Issue 82: Challenging Stereotypes

About this resource

Editor’s Note

It’s been a busy few months for the eating disorders sector in Australia, with travel opening up and allowing for the free exchange of ideas and innovations. In this bumper edition of our eBulletin, NEDC has ground-breaking new resources and research discoveries to share with our members.

NEDC were delighted to welcome 540 attendees on August 19 to our live webinar to help us celebrate the official launch of our newest resource, Management of eating disorders for people with higher weight: clinical practice guideline. “Be curious. Read and understand this Guideline and join us in becoming part of the solution,” said Guideline Development Group member Julia Quin. Read more here.

The 20 Years of ANZAED: Broadening our Horizons, held at Darling Harbour from 11-13 August, was a rare opportunity for the eating disorders sector – including people with lived and living experience, clinicians, academics and more - to meet colleagues, learn from each other and form connections. See our full report on the conference and NEDC’s presentations and workshops here.

NEDC spoke to lived experience advocate AJ Williams-Tchen, inaugural Aboriginal Social Worker of the Year, about creating cultural awareness of and culturally appropriate approaches for Aboriginal people at risk of or experiencing eating disorders and disordered eating. “Stereotypes should be challenged,” he said. See our video interview or read it here.

Learn about Upcoming Training and Events taking place in September and October here.

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Launch and new resources: Management of eating disorders for people with higher weight: clinical practice guideline

NEDC’s successful live webinar launch on August 19 of our key new resource, Management of eating disorders for people with higher weight: clinical practice guideline, represents the culmination of the extensive review and consultation process undertaken throughout 2020-22 by NEDC and the Guideline Development Group. The Guideline and accompanying resources are freely available to access through the NEDC website, and as an open-access article in the Journal of Eating Disorders.

You can watch the full webinar here.

You can access the Management of eating disorders for people with higher weight: clinical practice guideline page here and find resources, including:

“Until now there has been little guidance for clinicians about how they can manage eating disorders for people with a higher weight. I’m pleased that this new Guideline will address this gap and give Australians with lived and living experience the support they need,” The Hon. Emma McBride, MP, Assistant Minister for Mental Health and Suicide Prevention, and Assistant Minister for Rural and Regional Health, said in her introduction to the launch.

She added that the Management of eating disorders for people with higher weight: clinical practice guideline will be invaluable for health professionals and the people in their care and will make a significant difference to many Australians. “I want to thank the NEDC for its work on this important, practical and necessary national Guideline. I also thank the people with lived experience who have given their time and energy to inform the Guideline and for speaking today,” she said.

Lived experience advocate and member of the Guideline Development Group AJ Williams-Tchen gave a Welcome to Country and spoke of his dedication to raising mental health literacy.

Guideline Development Group member Jo Farmer spoke movingly of her lived experience of an eating disorder. She said access to quality psychological therapies, recommended in the Guideline, and learning to have compassion for herself was one of the few things that worked well in her treatment.

“Saying ‘just eat less’, which is definitely advice that health professionals have given me in the past, was never going to work for me, because it wasn’t really about the eating. It was about other things that were going on underneath that. The goal is to be content and happy in who I am regardless of what my body is like.”

“One of the consistent themes in accessing treatment for my eating disorder has been experience of weight stigma and fatphobia,” she said. “Health professionals constantly highlighting my weight as if that wasn’t something that I was already aware of. I live in this body every day. I know what it feels like.”

“Fundamentally everybody is deserving of care regardless of what their body looks like. It seems like such an obvious point to make but you’d be surprised how often that principle isn’t followed in the care that people receive.”

Jo said it was a privilege to be involved in Guideline project but there was still a way to go to ensure that everybody can access quality, safe, accepting, non-judgmental care.

“I hope that by contributing my experience no one else has to experience bad treatment.”

NEDC Research Lead and Management of eating disorders for people with higher weight: clinical practice guideline author Dr Angelique Ralph explained the development of the Guideline and the five-step consultation and review process, including input and feedback received and incorporated from expert review, peer review, lived experience organisations, NEDC members and NEDC Steering Committee, and the public.

Prof Phillipa Hay, Guideline Development Group chair and NEDC Steering Committee chair, said she was cautiously optimistic that things would get better. Currently eating disorders are prevalent in people with higher weight but often go unrecognised in metabolic and weight-loss clinics, general practices and mental health units, leading to severe under-treatment. Prof Hay’s key messages were that psychological, medical, nutritional and dietetic and activity therapies have a sound evidence base and are available; care should be multidisciplinary; there are always choices; address malnutrition and poor diet quality; and exercise intervention should focus on positive mental health benefits, not weight or shape change.

