A CENTRE OF TRANSLATIONAL RESEARCH AND ACTION FOR EATING AND WEIGHT DISORDERS ASTRA 2018 MATERNAL ANXIETY OBESITY 2018

MISSION STATEMENT

To translate knowledge of disordered eating, weight loss, and weight gain, as experienced by those who have suffered the mental and physical health impacts of weight and eating disorders, with the aim for all to have a healthy and positive relationship with food and body size.

CONTRIBUTORS

(Please see Appendix 1 for full biographies)

Dr Penelope Abbott Senior Lecturer in General Dr Freya McMillan Lecturer in Inter-professional Practice, School of Medicine. Health Science, School of Science and Health.

Prof Golo Ahlenstiel School of Medicine, Dr Haider Mannan Lecturer in Biostatistics, Gastroenterologist and Hepatologist THRI, School of Medicine.

Dr Janet Conti Lecturer, School of Social Dr Lucie Ramjan Associate Professor and Sciences and Psychology. Clinical Psychologist Academic Course Advisor for the Master of and Dietician. Primary Health Care Program and International Programs in the School of Nursing and Dr Ann Dadich Senior Lecturer School of Midwifery. Business, and a registered psychologist. Dr Milan Piya Senior Lecturer in Diabetes at the Professor Michael Edye Professor of Surgery Macarthur Clinical School. at WSU and Divisional Director of Surgery and Anaesthetics at Blacktown and Mount Druitt Professor Virginia Schmied Professor GenevieveHospitals. Z. Steiner, of Midwifery in the School of Nursing and Mahmoud A. Al-Dabbas, Midwifery. Registered Midwife and PhoebeDr Rakime Bailey, Elmir Lecturer in the School of Nursing and Midwifery. Professor of Esther Chang, Professor David Simmons Medicine at the Macarthur Clinical School. Sandra Garrido, Professor Phillipa Hay Foundation Chair of Emma S. George, Mental Health, School of Medicine, Psychiatrist. Dr Evelyn Smith Senior Lecturer in Clinical Frances R. Henshaw, Psychology. ProfessorMark I. Hohenberg, Gregory Kolt Dean of Science and HealthKaren Liu, and Professor of Health Science, School ofJennifer Science MacRitchie, and Health. Jane Mears, LeighA/Professor A. Wilson Kenny Lawson Associate Professor in Health Economics, Translational Health Research Institute.

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Contents CONTRIBUTORS 2

EXECUTIVE SUMMARY 4

INTRODUCTION 8

1. THE CHALLENGE 8 SUBSECTION 1A – Prevention and treatments for obesity: Why are they failing? 10 SUBSECTION 1B – The challenges at the opposite end of the weight spectrum 12

2. BACKGROUND: THE STRENGTHS AND LIMITATIONS OF EXISTING APPROACHES 15 SUBSECTION 2A – Behavioural treatments work well in eating disorders – why not for obesity? 15 SUBSECTION 2B – Overcoming ambivalence and the treatment gap in eating disorders 16

3. THE OPPORTUNITY: NEW APPROACHES 18 SUBSECTION 3A – Novel integrated therapeutic interventions for obesity and eating disorders 19 SUBSECTION 3B – Improving the treatment experience across the weight and eating disorder spectrum 21

4. WORKING TOGETHER FOR SYSTEMIC CHANGE: THE ROLE OF STAKEHOLDERS 23

5. THE OUTCOMES: IMPACTING HEALTH AND WELL- BEING IN AND BEYOND 25 SUBSECTION 5A: POLICY 25 SUBSECTION 5B: PRACTICE 26 SUBSECTION 5C: RESEARCH 28

6. FUTURE DIRECTIONS 29

7. REFERENCES 30

8. APPENDICES

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EXECUTIVE SUMMARY

As increasing numbers of people struggle with eating disorders and weight issues across the entire weight spectrum, a growing body of evidence is finding that eating disorders and obesity are intertwined in complex and important ways. At Western Sydney University (WSU), we believe future research initiatives should be integrated in order to reflect this crossover among weight-related issues and focus on translation of findings into policy and practice change.

