Ms Anna Burke (Chisholm, Australian Labor Party) Share this | Link to this | Hansard source

I move:

That the House:

(1)

notes that:

(a)

eating disorders—anorexia nervosa, bulimia nervosa, binge eating disorder and related disorders—are not illnesses of choice, but rather life-threatening mental disorders;

(b)

anorexia is the third most prevalent chronic illness in adolescent girls after obesity and asthma and has one of the highest mortality rates of any psychiatric disorder;

(c)

one in 20 Australian women has admitted to having suffered an eating disorder; and

(2)

expresses serious concern about recent reports that eating disorders are on the increase, especially among school-aged children;

(3)

condemns the lack of Government funding for the prevention and treatment of eating disorders; and

(4)

urges the Government to:

(a)

convene a national summit on body image to develop a national code of conduct to ensure the media, fashion industry and advertisers portray a healthy and diverse range of men and women; and

(b)

become a signatory to the Worldwide Charter for Action on Eating Disorders, which calls on those responsible for policy to educate and inform the community with programs that:

(i)

de-stigmatise eating disorders and raise awareness of the causes of eating disorders;

(ii)

increase public awareness of the signs and symptoms of eating disorders;

(iii)

make available comprehensive information about eating disorder services and resources;

(iv)

connect with the media to provide accurate information on eating disorders and to help shift the culture’s perspective on body image issues and weight and food issues;

(v)

develop and implement effective prevention programs targeting schools and universities;

(vi)

educate and train health care practitioners at all levels in the recognition and treatment of eating disorders to improve the quality of care;

(vii)

provide sufficient specialist services based on regional need;

(viii)

provide people with access to fully-funded, specialised treatment and care; and

(ix)

fund research into eating disorders.

There has been much talk in this chamber over recent months about the obesity crisis. It is important that we do discuss obesity, but sadly the flip side of that issue—that is, eating disorders—has been largely ignored. I would venture it has been irresponsible of the government to focus on one problem without considering the other. It is ironic, but medical professionals are now claiming that national focus on obesity has exacerbated the problem of eating disorders. An article in yesterday’s Sun-Herald revealed that five-year-old children are now being diagnosed with anorexia and that since 2001 there has been a 20 per cent increase in under-18s being hospitalised at the Children’s Hospital at Westmead, New South Wales, as a result of anorexia.

Anorexia is the third most prevalent chronic illness in adolescent females in Australia, after obesity and asthma. One in 20 Australian women has admitted to having suffered from an eating disorder. Of course, males too are affected by eating disorders: around 25 per cent of anorexic children are boys. While the federal government has boosted funding for obesity, there is an absence of funding for the prevention and treatment of eating disorders. So it is vital that we put eating disorders on the national agenda and start tackling this deadly problem before the situation gets worse.

In August this year I wrote to the Minister for Health and Ageing about the need for increased funding for the prevention and treatment of eating disorders. The minister did not respond; instead I received a letter from his parliamentary secretary. He wrote:

In Australia, the direct provision and regulation of public mental health services … is the responsibility of the State and Territory Governments.

Eating disorders know no boundaries, and passing the buck will not help Australians who are battling illnesses such as anorexia and bulimia. It will not do anything to help a brave young constituent in my electorate, Sarah Ralph, who has been fighting her eating disorder for over seven years.

I was also disappointed the minister for health ignored another letter I sent him this year in which I urged him to convene a national forum on body image and eating disorders. Although the media and fashion industries often deny they play a role in the development of eating disorders, medical professionals say otherwise. Yes, a lot of factors contribute to the onset of illnesses such as anorexia and bulimia. One medical resource for doctors treating patients with eating disorders states:

Eating disorders are a complex interplay of biopsychosocial factors, including development issues, relationship and family factors, life events, biological vulnerability and socio-cultural influences.

