Eating disorders effect an estimated one million Australians each year, yet despite the prevalence, far-reaching mental and physical impacts, and dedicated MBS item numbers, it can be an under-recognised area of general practice care.

Lived experience advocates have cited a need for further GP training to recognise, respond and support people with an eating disorder, an assessment backed by recent newsGP poll results. Fifty-seven per cent of respondents cited a desire for more support, with 26% saying they feel ‘not at all’ equipped to support these patients. Only 15% felt well equipped to manage eating disorders.

Dr Karen Spielman is a GP with a special interest in eating disorders and GP consultant at InsideOut Institute. She told newsGP there are some ‘great resources out there’ which may be underutilised.

‘We know GPs need more support, and InsideOut, along with others in the field are doing so much to increase research and workforce, so hopefully this will change,’ she said.

‘The National Eating Disorders Collaboration (NEDC) has a GP core skills training package which is excellent for foundational knowledge – four hours, self-paced online and free.

‘There is the RACGP’s “mental bites” webinar and … HealthEd has some great podcasts too. For those with a special interest who wish to join the Australia and New Zealand Academy for Eating Disorders [ANZAED] there’s a membership fee then access to a terrific webinar library, and also workshops online and face-to-face conferences.

‘There is something for every level of interest.’

The InsideOut Institute hosts a resource library for healthcare professionals, Dr Spielman adds, including e-learnings, on-demand webinars and the Essentials training course. It has also received Federal Government funding to rollout the GP hub and clinical decision support toolkit, which Dr Spielman and her team demonstrated at the WONCA World Conference in October to ‘such positive feedback’. 

‘This is most exciting and will be a paradigm shift, and real game changer,’ Dr Spielman said.

‘It’s a comprehensive online resource for all GPs at every stage that will cover everything from prevention to screening to diagnosis management and treatment team building.

‘We can’t wait to be able to roll it out [and are getting] testing done and setting it up for wider rollout next year.

‘InsideOut also auspice the Australian Eating Disorders Research and Translation Centre, which is spearheading innovative research, and there are some excellent initiatives there enlacing genetic studies and novel therapies and providing up-to-date evidence summaries – watch this space.’

Dr Spielman also recommends the Australian Society for Psychological Medicinewhich provides education and support for GPs who practice ‘critical’ whole-person-care – where she will be running a themed professional peer reflection group next year for members and non-members.

But with a seeming abundance of available resources, why are eating disorders an under-recognised area of healthcare where GPs report a need for more support?

One answer is that progress is happening in this space but is often dependent on funding and training curricula, according to Dr Spielman, who says many GPs are still uncertain about where eating disorders sit within their provision of care.

‘When I trained [there was] no undergraduate and minimal postgraduate training in the area; I expect that has changed and know there has been some recent work done to look into this … [but] research dollars in eating disorders are super low and so perhaps that plays a part at university level,’ she said.

‘It has certainly been a part of the adolescent health field but traditionally it has been seen to sit in psychiatry, but with big increases in incidence it is something GPs need to be more aware of, especially since the pandemic.’

During COVID-19, Australia saw a spike in eating disorders, particularly among young people, with many missed diagnoses estimated during the height of the pandemic.

Since then, the NEDC and ANZAED launched the first national eating disorder online directory, connect.ed, to help credentialed healthcare providers identify and fast track access to appropriate treatment and streamline referral pathways.

Additionally, when Australia’s first dedicated residential recovery centre for eating disorders opened its doors in the second half of 2021 on the Sunshine Coast, it offered improved referral and management pathways and better support for both patients and their healthcare providers.

Other states and territories began to follow the model, with construction of centres currently underway in the ACT, Victoria and New South Wales and plans for Tasmania and South Australia.

Western Australia is the only jurisdiction without plans for a residential recovery centre for people with eating disorders.

Following the 2019 introduction of new eating disorders MBS items, from 1 July 2023, 21 new Medicare items were set up to support shared care between providers and improve access to multidisciplinary, collaborative, and coordinated mental health care by allowing allied health practitioners to bill for their time while attending case conferences. Prior to these changes only GPs and other health practitioners could claim for case conferences.

The new items were designed to facilitate conferences involving patients being treated under Eating Disorder Treatment and Management Plans, and the Better Health Access Initiative.

‘These items should help improve communication and support the workforce I hope,’ Dr Spielman said.

‘Databases like connect.ed and InsideOut are excellent places to connect with colleagues to help support our patients. We have also partnered with GPMHSC to make templates available for GPs for these plans, which should be available soon.’

Dr Speilman plans to continue working to deliver best possible support to her GP colleagues and the wider workforce, as part of the shared care team, to manage patients experiencing eating disorders.

‘Eating disorders really require teamwork in order to achieve good outcomes,’ she said.

‘GPs are perfectly placed at the mind–body interface where eating disorders sit, to provide care for patients, families and the community from prevention all the way through to relapse prevention and rehabilitation.

‘I know we can make a huge impact on morbidity and mortality if we get this right and our team are so determined to support GPs to do what they do best – which is sensitive whole-person care, care coordination and teamwork.’