The purpose of this White Paper is to provide Model: Optimising Health and Well-being for an overview of past and present research by People with Weight and Eating Disorders. multi-disciplinary WSU experts relating to weight related conditions. We summarise challenges faced by researchers in the fields of eating disorders and obesity and highlight key learnings from each that could benefit Closing the the other. We build upon those findings to treatment gap Improved propose a collaborative, multi-disciplinary across the weight treatments for approach to future research. This program disorder spectrum longstanding will draw on expertise from within WSU in weight and eating the areas of psychology, nursing, midwifery, dietetics, obesity surgery, medicine, social disorder sciences, exercise and activity, as well as on the experience and expertise of key community stakeholders. A fundamental component will be the strength of the WSU Translational Health Research Institute (THRI) in the measurement Eectual of public health impact, cost effectiveness and return on investment of appropriate advocacy and interventions. policy change Reduced Future research will be developed in relation to morbidity from our proposed model of optimising health and eating disorders well-being for people with weight and eating and obesity disorders. We show how by working together and sharing knowledge, we have opportunities to have a major impact on the assessment, Increased understanding, and health care of people with productivity and comorbid eating disorders and obesity, or either well-being problem alone. Ultimately this approach will translate into improved outcomes for all.

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ACRONYMS DEFINITIONS Other Specified Feeding or Eating Disorder AN Anorexia Nervosa Eating disorders are moderate to severe mental (OSFED) - According to the DSM-5 (APA, 2013), a person with OSFED may present with ANZAED The & New Zealand illnesses characterised by disturbances in Academy for Eating Disorders behaviour and thinking around food, eating, many of the symptoms of eating disorders ANZOS The Australian and New Zealand weight and/or shape. such as Anorexia Nervosa, Bulimia Nervosa or Obesity Society Binge Eating Disorder but will not meet the full BED Binge Eating Disorder Anorexia Nervosa (AN) is characterised by criteria for diagnosis of these disorders, or have BN Bulimia Nervosa persistent energy intake restriction, intense recurrent purging without binge eating or Night CaHPRI Clinical and Health Psychology fear of gaining weight and disturbance in Eating Syndrome. Research Initiative self perceived weight or shape. Typically (Sources: Centre for Eating & Dieting Disorders CEDD Centre for Eating and Dieting Disorders are underweight but may be normal weight 2017; National Eating Disorders Collaboration CRE EPOCH Centre for Research Excellence in (categorised under OSFED – below) if their pre- the Early Prevention of Obesity in Childhood illness weight was high. 2017) ED Eating Disorder Bulimia Nervosa (BN) is characterised by Obesity - Overweight and obesity are EDOC Eating Disorders and Obesity measured in adults using the Body Mass Index psychology research Clinic repeated episodes of binge eating followed (BMI), which is calculated by dividing weight GBA Gastric Balloon Australia by compensatory behaviours (for example self-induced vomiting or excessive exercise). in kilograms by height in metres squared. HAPIFED a Healthy APproach to weIght Overweight is classified as a BMI of 25 or more management and Food in Eating Disorders In addition, people with BN place an excessive with obesity determined at a BMI of 30 or more. MHPN Mental Health Professional Network emphasis on body shape or weight in their self- evaluation. These cut-off points are based on associations MQ Macquarie University between chronic disease and mortality and Randomised Controlled Trial RCT Binge Eating Disorder (BED) is characterised have been adopted for use internationally by SONM School of Nursing & Midwifery by regular episodes of binge eating. Unlike the World Health Organisation. Obesity is not THRI Translational Health Research Institute BN, a person with BED will not use regularly considered a mental disorder, however there are UNSW University of compensatory behaviours, such as self-induced associations between obesity and a number of USYD vomiting or over-exercising after binge eating. mental health disorders, including BED. UTS University of Technology, Sydney (Sources: American Psychiatric Association WSU Western Sydney University 2013; Obesity Australia 2017)

THANKS/ACKNOWLEDGMENTS Phillipa Hay is primary author of this White Paper. Phillipa Hay and Evelyn Smith together conceived the idea and plans for this Paper. We thank all contributors, A/Professor Leah Brennan for her independent review, and Julie Black for editorial assistance in preparation of this White Paper.