But the growing pressure on young men and women to look a certain way, usually stick thin, is undoubtedly taking its toll—increasingly on school aged children. Dr Rick Kausman of the Australian Medical Association says:

I think there is increasing pressure on kids to grow up much sooner than what might be best for them, and I also think we’ve got caught up in a culture where the way we look is all important, even from a very young age …

So reports that primary school children are wishing they were skinnier and going on starvation diets should not be ignored, especially when, according to a British medical journal, dieting is the greatest risk factor for the development of an eating disorder. There is an urgent need for the government to draw together various bodies, including the media, the fashion industry, advertisers and health and education professionals, to develop a national code of conduct on body image to ensure that young Australians grow up with healthy and diverse role models. We need to encourage our children to grow up loving themselves—not despising themselves because they do not look a certain way. Although the Parliamentary Secretary to the Minister for Health and Ageing responded to my letter, he refused to commit to my proposal for a national forum.

Today I also want to voice my support for the Worldwide Charter for Action on Eating Disorders. The charter was developed by the Academy for Eating Disorders and various other international eating disorder organisations in response to the unmet needs of those living with an eating disorder. It establishes a set of rights for those living with eating disorders and their carers, including the right to communicate with health professionals; the right to comprehensive assessment and treatment planning; the right to accessible, high-quality, fully funded, specialised care; the right to respectful, fully informed, age appropriate, safe levels of care; the right of carers to be informed, valued and respected as a treatment resource; and the right of carers to accessible, appropriate support and education resources.

I hope that Australia will become a signatory to this charter, because at present too many people suffering from eating disorders are not getting the most appropriate treatment for their individual needs. There is a lot of misunderstanding about eating disorders. Many people believe that eating disorders are an illness of choice or a silly phase that teenagers go through. These myths need to be dispelled. Anorexia has the highest mortality rate of any psychiatric illness. I call on the Howard government to stop ignoring the growing trend of eating disorders. We need to take action against these illnesses. It is a matter of life and death.

I want to put on record my thanks to Sarah Ralph, a constituent of mine, for bringing this serious issue to my attention and for her brave efforts in coming up to Canberra and speaking about her own situation. It caused her a great deal of pain and suffering to actually come on that day. She was sacked from her job and actually went backwards in her own treatment program. I want to thank Sarah very much for raising awareness about this issue. (Time expired)

Peter Lindsay (Herbert, Liberal Party) Share this | Link to this | Hansard source

Is the motion seconded?

Kate Ellis (Adelaide, Australian Labor Party) Share this | Link to this | Hansard source

I second the motion and reserve my right to speak.

Mal Washer (Moore, Liberal Party) Share this | Link to this | Hansard source

I thank the member for Chisholm for bringing this important issue to the attention of the House. Eating disorders are psychological disorders where dieting and eating behaviours are severely disturbed and become the focus of one’s life. The most widely recognised disorders are anorexia nervosa and bulimia nervosa. Anorexia is hallmarked by an extreme reluctance to consume food as a result of a psychological disturbed body image. This may lead to extreme malnutrition and weight loss, which may become potentially life threatening. The incidence of the disease is around one to two per cent among schoolgirls and university students and is 10 times more common in women. Suicide has been reported in two to five per cent of patients with chronic anorexia nervosa and the mortality rate per year is around 0.5 per cent. Fifty per cent of sufferers make a full recovery, 30 people cent a partial recovery and, sadly, 20 people cent do not recover.

Unfortunately drug treatment has had limited success except to symptomatically treat insomnia and depressive illness. Bulimia is characterised by episodic, uncontrolled and impulsive binge eating followed by self-induced vomiting or consumption of laxatives or purgatives to avoid the weight gain associated with such behaviour. Like anorexia, bulimia is a condition 10 times more common in women than men; the usual onset is between 16 and 18 years of age. Any given woman has a one to four per cent chance of developing this condition throughout her lifetime. Prognosis for bulimia is better than for anorexia, with approximately 60 per cent of patients recovering with appropriate treatment.

