Scope

SCOPE OF EFFORT

The Missouri Eating Disorders Council, in collaboration with appropriate organizations and stakeholders, in addition to the Departments of Mental Health, Health and Senior Services, Elementary and Secondary Education and Higher Education, will lead the development of eating disorders education, awareness and research initiatives throughout the state, and promote increased access to treatments supported by clinical practice guidelines (i.e., considering the relevant scientific literature, as well as the potential harms and benefits of treatment for each case).^1-3

The Council will focus on children, adolescents, and adults with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), atypical AN, sub threshold BN, sub threshold BED, and avoidant/restrictive food intake disorder (ARFID). These are the major diagnostic categories included in DSM-5.⁴ It will include the sub threshold diagnoses (atypical AN, sub threshold BN, sub threshold BED) because patients with these disorders demonstrate levels of distress and/or impairment similar to full-syndrome AN, BN, and BED.⁵

Eating disorder awareness, detection, prevention, treatment and recovery is of paramount importance and must start early. Early intervention is linked to better treatment outcomes, but requires enhanced awareness and screening.⁶ The Council will focus on helping professionals to recognize individuals with eating disorders and individuals at high risk for developing an eating disorder (e.g., those with high weight/shape concerns or low levels of compensatory behaviors).^7-8 The Council will advocate for increased access to care for this population, as well as promote early intervention and prevention programs and recovery supports.

The absence of adequate coverage for treatment is a critical barrier to access to care for the patient.⁹ The high costs of medical complications, disability, and loss of life are significant health concerns.^10-12 The Council will advocate for third party reimbursement for eating disorders, including coverage through private and public insurance plans.

The Council will work with identified partners, including state departments, to develop an eating disorders awareness program that targets patients with eating disorders as well as non-patient community members. This program will be designed to communicate that eating disorders are serious illnesses that require complete treatment, and to foster recognition of eating disorder symptoms and support for seeking treatment. The objectives of the awareness program are to educate Missouri citizens on the true and serious nature of the disease, dispel myths on who is affected, drive early intervention and encourage appropriate treatment for those suffering or those at risk.¹³

Approved 7/03/2013

References: 1. Institute of Medicine, Report Brief: Clinical Practice Guidelines We Can Trust, March 2011.
2. American Psychiatric Association, Practice Guidelines for the Treatment of Psychiatric Disorders, 2006
3. National Institute for Health and Care Excellence, Clinical Guidance, 2004
4. American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, May 2013
5. Thomas JJ, Vartanian LR, Brownell KD. The relationship between eating disorder not otherwise speciﬁed (EDNOS) and oﬃcially recognized eating disorders: meta-analysis and implications for DSM. Psychological Bulletin. 2009;135:407-433.
6. Wilfley DE, Agras SW, Taylor CB. Reducing the burden of eating disorders: a model for population-based prevention and treatment for university college campus. Int J Eat Disord. 2012;46(5):529-532.
7. Jacobi C, Hayward C, de Zwaan M, Kraemer HC, Agras WS. Coming to terms with risk factors for eating disorders: application of risk terminology and suggestions for a general taxonomy. Psychol Bull. 2004 Jan;130(1):19-65.
8 Jacobi C, Fittig E, Bryson SW, Wilfley D, Kraemer HC, Taylor CB. Who is really at risk? Identifying risk factors for subthreshold and full syndrome eating disorders in a high-risk sample. Psychol Med. 2011 Sep;41(9):1939-49.
9 Silber TJ, Robb AS. Eating disorders and health insurance understanding and overcoming obstacles to treatment. Child Adolesc Psychiatr Clin N Am. 2002;11(2):419-428
10. Trent SA, Moreira ME, Colwell CB, Mehler PS. ED management of patients with eating disorders. Am J Emerg Med. 2013;31(5):859-865
11. Arcelus J, Mitchell A, Wale, J, & Nielsen S. Is there an elevated mortality rate in anorexia nervosa and other eating disorders? A meta-analysis of 36 studies. Arch Gen Psychiatry. 2011; 68:724-731.
12. Preti A, Rocchi MB, Sisti D, Cambon, MV, & Motto P. A comprehensive meta-analysis of the risk of suicide in eating disorders. Acta Psychiatrica Scandinavica.2011;124:6-17
13. Hart LM, Jorm AF, Paxton SJ. Mental health first aid for eating disorders: pilot evaluation of a training program for the public. BMC Psychiatry. 2012 Aug 2;12:98