Response to Four Corners episode: “Fading Away”

On 27 February. ABC Four Corners showcased an episode on eating disorders in Australia entitled “Fading Away”. This episode can be viewed on iview. Given people impacted by eating disorders are vulnerable and often feel hopeless and alone, BodyMatters wanted to provide our own analysis of this episode. BodyMatters wishes to thank Four Corners for keeping the important topic of eating disorders on our minds and in the news, and for the brave people with lived experiences who stepped forward to share their stories.

Strengths of “Fading Away”

“Fading Away” highlighted the very real, current limitations of treatment for people in Australia. This is particularly the case with severe and enduring anorexia, which has limited appropriate public health and private treatment options. Sufferers are often caught in a treatment merry-go-round, often being admitted and discharged from hospital again and again with limited long term benefit. 

In particular, the very real issues the episode accurately highlighted include:

-The reality of very limited dedicated public hospital beds across Australian states and territories.

-The high cost of accessing private treatment options. Please note: we always recommend people increase their private health insurance cover when impacted by an eating disorder, if this is possible, This improves access to private hospitals, which would otherwise be unavailable. However given eating disorders impact on physical and psychological health, a higher level of cover can also improve access to treatment for other conditions that may co occur with, or result from eating disorders.

-The reality that treatment, particularly refeeding in hospital, can often be experienced as punitive and can also be traumatic. This is particularly the case if refeeding is urgently required for medical safety, recognising that cognitive function declines with severe malnourishment.

-There are additional challenges in accessing treatment for people in regional and remote areas of Australia, which have a dire lack of services and resources.

-We do need more residential treatment facilities such as Wandi Nerida and we absolutely need treatment options that are accessible for everyone with an eating disorder. This is particularly relevant for those who currently “fall through the cracks” and obviously needs to consider appropriate stages of care. It is simply not good enough in a country like Australia that people with eating disorders are considered “too sick” for some treatment options yet not given adequate alternatives.

Opportunities missed by “Fading Away”

Despite these strengths, there were some limitations that it is important to articulate. 

-”Fading Away” largely perpetuated the idea that people with eating disorders are young, white, thin females- which is an unhelpful stereotype. Every sufferer in the show, with the exception of one, met this profile. Stereotypes perpetuate shame and stigma and prevent people with eating disorders from help seeking.

-”Fading Away” predominantly featured one eating disorder presentation- anorexia nervosa- and a presentation that is severe and enduring. This is a story that needs to be told, but it is certainly not a typical eating disorder presentation. It is important for us to remember that anorexia nervosa is the least common of all eating disorders. Bulimia nervosa and binge eating disorder are more prevalent and are also serious, life threatening disorders. Bulimia nervosa and binge eating disorder do not attract the same interest or representation in the media as anorexia nervosa. There are also fewer treatment and clinician training opportunities dedicated to these disorders.

-There was no recovery narrative. We were pleased to hear Dr Warren Ward clearly state that eating disorders are treatable and that no person is beyond help. We agree with this sentiment and hold hope for every single person currently suffering. Rather than presenting narratives of people who are currently still sick and in treatment, who speak through that lense, it is important to have more representation by people who have recovered. This prevents some of the ethical dilemmas of involving someone who is still on their treatment journey in the media: being involved in a very public, high profile story may have positive or adverse results on a persons identity and recovery, including treatment options that are available to them. Representing the narratives of people who have recovered from eating disorders provides the opportunity to share wisdom about recovery itself and it upholds hope. You can listen to some narratives from Recovery Champions on our Understanding BodyMatters podcast.

-The state of eating disorder services in Australia was presented as dire and inadequate- which it is, particularly for people with severe and enduring anorexia and/ or who have not yet found treatment that works for them. However treatment resources are available and people can and do recover. We believe recovery occurs when suffers find their trifecta of the right treatment approach, right therapist and right timing for them. We also believe that many people can and will find effective treatment that works for them.

-The services that actually are available, and where to source help, were not clearly presented. Yes it is paramount that the number of dedicated hospital beds increases in every state, particularly those states who have no services. However many states have more hospital capacity for treatment than the “dedicated beds” system indicates, via local public hospital beds. There has been a concerted effort over the past decade to increase capacity to treat eating disorders in any public hospital, for example in NSW this has been via Eating Disorder Coordinators in each local health district. Services such as Centre for Excellence in Eating Disorders (CEED) in Victoria offers clinical support and consultation to support clinicians including hospitals manage complex cases who are not in dedicated eating disorder beds. 

-Our national Eating Disorder Charity, The Butterfly Foundation and State counterparts, such as Eating Disorders Victoria and Eating Disorders Queensland as well as Eating Disorders Families Australia do an amazing job in providing support for people impacted by eating disorders, including family members, and linking them to services that are available to them. 

-Further, when it comes to eating disorders, hospitalisation is rarely a panacea. This is an often misunderstood component of eating disorder treatment and “Fading Away” did not provide any education around this. Admission goals are primarily: (i) medical  stabilisation/ management; (ii) weight restoration; (iii) medication review/  adjustment; and/or (iv) symptom improvement/ interruption. Most people who recover from eating disorders actually do so in outpatient settings. This has become more accessible via the Eating Disorder Treatment Plan, which provides up to 40 medicare rebates per year for people recovering from eating disorders to see a psychologist and 20 medicare rebates per year to see a dietitian, This is significantly more than any other mental health conditions. These sessions are also available via telehealth, increasing capacity to people in regional and remote areas- including states and territories that have limited resources.

-There has been a concerted effort to build the workforce of clinicians skilled in treating eating disorders over the past few years. This has occurred via the amazing work of ANZAED and the NEDC to introduce the Eating Disorder Credentialling System which assists people with eating disorders  to find treatment by clinicians who have undertaken minimum training standards in and made a commitment to continue professional development in working with eating disorders. There have been a considerable injection of funds to support clinicians to become credentialed across Australia . 

-We are also concerned about people who may have been triggered by the episode. Despite a broad trigger warning at the beginning of the episodes, there was still information that was triggering including the use of numbers (eg 2kg weight loss) and sense of confusion and hopelessness that many people impacted by eating disorders will likely have from viewing the episode. There are helpful media guidelines on the coverage of eating disorders which should always be observed. 

In conclusion, we do hope you find this information useful as you reflect on how this episode landed for you. Whilst there was some value to “Fading Away”, a short TV episode is never going to be able to accurately explore the many nuances of such a highly complex problem. If you do require debriefing we recommend you contact our national Eating Disorder Charity, The Butterfly Foundation or State counterparts, including Eating Disorders Victoria and Eating Disorders Queensland. If you are looking for treatment, you can start by searching the Connect.ed website to find  a Credentialled Eating Disorder Clinician with availability to help. Our team at BodyMatters have recently expanded and we also have immediate availability for treatment of most eating disorder presentations, including via telehealth (or face to face near Sydney CBD) with our psychologists and dietitians. Please contact us to find out how we can support you.

Image source here.