There are a few predisposing factors for the development of eating disorders. The main risk factor seems to be a family history of psychiatric illness or a coexisting psychiatric problem. Whether this trend represents a genetic or environmental link is not entirely known—the incidence of eating disorders may be increasing—however, it may also be due to better recognition and detection of these diseases. Figures produced by the Australian Institute of Health and Welfare on the annual numbers of hospital episodes associated with eating disorders show that there was a decline of 19.8 per cent for anorexia and a 20.7 per cent decline for bulimia between 1998 and 2005. These figures can give an indication of the severity or degree of eating disorders over time for which hospitalisation is required.

Even though the responsibility of provision and regulation for mental health services lies with the state and territory governments, the Australian government has played a significant role through the Mental Health Strategy. The last budget included $1.9 billion in new funding to further improve services for people with a mental illness, their families and carers. Importantly, for those who are suffering from eating disorders, this included $538 million for the Better Access to Psychiatrists, Psychologists and GPs through the Medicare Benefits Schedule initiative. This initiative enables GPs to provide early intervention and assessment of patients with mental disorders. Early intervention is critical to successfully treating eating disorders. The earlier it is recognized, the greater the chance of recovery.

In addition, the Australian government has awarded $2.25 million in the last six years for research investigating eating disorders and people support schemes. The Worldwide Charter for Action on Eating Disorders has been prepared by the Academy for Eating Disorders. Signatories include individuals and organisations, not countries, and the charter has no legal standing in relation to a nation’s obligations. It is a well-intended document that is designed to make people and organisations more aware of the disease and the help that sufferers and families need. The government know how debilitating this illness is for those who suffer from it and the families and friends who suffer alongside them. We take this disease, like all mental illness, very seriously and will continue to fund research and support in this area.

Jill Hall (Shortland, Australian Labor Party) Share this | Link to this | Hansard source

I would like to congratulate the member for Chisholm on bringing this very important motion to the House today. Eating disorders develop around body image. Body image refers to a person’s perception of their body as well as their emotions and attitudes towards it, which can be positive or negative. Many Australian women—and, to a lesser extent, men—have a negative body image. This is closely linked to how a person feels about themselves and their quality of life. Poor body image has been found to be related to feelings of depression and engagement in unhealthy eating practices. Influences on a person’s body image include the way men’s and women’s bodies are portrayed in the media via unrealistic images of beauty and emphasis on dieting, modelling by parents, childhood teasing and stigmatisation of overweight and obesity problems, amongst other things.

Body image is a serious clinical issue, as perceiving oneself as fat is one of the criteria for anorexia nervosa and other eating disorders. Anorexia nervosa is an eating disorder which has been shown to impact on both men and women’s behaviour as well as the behaviour of children. It is known that children as young as seven—or even five, as stated by the member for Chisholm—can have body image disturbances leading to the development of eating disorders. In particular, when girls reach puberty it can have an emphasis on body image. Some girls are proud of their womanly shape, while others do all they can to try to stop this natural process by covering up their curves and undertaking severe dieting.

This internalisation, or acceptance of the ‘thin ideal’, is a risk factor for body image disturbance. It can lead to the development of anorexia nervosa, which is far more entrenched in women. For women there is greater pressure to live up to the thin ideal than the ‘muscular ideal’ represents for men, even though dissatisfaction with body image has increased for men, possibly due to the change in representation of the ideal male ‘metrosexual’, who has a fit, slim, toned body, which, as with women, can be achieved by only a few men. These are unrealistic expectations and cannot be reached without hiring a personal trainer and strict dieting.

Influences on a person’s body image can be positive or negative depending on factors such as family, with the mother dieting and making negative comments about her body; peer influences, such as teasing those who are overweight and perceiving defects in others’ appearances; community attitudes to eating and weight; and the representation of beauty in the media. A person is ‘beautiful’ if they are thin, and if they are overweight they are much less of a person.