Julia Quin, lived experience advocate and Guideline Development Group member, spoke of unhelpful stereotypes persisting in the community and clinical settings leading to extended suffering and low rates of recovery.

“My hope is that families can have different experience to ours,” she said. “We need providers to be curious and to ask the questions – ‘How’s your relationship with food?’ ‘Have the people in your life expressed concern with your relationship with food or your body?’ Really listen to those answers and set aside preconceptions about who develops eating problems.

“Read and understand this Guideline and join us in becoming part of the solution.”

Guideline Development Group member and NEDC National Manager Dr Sarah Trobe moderated the lively Q&A session, which covered topics including promoting person-centred care, removing weight criteria from anorexia diagnoses, how to educate GPs and bariatric clinics or weight-loss clinics to screen for eating disorders, and a discussion on terminology.

Prof Hay said clinicians should be respectful and invite the person they are talking with to give their preferred term. She also noted that the average length of time before people seek or receive treatment is 10 years so don’t delay. “Take the eyes off the weight and put the eyes on the person, and the person's physical and mental health needs,” she said.

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Report on the ANZAED Sydney Conference

The first in-person ANZAED Conference since 2019 also marked the 20^th anniversary of the ANZAED annual meeting. Conference Conveners Joanne Titterton and Deborah Mitchison developed a diverse and stimulating program that brought together the eating disorders community and provided a long-awaited opportunity to connect and share ideas.

Dr Eric Stice’s international keynote, Scaling-Up Implementation of Eating Disorder Prevention Programs and Treatments, presented informative statistics on the effectiveness of interventions for the prevention of eating disorders and the Body Project. NEDC’s Steering Committee Chair Prof. Phillipa Hay’s local keynote, Disentangling and Re-imagining the Diagnostic Spectrum of Eating Disorders, examined historical biases and inconsistencies and considered emerging approaches.

Highlights included the warm introduction from Aunty Professor Kerrie Doyle and the entertaining and musical Welcome to Country, the inaugural ANZAED Indigneous Scholarship and AJ Williams-Tchen’s cultural awareness workshop. The plenary on Autism and Eating Disorders: Broadening Our Understanding, featuring presenters Will Mandy, Meagan McGregor, Jac den Houting and Annie Crowe was thought-provoking and challenging.

NEDC are pleased to report that our National Director, Dr Beth Shelton, received the Distinguished Achievement Award on the final day of the conference. At the ceremony, Dr Shelton said she felt grateful and deeply encouraged. She acknowledged the support of three teams that have nurtured her throughout her career - Susan Paxton’s Body Image research team at Latrobe University, her former colleagues at CEED and her current NEDC team – and thanked ANZAED for giving people the chance to meet others committed to collaborating on solving problems. Working in the eating disorders field need not be a “lonely slog”, she said: "Everything that we do is an interplay of action, intelligence, framework and evidence with other human beings." Dr Shelton also acknowledged the unsung heroes of the field – people with lived experience, carers, clinicians “who go the absolute extra mile” and advocates “prepared to push past being nice into being insistent so we get actual change”.

See the full video here.

Read about NEDC’s contributions here.

If you are interested in receiving more information about any of the presentations, please contact the NEDC team at info@nedc.com.au

National Strategic Landscape: Overview and consultation

“Research is like the lifeblood and the system of care is the whole body.”

On the first day of the conference, NEDC held an evening session to discuss the National Strategic Landscape. After a full day of workshops, nearly 100 attendees joined us to find out more about the Australian Eating Disorders Research and Translation Strategy 2021-2031 and NEDC’s forthcoming National Eating Disorders Strategy 2023-2033, and how these strategies will shape the national landscape and eating disorder system of care over the next decade.

The session began with a lively and engaging conversation between Dr Beth Shelton, NEDC National Director, and Associate Professor Dr Sarah Maguire, InsideOut Institute Director and Centre Director, Australian Eating Disorders Research & Translation Centre. This conversation focused on the intention and purpose of each strategy, what success would look like, and how the strategies will complement each other to achieve their vision. A powerful metaphor, research as the lifeblood, and the system of care as the body, helped to illustrate how the two strategies will work together to build and invigorate the system of care. Attendees were left with an optimistic vision for the future, where an equitable, high quality, evidence-based system of care will be accessible to all Australians.

