drobnjak et al. (2014)

Cumella EJ, Kally Z (2008b.) Profile of 50 women with midlife-onset eating disorders. Eat Disord, 16:193–203. Cited in Drobnjak et al. (2014)

Drobnjak, S., Atsiz, S., Ditzen, B., Tuschen-Caffier, B & Ehlert, U (2014) Restrained eating and self-esteem in premenopausal and postmenopausal women. Department of Psychology, Division of Clinical Psychology & Psychotherapy, University of Zurich, Switzerland.

Fairweather-Schmidt, K., Lee, C & Wade, T (2014). Disordered eating among mid-age women: is quality of life impacted over time? Flinders University, Adelaide, Australia.

Field AE, Austin SB, Taylor CB, Malspeis S, Rosner B, Rockett HR, Gillman MW (2003) Relation between dieting and weight change among preadolescents and adolescents. Pediatrics 2003, 112:900–906.

Slevec JH, Tiggemann M (2011) Predictors of body dissatisfaction and disorder eating in middle-aged women. Clin Psychol Rev 2011, 31:515-524.

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New evidence based economic report

In 2014, the Butterfly Foundation for Eating Disorders commissioned Deloitte Access Economics to undertake a cost benefit analysis of treatment for eating disorders in Australia. The report, Investing in Need- cost effective interventions for eating disorders report, examines the cost-effectiveness of ‘treatment as usual’ versus ‘optimal treatment’ for eating disorders in Australia, using the prevalence trends and costing framework from the 2012 Deloitte Report Paying the Price.

The ‘Investing in Need’ report was launched by The Hon. Sussan Ley, Minister for Health at Parliament House on Monday 2 March 2015.

The analysis in the report is based on the 213,208 newly developed eating disorders cases in 2014. Key findings of the Investing in Need report include:

• The total cost, if Treatment As Usual occurs, for those who develop an eating disorder in 2014, is equivalent to $103.2 billion(Net present value over 10 years). The total cost, if optimal treatment occurs, for those who develop an eating disorder in 2014, is equivalent to $49.9 billion (Net present value over 10 years).
• Best practice treatment is up to 50% more cost-effective than standard practice. There is a 5:1 benefit cost ratio for implementing optimal treatment interventions.
• Under the current system, in any given year, the great majority of people with an eating disorder do not access treatment. For those who receive treatment as usual, it will be truncated; often hospital based and will not follow through to sustainable recovery. Some with an eating disorder will never recover – one in every ten of those with anorexia will die prematurely. Many will struggle with their disease for decades, and most will face five to ten years with high morbidity.
• Early intervention in illness and in episode significantly reduces the duration and impact of the illness, and increases the rate of sustainable recovery.
• Rolling out a best practice multidisciplinary approach will take five years at a cost of around $2.8 billion. New cases of eating disorders in 2015 and onwards will cost the economy billions of dollars in lost productivity

This report was informed by information taken from NEDC publications. The entire report can be downloaded from the Butterfly Foundation.

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29-30 May 2015, Melbourne, Australia

At Home with Eating Disorders 2015 is the 2nd Australian conference for carers of people with an eating disorder.

Best evidence treatment for eating disorders shows that the close involvement of families and carers in the care of their loved ones can play a significant role in improving early detection, management and recovery of eating disorders. For parents and carers, however, the journey can be confusing, challenging and difficult to navigate.

At Home with Eating Disorders directly addresses the need for families and carers of people with eating disorders to have access to better information, and to be given training in skills that will directly impact on the way they carry out their caregiving role. This conference will increase knowledge, provide support, assist learning and empower families and carers to seek out appropriate services for their loved one and to develop the best possible home environment to support recovery from these complex and devastating disorders.

The primary aim of the At Home With Eating Disorders conferences is to provide access to a range of expert knowledge and skills for families and caregivers of people with eating disorders, so that they can leave the conference feeling better informed and more able to support, care for and assist in the recovery of the person with the eating disorder.

The secondary aim of the conference is to provide families and carers of people with eating disorders with opportunities to network and connect with other people with similar experience, in a safe and supported environment, so that they can benefit and gain confidence and new insights from shared knowledge and experience.

Who is the Conference For?

The conference is aimed at carers, parents, partners, siblings, grandparents, friends - anyone, in short, who is involved in caring for someone with an eating disorder, in a non-professional sense.

A pre-conference workshop for clinicians will also be held on the 28th May.
Registration and more details can be found on the event website.

Other events

As part of our ongoing series of regional professional development forums NEDC will be running the following sessions in April:

• Gippsland Eating Disorder GP Information Dinner
• Gippsland Eating Disorders Forum for Health Professional
• Gippsland Eating Disorders Carers and Community Session
• Cairns Eating Disorders GP Information Dinner
• Cairns Eating Disorders Forum for Health Professionals
• Cairns Eating Disorders Forum for Schools

More events can be found on the Professional Development  section of our website.

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NEDC are excited to launch our new video: Eating Disorders Myths…Busted. A follow up to last year’s Eating Disorders 101 video, this animated video highlights and dispels five common myths and misconceptions that affect how people and communities respond to eating disorders.

This video has been developed for use online, particularly through social media, to target the general public. Through our last video we were able to reach a broad audience and we hope that this follow up continues to encourage interaction with information on the NEDC website and contribute to the improvement of eating disorders awareness and understanding in Australia.

Eating Disorders Myths…Busted can be shared via YouTube

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