Education through schools with antibullying policies is a more positive influence, as are parent modelling exercises, healthy eating, a focus on personal qualities and peer acceptance of others despite their appearance. Early intervention is the key to overcoming body image disturbances and the resulting depression, anxiety and eating disorders. Doctors and other health professionals, teachers and parents need to recognise early warning signs of body image disturbance and identify where help is available. More access to mental health professionals is also important. The message from sufferers of eating disorders is that it is not a choice but a serious psychological illness. No one person or thing can be blamed; it is a combination of social values, beliefs, personality traits and environment.

One size does not fit all, and a purely medical approach is not as effective in dealing with eating disorders as a more varied approach. Eating disorders need specialised and individual treatment options. It is vital that individuals be separated from the illness and that the treatment they undergo shows them respect and upholds their rights. As access to effective treatment is vital, funding must be made available for the increasing number of sufferers. (Time expired)

Danna Vale (Hughes, Liberal Party) Share this | Link to this | Hansard source

I recognise the member for Chisholm in raising this important issue in the community. Anorexia nervosa and bulimia nervosa are the two most serious eating disorders and are a blight on the lives of tens of thousands of young Australians. Figures I have seen indicate that anorexia affects two out of every 100 teenage girls and bulimia may affect up to three in every 100 teenage girls. For some it is a death sentence. One in every five anorexics eventually dies because of their disease, yet there is little evidence that conventional treatments actually work.

Some good news is that medical authorities in Sydney have received funding to conduct the world’s first study into the most effective method to treat anorexics, in hospital or as outpatients. The research comes as figures show the number of New South Wales children suffering from the disorder has increased dramatically over the past five years. Doctors at the Children’s Hospital at Westmead have been given $533,000 by the federal government’s National Health and Medical Research Council to lead a three-year trial. The hospital’s eating disorder service, which treats most anorexia cases in New South Wales involving people under 18, recorded a 20 per cent rise in the number of admissions between 2001 and 2006. Most children admitted had malnutrition so severe that they were at grave risk of dying. The number of patients treated by doctors, in and out of hospital, doubled in the same period, although readmission rates dropped. About 45 new patients are admitted to the hospital each year. A similar number of people aged between 15 and 20 are admitted to the psychiatric ward at Westmead Hospital.

The best time to discharge an anorexia patient is a controversial topic among the international medical community, with doctors in the United States and Europe holding vastly different opinions. American patients are hospitalised in general pediatric or medical units for two to three weeks, which is the time it usually takes young people with anorexia to regain a normal heart rate, blood pressure and control over their own temperature. In Europe and Britain, patients are admitted to psychiatric units for up to six months so they can reach a minimum normal weight. Although there are no Australian guidelines, the average length of hospital stays in New South Wales varies between six and eight weeks. Victorian patients tend to be admitted for three to four weeks.

In addressing this serious health issue one initiative is research in programs conducted by two Swedish scientists, Professor Per Sodersten and his partner, Dr Cecilia Bergh, of the Karolinska Institute. These scientists have impressed many with their new treatments. Even a number of Australian families are adamant that the new treatment has saved their daughters’ lives. Sodersten and Bergh’s treatment is based on the notion that eating disorders are not a mental illness—that is, the often bizarre psychiatric symptoms that one sees in anorexics and bulimics, such as overexercising and obsessions about food intake, are a consequence of starvation. It is fundamental to the apparent success of the Swedish treatment that the cause of eating disorders is much simpler: people slide into the disease as they starve and overexercise.

What I find extraordinary about this treatment is that it has its origins in the ruins of war-ravaged Europe. Sixty years ago, allied commanders sent an urgent request for assistance back to the United States. While pushing the Nazis back towards Berlin, they realised they lacked the knowledge necessary to help millions of starving refugees stay alive.

In Australia, treatment is based on the idea that what causes eating disorders is a pre-existing psychiatric illness, such as depression, an obsessive compulsive disorder, trauma suffered after a sexual abuse or some other notion of underlying cause firmly rooted in the 19th century psychoanalytical notions of Sigmund Freud. One of the most prestigious scientific journals, Proceedings of the National Academy of Sciences, recently published a peer reviewed trial of the Swedish treatment, showing 75 per cent of the Karolinska Institute’s patients went into remission after just 12 months of treatment. Only 10 per cent relapsed—a previously unheard of success rate—and none of their patients has died. These success rates demand that Australia take a closer view of the Karolinska Institute’s treatment programs. These results cannot be ignored and Australian families have the right to know that world’s best practice is available to them and their children.

