Eating disorders are on the rise. A new approach may help

More than one million Australians live with an eating disorder. Treatment approaches haven’t changed much since the ’60s, but a new research program is bringing hope.

In May 2023, 15-year-old Olivia Evans lost her life to anorexia nervosa, an eating disorder she’d spent more than two years grappling with.

For 90 per cent of that time, she was in hospital, often with a nasogastric feeding tube inserted and, increasingly, desperately not wanting to be there.

“Liv was admitted to hospital about 40 times over the journey, the last 20 of which had to be done under a Community Treatment Order so that we could save her if she hadn’t eaten for a period of time, or if her weight dropped below a certain point,” Olivia’s dad, Robb Evans, says.

“That involved police and ambulance arriving at the house to medically and physically restrain Liv, usually with six-point restraints, in order to transfer her to hospital where she’d then scream for the next six to eight hours.”

A cookie-cutter approach failed Olivia Evans

The aim of the hospital stays? To get Olivia’s weight up.

“Doctors would talk about her medical treatment and what they were going to do with her feeding, and I remember in the beginning asking, ‘OK, so at what point do we work on the mental health side of things?’,” Robb says.

“I was told the hospital’s job was just to get her medically stable and then you work on the other things out in the community, once she’s discharged.”

Robb says there are two problems with a cookie-cutter approach.

“For people whose eating disorders aren’t as severe as Liv’s, that might work, but because Liv had to spend so much time in hospital, there really wasn’t any usable ‘out in the community’ time,” he says.

“And, even if there had been, the waiting list to see a mental health professional was massive.

“The irony is, I was finally able to pick up a mental health plan for Liv from her GP on the day she died.”

Why new treatments for eating disorders are needed

More than one million Australians live with an eating disorder, yet some experts say the way treatment is delivered hasn’t really changed since the 1960s.

Even when treatment does progress past the weight-stabilisation stage, the current standard approach is still focused on talk therapies – and while these have been around for decades, many people don’t respond to them.

Monash University Head of Psychiatry Professor Jayashri Kulkarni says a new approach is needed.

“I don’t think it’s good enough that we haven’t seen new treatments for eating disorders and a better understanding of what’s going on in the brain when they occur,” Prof Kulkarni, who is director of the university’s HER Centre Australia, says.

HER Centre Australia is dedicated to understanding and treating mental illnesses experienced by women, and has clinical partnerships with Alfred Health and Cabrini Health.

“One of my concerns is that while Australia has been good at developing and funding clinics or services, what we haven’t done enough is invest in developing innovative new treatments,” Prof Kulkarni says.

New hope for people living with an eating disorder

Recently appointed as the research leader of a pioneering eating disorder research program, The Li Transformative Hub for Research into Eating Disorders (THRED), Prof Kulkarni is hopeful that the clinical trials THRED has planned will change this.

The trials, expected to start this year, will assess everything from brain stimulation to hormonal manipulation and novel drug therapies.

“Essentially, we want to look at the brain biology in people with these conditions to see if we can add some new and more effective treatments into the field, given there’s so many different types of eating disorders, but also so many differences in terms of severity,” Prof Kulkarni says.

“Treatments need to be able to reflect and respond to that.”

Raising awareness of eating disorders

Since Olivia’s death, Robb has met with everyone from independent MP Zoe Daniel to Eating Disorders Victoria to raise awareness of eating disorders.

He’s also been asked to provide input into the National Eating Disorders Strategy 2023-2033, which aims to provide and build an eating disorder system of care.

Robb says he’s doing whatever he can to push for change that would have given Olivia a lifeline.

“Even when Liv did see a therapist at some stage, she never opened up,” he says.

“She was always worried that whatever she said would be cause to send her back to hospital.”

Robb says it was only three or four months before Olivia died that she told him what she believed had triggered her eating disorder when she was just 13.

“Ultimately, she’s not here because she was bullied by the other girls at her school.

“She told me that if she could turn back time and take the moment back when all that started, she probably wouldn’t have an eating disorder.”

Now, Robb is focused on helping a new eating disorder treatment program get off the ground.

“Alfred Health here in Melbourne is developing a home treatment program, but it needs funding,” Robb says.

“I’m determined to do what I can to help make that happen because a program like that, that keeps people out of hospital and doesn’t dehumanise them, would probably have saved Liv’s life.”

If you need help or support for an eating disorder, contact the Butterfly Foundation. You can also call the national helpline on 1800 334 673.

Read more on eating disorders:

• What I want you to know about male eating disorders
• When ‘eating healthy’ becomes an unhealthy obsession
• What to know about disordered eating in kids and teens

Written by Karen Fittall.