This discussion was followed by a consultation activity to inform the development of the new National Eating Disorders Strategy, facilitated by NEDC Strategy and Policy Lead Louise Dougherty. Delegates were invited to share ideas and reflections on system challenges, ways to strengthen the system of care, and potential benefits of a new National Eating Disorders Strategy. The rich insights generated by each group during the consultation activity will inform the development of the National Eating Disorders Strategy 2023-2033, which will be released in August 2023. NEDC members will be kept up to date on progress and further opportunities for input to help shape the strategy.

Access the Australian Research and Translation Strategy here.

Find out more about the forthcoming National Eating Disorders Strategy 2023-2033 here.

Evaluating the effectiveness of evidence-based online foundational eating disorder training for general practitioners

“Completion of NEDC’s online foundational training ‘GP Core Skills’ improved GPs’ knowledge and confidence to provide care for people experiencing eating disorders.”

On Friday 12^th August, NEDC Strategy and Policy Lead Louise Dougherty presented evaluation data on the uptake and effectiveness of NEDC’s free, evidence-based online foundational eating disorder training for general practitioners (Eating Disorder Core Skills: eLearning for GPs).

The evaluation explored uptake and course completion rate, as well as the change in GP knowledge of eating disorders, and confidence and willingness to provide care for people experiencing eating disorders before and after completing the course. In the year since the release of the course (in June 2021), 536 GPs have commenced the course, and of these, 242 have completed the course (45% completion rate). This completion rate is higher than the average completion rate for eLearning courses and suggests that GPs found the course to be relevant, useful and engaging. Completion of the course was associated with a statistically significant improvement in GPs self-reported knowledge of eating disorders, and confidence and willingness to provide care for people experiencing eating disorders. Notably, prior to undertaking the course, only 7.4% of GPs felt that their knowledge of the stepped system of care for eating disorders was good or excellent, compared to 97% of GPs after completing the course. Similarly, only 11.6% rated their level of knowledge of best practice medical care as good or excellent prior to undertaking the course, compared to 96% of GPs after completing the course.

These outcomes indicate that the course achieves its aim, which was to provide an effective and accessible eating disorders training, to support the development of a skilled primary care workforce and to ultimately improve delivery of safe, evidence-based care for people experiencing eating disorders. Having all GPs in Australia with eating disorder knowledge, confidence, and willingness to provide care will make a meaningful difference to people experiencing or at risk of an eating disorder being able to get the care that they need, when they need it. We thank our members for helping us to spread the word about GP Core Skills, and encourage our members to continue sharing information about this freely available course with health professionals and service leaders.

Management of eating disorders for people with higher weight: clinical practice guideline

“Eating disorders in people with higher weight are under-recognised and under-treated.”

On Friday 12th August, Dr Angelique Ralph, Research Lead at NEDC, presented at the ANZAED 2022 conference on ‘Management of eating disorders for people with higher weight: clinical practice guideline’ on behalf of NEDC’s Guideline Development Group. The Guideline has been recently finalised by NEDC after a two-year development and consultation process and is now published in the Journal of Eating Disorders here.

The presentation highlighted key messages of the Guideline including the under-recognition and under-treatment of eating disorders experienced by people with higher weight, the harmful impact of weight stigma, and the importance of trauma-informed care. Key recommendations for psychological therapy for adults, children and adolescents were also discussed.

Access the full Guideline, including recommendations for psychological therapy for adults, children and adolescents, pharmacotherapy, medical and nutritional management, physical activity interventions and family and other interventions here.

A snapshot of the current eating disorders workforce in Australia: Who is ready, willing, and able? Characteristics of clinicians upskilling in eating disorders treatment

How do we support the uptake of evidence-based treatment for eating disorders: Listening to clinicians about the key barriers and enablers

"Eating disorder workforce shortages are reducing access to timely, effective treatment and care for people experiencing eating disorders."

Unfortunately, treatment outcomes for people experiencing eating disorders are still not good enough. While continuing to understand and develop treatment is incredibly important, so too is information that assists in attracting and retaining people in the eating disorders workforce, and understanding the things that help and hinder their work with people experiencing eating disorders within their work settings.

On Friday morning, NEDC National Manager Dr Sarah Trobe and NEDC Workforce Development Coordinator Dr Emma Spiel delivered two presentations giving data on clinician characteristics and perceived barriers and enablers to implementing effective care for people with eating disorders from baseline evaluation data collected from 480 dietitians and mental health clinicians as part of the Credential Professional Development Packages.

Clinician responses suggest that with the option of free training and supervision, a substantial number of willing and motivated clinicians will enter the workforce. Responses also indicated that more can be done to attract a wider array of professions and clinicians of diverse backgrounds to the sector, and that those clinicians who are early in their career, those working in regional areas and in general health and mental health services face a greater number of barriers, and fewer enablers to providing eating disorder treatment and care.