Kate Ellis (Adelaide, Australian Labor Party) Share this | Link to this | Hansard source

I rise today to also speak in support of the motion on eating disorders moved by the member for Chisholm. The member for Chisholm has been highly active in raising awareness of poor body image and eating disorders.  I commend her on putting forth this motion that calls not just for greater awareness but, importantly, for action to address these devastating illnesses.

I make it clear at the outset that eating disorders are not just about a quest to be thin; they are psychological illnesses with devastating physical consequences. One in 20 Australian women admits to having suffered from an eating disorder, and anorexia is the third most prevalent chronic illness in adolescent girls. It is devastating to look at this nation’s high schools, where very few of the students would not know a schoolmate or fellow student who is suffering from one of these illnesses.

There is an unbelievable pressure in particular on women in our society to be very thin. I do not think that we can stereotype the sort of people who are suffering from these disorders. Just recently, I had a conversation with a friend of mine, who is a highly educated, successful and intelligent woman. I was shocked when she told me that she wished that she could be anorexic but she just did not have the discipline for it. What sort of society are we encouraging when we actually have people seriously wishing that they had psychological illnesses? Eating disorders have been sidelined for far too long. It is long past the time when we must shine the spotlight on them.

As Dr Vivienne Lewis of the University of Canberra has long suggested, early intervention is the key to overcoming body image disturbances and resultant mental health issues such as depression, anxiety and eating disorders. The federal government has an important role to play here. A growing number of young Australians are developing eating disorders, and this is a trend that none of us should allow to continue.

While researching this issue, I came across some rather frightening websites, some based in Australia but most based in the US, although easily accessible by young people in Australia. I will not delve into the disturbing images these pro-ana sites—pro-anorexia sites—conveyed, but their messages are universally horrific: from starving during pregnancy to egging each other on in the race to be skeleton thin. This is an issue that the member for Chisholm has been working on for quite a while.

I know many Australian web servers have been active in removing these pro-ana sites. However, those that remain are sending horrific messages that bones equal beauty, that people do not need food and, as one site quotes, ‘Nothing can’t be fixed with hunger and weight loss.’ As well as demonstrating the need of many anorexia sufferers to communicate with someone who understands what they are going through, these sites also show just how dangerous eating disorders can be. With better programs aimed at early prevention and treatment of eating disorders, hopefully Australian women and men can find comfort and communication with people there to help, not hinder, their condition.

This is a problem that requires action from those right across our society—for example, Cosmopolitan magazine has been very proactive in tackling the issue of poor body image. Individual models, designers and photographers have begun to take this issue very seriously and realise the role that fashion and the beauty industry have to play in influencing body image. I for one do not come from the school of thought that we address this issue by allocating blame alone. Some people like to point the finger at the media, the beauty industry or our magazines; I believe that we must all come together and work together on this issue. I argue that the government should convene a national summit on body image to develop a national code of conduct to ensure the media, the fashion industry and advertisers portray a healthy and diverse range of men and women and ensure that it has effective awareness and action campaigns in place.

On an international scale—and this, sadly, is a global issue—Australia should become a signatory to the Worldwide Charter for Action on Eating Disorders, which calls on those responsible for policy to educate and inform the community about the dangers of eating disorders. With rapid improvements in communications and technology, we are in a better position than ever to utilise these resources, such as the internet, to educate and inform individuals about the issue.

