Health: Can Eating Disorders Be Cured? ; Treatments for Anorexia and Bulimia May Have Little or No Effect, Suggests a New Report. but Where Does That Leave Millions of Sufferers? Sophie Petit-Zeman Weighs the Arguments
Petit-Zeman, Sophie, The Independent (London, England)
A report in the medical journal The Lancet last month has sparked debate among those treating eating disorders such as anorexia and bulimia. It claims that there is no evidence that proves the benefits of current treatments: patients fare equally well, or indeed badly, with or without them.
An estimated 1.1 million people in Britain have an eating disorder, most commonly anorexia or bulimia. Characterised by a desperation to be thin, people with anorexia restrict food intake while their bodies waste away. Those with bulimia may maintain normal weight, but have distressing cycles of starving, bingeing and purging. In both conditions, problems often begin in adolescence or early adulthood and the underlying emotional turmoil is usually immense.
Anorexia and bulimia have the highest mortality rate of any psychiatric condition. About one in five sufferers die, because they become too thin to live, develop serious physical complications including kidney or heart failure, or commit suicide.
The Lancet paper, from a team of psychiatrists and epidemiologists led by David Ben-Tovim, charted the progress of 220 people with eating disorders in Adelaide, Australia. The patients were divided into those who had and had not received specialist treatment, and further classified by whether this was in- or outpatient, and how long it went on. Five years after their initial contact with services, according to the report, "our results indicate that many patients make a good recovery without accessing specialised treatments of any kind. Furthermore, there was no indication that resource-intensive and widely used treatments, such as lengthy admissions for weight gain, or long-term outpatient care, necessarily affected long-term patient outcome".
The report comes at a time of intense pressure on health professionals to practice evidence-based medicine - offering treatments that are demonstrably beneficial. But, in common with many medical specialties, ascertaining what "works" for those with eating disorders is complex.
Paul Flower is a child and adolescent psychiatrist at Ellern Mede, a major new centre for the treatment of young people with eating disorders that opens in London in July. He says that: "Eating disorders involve both severe physical problems, and complex emotional and psychological needs. It's not enough to say treatment has worked if the patient is simply heavier or happier. Recovery needs to be clear in both these areas, and sustained. Also, eating disorders often occur in a family context. Families are not to blame, but they are involved. We must measure the impact of treatments on family functioning as well as on individuals."
One of the big questions simmering in the melting pot of differing clinical opinion, with a generous sprinkling of professional rivalry, is whether it is better to treat those with eating disorders as in- or outpatients. Whether therapy, medication, or both are offered, the arguments in favour of hospital admission are compelling: it may be life-saving, allows the chance for comprehensive assessment and intensive treatment, including that for other psychological problems that may occur alongside eating disorders, and helps patients develop autonomy in a new setting.
Stephanie Grace's daughters, Jill, 21, and Sara, 23, are both recovering from eating disorders. She fought long and hard to find the right treatment for them and is excited to hear about the facilities on offer at Ellern Mede. She believes strongly that her daughters' hospital treatment has helped them towards recovery. "Recovering from eating disorders needs a kick-start, which is only effective as an in-patient," she says. Sara, who developed bulimia when she was 10, but was not diagnosed until 17, is still two stone underweight and has spent more than a year in hospital, spread over five admissions. Yet Grace says: "Sara's cracked it, she's getting better. …