Workplace culture, perceived knowledge, skill, and capacity, and recognising eating disorders as “core business” were key to clinicians being supported to implement this work. Returning to a workplace where there is a lack of skill, knowledge, access to supervision and appropriate resources makes engaging in this work over the longer term much harder for clinicians.

Disordered Eating and Eating Disorders in High Performance Sport - Prevention, early intervention and the role of the clinician

"Everyone in the high performance sports system has a role as early identifiers of disordered eating."

Disordered eating and eating disorders can occur in any athlete, in any sport, at any time, crossing boundaries of gender, age, body size, culture, socio-economic background, athletic calibre and ability. NEDC’s National Manager Hilary Smith and the Australian Institute of Sport (AIS) Senior Dietitian and Disordered Eating Project Lead Nikki Jeacocke have worked together for several years on the development and roll-out of the AIS-NEDC position statement on disordered eating in high performance sport and accompanying resources and training across the High Performance sport sector. You can find the position statement and resources on the AIS website here.

On the afternoon of Friday 12 August, Nikki Jeacocke and NEDC’s Dr Emma Spiel, Workforce Development Coordinator, presented a workshop at the ANZAED conference. The focus was to bring this material to life for clinicians who, while familiar with eating disorders, may be less aware of the specific factors at play both for athletes as individuals and within the sporting environment. This included a deep dive into cultural challenges within sport, what is being done to address them, and how clinicians and others can equip themselves to work effectively with the team and systems around the athlete.

Connecting the sector with the ANZAED Eating Disorder Credential

"As a sector we need to think about how we are providing the necessary support to clinicians new to the workforce."

NEDC were part of the Credentialing breakfast meeting on Saturday morning. NEDC National Manager Dr Sarah Trobe provided an update on the rollout of the Credential Professional Development Packages which are designed to support mental health professionals and dietitians to better respond to eating disorders and to help meet the eligibility and ongoing requirements for the ANZAED Eating Disorder Credential.

Through the PD Package program, NEDC is providing up to 900 PD Packages of free training and/or supervision to clinicians from across Australia over a 12-month period. To date, 844 clinicians have been awarded a PD Package, with 268 mental health professionals and 99 dietitians having completed the training component of their Package within the first four months of the rollout.

Through a comprehensive evaluation of the program, NEDC along with ANZAED will be exploring and implementing strategies to support this cohort of clinicians new to providing treatment for people experiencing eating disorders.

Interview with AJ Williams-Tchen and video

Watch the video interview here.

Accredited Mental Health Social Worker AJ Williams-Tchen became involved in the eating disorders world through personal experience. As a teenager, he lived with bulimia from the ages of 14-18.

“It was really hard being an Aboriginal kid and having an eating disorder, because no one really believed that I had an eating disorder,” he says.

“When they worked out that I had an eating disorder, the treating staff – nurses, doctors, social workers – said, ‘You don’t match the stereotype we have or the reflection of any of the case studies’, which means that the case studies were all around young females. There wasn’t anything for young males.

“The literature that I got to help me through things was telling me my periods would stop, my breast development would be affected, and I might have trouble bearing kids in the future. Everything a young 14-year-old Aboriginal boy wants to hear!”

AJ gained qualifications in mental health, social work and youth work, and his experience is reflected in his practice, including his consulting work educating communities on cultural awareness and trauma-informed approaches.

“I’ve worked with clients that have had eating disorders and I’ve always tried to do my best to help them. But there wasn’t a lot of training even 20-30 years ago around eating disorders,” he said.

“I can’t make diagnoses, but I would say that the majority of the people I work with have some sort of disordered eating. We know that for all eating disorders, disordered eating is a common factor, so my job is to work with people to seek additional professional help so they can get the diagnosis of whatever the eating disorder is.”

AJ also works to raise awareness for all professions in how to identify considerations when engaging and working with Aboriginal clients and families.

“What we do know is that as professions we haven’t been doing it very well,” he said. “If we had, we wouldn’t have this huge health gap that exists. We wouldn’t have gaps in education and employment. We need to look at other ways, new ways, of actually working with people.”

AJ believes there needs to be more understanding of the trauma triggers faced by Aboriginal people, beyond colonisation, such as Stolen Generations issues, and the impacts of the high removals of Aboriginal children.

“There’s so much of recent history that professionals don’t understand, and they are also trauma points for people,” he said. “In 2022 we have more kids in out-of-home care than ever in Aboriginal affairs. Sometimes people don’t understand where the trauma comes from because they don’t have that historical understanding.”