Combating eating disorders in Australia will require united efforts abroad. The charter provides people with eating disorders, their families and their loved ones with a list of their basic rights and reasonable expectations regarding eating disorder treatments and services. I believe that if the government wants to send a message to Australia’s young people that healthy is beautiful and that this parliament takes the issue of poor body image and eating disorders seriously then we must become a signatory to this charter. I urge the government to act on this motion. We should do everything in our power to stop the suffering. (Time expired)

Jackie Kelly (Lindsay, Liberal Party) Share this | Link to this | Hansard source

I have a few issues to raise concerning this private member’s motion on eating disorders, but first I will mention what my research has indicated on the eating disorders of anorexia and bulimia. In the last few decades there has been a notable increase in the incidence of all eating disorders, of which anorexia and bulimia are part. It is, however, uncertain if this is due to an increasing number of people developing the disorders or because of improved recognition, which has led to more cases being diagnosed.

Currently most of the data on the number of people suffering from eating disorders has been gathered by hospital admissions. The number of people admitted represents only a small percentage of all the people affected. It is estimated that eating disorders affect between 0.5 per cent and three per cent of the Australian population. At Westmead, the major hospital in New South Wales for the treatment of anorexia, they have 10 beds and 175 patients on a waiting list, the youngest of whom is eight years old. The Australian government is committed to continued reform and improvement of all mental health policies so that sufferers and their families can receive the best possible care and support available.

Under Australia’s system of federation, the provision of public mental health services, which currently includes anorexia and bulimia, is the responsibility of the states and territories. The Australian government provides funding through the National Mental Health Strategy to support the policy decisions made by the states and territories. In the 2006 federal budget $1.9 billion in new funding was added to improve services for people with mental illness, their families and their carers as part of the Commonwealth government’s commitment to the Council of Australian Governments’ National Action Plan on Mental Health. As part of this package, the Commonwealth government is providing $538 million for the Better Access to Psychiatrists, Psychologists and GPs initiative through the Medicare Benefits Schedule. This initiative is designed to increase community access to mental health professionals.

The COAG package includes $28 million for the new early intervention service for parents, children and young people. It is anticipated that this program will provide early intervention for primary school children at risk of developing a mental illness, targeting resources and support for groups of children at risk, plus providing support for parenting programs and the provision of information to children, youths and their families. The Commonwealth government’s initiatives include MindMatters, KidsMatter and the National Youth Mental Health Foundation. In addition, the governments’ main health and medical research body, the NHMRC, provides continuing support for research into eating disorders, and since 2000 has awarded $2.25 million towards continued research that investigates eating disorders. As mentioned by the member for Hughes, half a million dollars was recently awarded to the Westmead Children’s Hospital to continue the study of anorexia.

Last Wednesday night I attended the Westmead Millennium Institute’s granting of initiating awards. I have an interest in the grants, as does the member for Greenway and any other member of this House who has ever joined the minister for health on his regular Pollie Pedal. Last year we raised $300,000 to go towards research at the Westmead Millennium Institute. I met two young researchers there who were investigating anorexia. They were discussing how evidence had come to the fore that when children as young as five, seven and eight—as has been mentioned here today—are developing anorexia, the causes were biological and not mental health. A lot of the consequences we are seeing are the consequences of starvation, hormones and hypothermia which happen when you lose such vast amounts of weight. That view has been looked at by Professor Per Sodersten and Dr Cecilia Bergh at the Karolinska Institute in Stockholm, which the member for Hughes mentioned. Several of my own constituents have gone to Sweden for treatment at this institute, which has a high success rate. The federal government supports overseas treatments that are unavailable in Australia if they are efficacious, cost-effective and life saving.

It is interesting that there is dispute within the scientific community as to whether the cause of eating disorders is biological or psychological. The school of thought that says it is psychological goes along the lines of what all the members here have said today—that dieting and weight preoccupations are used to avoid, or ineffectively cope with, the demands of a new life stage such as adolescence or a new milestone such as the expectations of adult sexuality or breaking up with a partner. Further research needs to be done. This government is funding that. A national talkfest will not help very much. (Time expired)

Duncan Kerr (Denison, Australian Labor Party) Share this | Link to this | Hansard source

Order! The time allotted for the debate has expired. The debate is adjourned and the resumption of the debate will be made an order of the day for the next day of sitting.