The Second Wave of Public Policy Advocacy for Eating Disorders

Austin, S. Bryn; Hutcheson, Rebecca; Wickramatilake-Templeman, Shalini; Velasquez, Katrina

doi:10.1016/j.psc.2019.01.013

Cited by 11 publications

(17 citation statements)

References 23 publications

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“…Our study also helps to illuminate key leverage points where decision makers in both government and the healthcare sector could take action to reduce the social and economic burden of eating disorders. Informed by our study findings, top priorities for policy action include: Funding : Recent studies have documented extreme underfunding of eating disorders research relative to other mental health conditions, with U.S. National Institutes of Health (NIH) funding for eating disorders research totaling between $0.73–$1 per person affected by an eating disorder in their lifetime compared of $59–$109 for autism research per affected person and $69–$87 for schizophrenia research per affected person (Austin et al, 2019; Murray, Pila, Griffiths, & Le Grange, 2017). These estimates combined with our study findings underscore the need for increased funding opportunities via governmental and foundation funders to advance study of effective and cost‐effective primary and secondary prevention, screening, and treatment interventions.…”

Section: Discussionmentioning

confidence: 99%

Social and economic cost of eating disorders in the United States: Evidence to inform policy action

Streatfeild¹,

Hickson²,

Austin

et al. 2021

Intl J Eating Disorders

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Objective To estimate one‐year costs of eating disorders in the United States (U.S.) from a societal perspective, including the costs to the U.S. health system, individual and family productivity costs, lost wellbeing, and other societal economic costs, by setting and payer. Findings will inform needed policy action to mitigate the impact of eating disorders in the U.S. Method Costs of eating disorders were estimated using a bottom‐up cost‐of‐illness methodology, based on the estimated one‐year prevalence of eating disorders. Intangible costs of reduced wellbeing were also estimated using disability‐adjusted life years. Results Total economic costs associated with eating disorders were estimated to be $64.7 billion (95% CI: $63.5–$66.0 billion) in fiscal year 2018–2019, equivalent to $11,808 per affected person (95% CI: $11,754–$11,863 per affected person). Otherwise Specified Feeding or Eating Disorder accounted for 35% of total economic costs, followed by Binge Eating Disorder (30%), Bulimia Nervosa (18%) and Anorexia Nervosa (17%). The substantial reduction in wellbeing associated with eating disorders was further valued at $326.5 billion (95% CI: $316.8–$336.2 billion). Discussion The impact of eating disorders in the U.S. is substantial when considering both economic costs and reduced wellbeing (nearly $400 billion in fiscal year 2018–2019). Study findings underscore the urgency of identifying effective policy actions to reduce the impact of eating disorders, such as through primary prevention and screening to identify people with emerging or early eating disorders in primary care, schools, and workplaces and ensuring access to early evidence‐based treatment.

show abstract

Section: Discussionmentioning

confidence: 99%

Social and economic cost of eating disorders in the United States: Evidence to inform policy action

Streatfeild¹,

Hickson²,

Austin

et al. 2021

Intl J Eating Disorders

Self Cite

160

125

View full text Add to dashboard Cite

show abstract

“…There have been calls for research into system-level barriers to treatment access (Regan et al, 2017). It has further been recognized that factors such as policy, funding, and regulation have wide-reaching effects on access and represent potential leverage points for positive change (Austin, Hutcheson, Wickramatilake-Templeman, & Velasquez, 2019;Whiteford & Weissman, 2017). However, formal methods to understand the complexity of the treatment access system have not been applied.…”

Section: Directions For Future Researchmentioning

confidence: 99%

A systems thinking perspective on the barriers to treatment access for people with eating disorders

Lane

Read

Cook

et al. 2019

Intl J Eating Disorders

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Treatment access remains low for people with eating disorders. In addressing the complexity inherent in this challenge, this article introduces systems thinking and argues that it could provide new insights. Systems thinking views behavior as an emergent property of a system and considers the relationships between technical, organizational, and social components. Several methods used in safety science incorporate this thinking. For example, AcciMap draws focus to the influence of decisions and actions made across hierarchical levels of a system, including those by government, regulatory bodies, management, services, and individuals. By examining the findings of the existing literature on barriers to eating disorder treatment access according to these levels, it is evident that most identified barriers relate to individuals and that further research is needed to consider the influence of high‐level stakeholders. Research using systems thinking should consider the causal networks of influence from government, regulatory, and organizational decisions and actions through to outcomes for clinicians and individuals. The understanding of how barriers operate within specific healthcare systems also warrants investigation. Systems thinking is yet to be formally applied in the area of eating disorders and thus represents an opportunity to inform the development and implementation of more effective, system wide interventions.

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“…Although there have been two meta-analyses estimating eating disorder-related mortality, 5,8 the existing literature has methodological problems, including a lack of population-based surveillance data (limited to subregional studies and registries from restricted clinical practices 3,22 ), selection of study population, identification of cases and small sample sizes. 9,10,17,[23][24][25] Finally, our results demonstrate the degree to which patients diagnosed with eating disorders also experience important medical conditions and comorbidities, such as congestive heart failure, diabetes, COPD and hypertension. Mechanisms by which eating disorders may have a causal impact on diverse chronic diseases have been described elsewhere.…”

Section: Discussionmentioning

confidence: 90%

Excess mortality associated with eating disorders: population-based cohort study

et al. 2020

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Background Individuals with eating disorders have a high mortality risk. Few population-based studies have estimated this risk in eating disorders other than anorexia nervosa. Aims To investigate all-cause mortality in a population-based cohort of individuals who received hospital-based care for an eating disorder (anorexia nervosa, bulimia nervosa or eating disorder not otherwise specified) in Ontario, Canada. Method We conducted a retrospective cohort study of 19 041 individuals with an eating disorder from 1 January 1990 to 31 December 2013 using administrative healthcare data. The outcome of interest was death. Excess mortality was assessed using standardised mortality ratios (SMRs) and potential years of life lost (PYLL). Cox proportional hazards regression models were used to examine sociodemographic and medical comorbidities associated with greater mortality risk. Results The cohort had 17 108 females (89.9%) and 1933 males (10.1%). The all-cause mortality for the entire cohort was five times higher than expected compared with the Ontario population (SMR = 5.06; 95% CI 4.82–5.30). SMRs were higher for males (SMR = 7.24; 95% CI 6.58–7.96) relative to females (SMR = 4.59; 95% CI 4.34–4.85) overall, and in all age groups in the cohort. For both genders, the cohort PYLL was more than six times higher than the expected PYLL in the Ontario population. Conclusions Patients with eating disorders diagnosed in hospital settings experience five to seven times higher mortality rates compared with the overall population. There is an urgent need to understand the mortality risk factors to improve health outcomes among individuals with eating disorders.

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The Second Wave of Public Policy Advocacy for Eating Disorders

Cited by 11 publications

References 23 publications

Social and economic cost of eating disorders in the United States: Evidence to inform policy action

Social and economic cost of eating disorders in the United States: Evidence to inform policy action

A systems thinking perspective on the barriers to treatment access for people with eating disorders

Excess mortality associated with eating disorders: population-based cohort study

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