AJ has collaborated on projects with Butterfly, ANZAED and NEDC. “I’m still on a learning journey, learning a lot more about eating disorders. I’m working with a lot more clinicians that specialise in working with eating disorders and that’s been very helpful for me,” he said. “I want to make sure that people are aware that there are eating disorders in Aboriginal communities.”

Dr Adam Burt et al’s 'Eating disorders amongst Aboriginal and Torres Strait Islander Australians: a scoping review' strongly suggests greater eating disorder prevalence among Aboriginal and Torres Strait Islander peoples than non-Indigenous Australians.

AJ said that there needed to be more awareness that eating disorders affect “every single person” and that “any body type, any culture, any religion, any gender, can experience an eating disorder”. He said eating disorders should not be seen in regard to body shape, but more about behaviours. He hoped for more publicity and promotion of Aboriginal people with eating disorders and particularly males.

“I do think there needs to be a lot more research using case studies that are not just white females,” he said, adding that reflecting Aboriginal, Asian, African, and a wider range of experiences, languages and imagery would be helpful. “I want to make sure that people are aware that eating disorders actually exist in other communities.”

“I want to see more publications that have young men as case studies. I want to hear more men’s stories, I want clinicians to understand that young men do actually have eating disorders and that materials become more reflective of people from different cultures.”

At the 2022 ANZAED Sydney Conference held August 11-13, AJ presented a workshop: Cultural Insightfulness: Strategies for working with Aboriginal & Torres Strait Islander people, project & programs. The interactive workshop touched on recent history of trauma points and looked at general awareness, working with people in trauma and covered practical engagement skills in how to work with Aboriginal people in clinical practice or research, policy development or programs.

AJ also contributed to the two-year development process of NEDC’s Management of eating disorders for people with higher weight: clinical practice guideline as a member of the Guideline Development Group and presented the Welcome to Country at the August 19 launch.

“It has been a real journey. I think being able to provide my own story within that has been really good and I’ve also been able to look at the Guideline in general and get the other experts to look at things from cultural angles within it as well,” he said. “We tried not to make the Guideline just pure theory but to also provide actual strategies that clinicians can use when working with any person that has an eating disorder.”

AJ describes this as “trying to ‘unclinicalise’ it at times”, so that a youth worker or social worker, or someone who hasn’t been trained in eating disorders, would be able to have a good understanding of the practical considerations that need to be taken into account rather than just presenting the literature. “It is a very practical document,” he said.

AJ Williams-Tchen is an Aboriginal man of Wiradjuri / Wotjobulak background. He is an Accredited Mental Health Social Worker who works in private practice (Girraway Ganyi Ganyi Consultancy) delivering counselling services, mentoring programs (for workplaces and schools), mental health literacy programs and cultural awareness workshops. With 30 years of experience in health and community services, AJ continues to provide advocacy and social work practice in ways to increase the voices of those that have been historically silenced. He shares his experiences of issues of Stolen Generations, Aboriginal issues, trans-generational trauma and mental health and presents strategies and pathways to alleviate disadvantage.

Upcoming Training and Events

SEPTEMBER

Webinar: Eating Disorders Families Australia (EDFA) - Orthorexia and ARFID

Workshop: Western Australia Eating Disorders Outreach and Consultation Service (WAEDOCS) - Eating Disorder Essentials for Dietitians

Workshop: Eating Disorders Training Australia - Assessment and treatment of adolescents and adults with Eating Disorders in private practice (Intro + CBT-E).

Webinars: Butterfly - Let's talk body confident children and teens, and Understanding Eating Disorders in Young People

Workshop: BodyMatters - Treating ARFID using Maudsley Family Therapy

Training: Butterfly - Body Esteem Educator Training

Training: The Centre for Eating, Weight and Body Image - Schema Therapy for Eating Disorders

OCTOBER

Training: The Victorian Centre of Excellence in Eating Disorders (CEED) - Specialist Supportive Clinical Management for Adult Eating Disorders (SSCM) and Family-Based Treatment for Adolescents with Anorexia Nervosa

Training: The Centre for Eating, Weight and Body Image - Guided Self Help CBT for Eating Disorders, Family Based Therapy for Adolescents with Anorexia Nervosa, and MANTRA for Anorexia Nervosa

Workshop: Butterfly - Body image and boys for educators

Training: Western Australia Eating Disorders Outreach and Consultation Service (WAEDOCS) - Understanding the Principles & Complexities of Avoidant Restrictive Food Intake Disorder (ARFID) Management for Dietitians

Click here to access these and other upcoming events.

Click here to submit your own event.