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INTRODUCTION

Eating Disorders have traditionally been considered entirely separate to the growing problem of obesity. However, recent research suggests this polarisation is flawed and that eating disorders and obesity are related in Normal Weight many significant ways. Eating Disorders

It is evident that a debilitating impact on health and well-being is common to those suffering eating disorders and those living with a larger size. Impairments include psychiatric and behavioural effects such as low self-esteem Binge/Purge BED and BN and social withdrawal, and may involve medical AN complications, premature death and an increased risk of suicide. Comorbid obesity and eating disorder has increased at a faster rate than either obesity or eating disorders alone (da Luz et al. 2017a; National Eating Disorders Collaboration (NEDC) 2017). One in five people with obesity also presents with disordered Restricting Obesity eating, usually Binge Eating Disorder (BED) AN Atypical AN but in some cases strict dieting and/or purging behaviours (da Luz et al. 2017a).

Yet despite these links, approaches to treatment matters. A key concern regarding this divide have classically been quite distinct. Eating is that in attempting to address one condition, disorders have generally been regarded we are at risk of exacerbating the other. When as psychosocial in origin and best treated inappropriate messages are presented or by psychological therapies, in particular practices undertaken, those who are obese cognitive behavioural therapy or family-based may be at risk of developing or intensifying interventions with some pharmacotherapy an eating disorder, while others might find as appropriate. In contrast, obesity has been themselves eating excessively. considered a medical condition with metabolic and genetic origins, thought best treated by This present White Paper outlines these major mainstream medicine involving dietary, drug public health concerns and the effects of or surgical treatment. Therapies for eating comorbidity for sufferers, as well as the very disorders generally do not address weight real challenges that are faced when attempting management while, conversely, most weight loss to assist people with these conditions. Our programs do not address psychological aspects. objective is to increase collaboration among interested research groups and community Further, polarisation and interpretation of stakeholders with the ultimate aim of messages can be misinterpreted across the improving treatment outcomes. It is our camps – where health at every size message contention that only an integrated approach can be interpreted as minimising risks of can reduce the burden of illness for all obesity and messages from obesity field may people, whatever their position on the weight be misinterpreted that weight loss is all that spectrum.

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1. THE CHALLENGE

SUBSECTION 1A – PREVENTION AND TREATMENTS FOR OBESITY: WHY ARE THEY FAILING? In Australia, treatments for obesity are NOT JUST A PHYSICAL ISSUE THE WAY AHEAD associated with poor long-term outcomes with Obesity and its physical comorbidities such To address these challenges, research high levels of relapse and attrition (Cheng et al. as diabetes and cardiovascular disease exploring how better to address obesity with 2016; Sumithran et al. 2016; Shaw et al. 2005). have been associated with mental health eating disorder is needed. Examples of critical The approach is generally multi-disciplinary disorders including anxiety and depression issues include: requiring the efforts of surgeons, physicians, (Jantaratnotai et al. 2017). These need to 1. How to discuss childhood obesity with dietitians and psychological therapists, yet be assessed and treated simultaneously, taking into account weight stigma (O’Brien parents, what language to use, where and outcomes remain disappointing. Despite this, et al. 2016; Peckmezian & Hay 2017). A major when to refer for specialised management. levels of public concern are high and there reason prevention and treatment of obesity is Children are generally included in is almost universal positive endorsement of failing we contend may be due to the severe discussions and consultations with treatments. neglect of the predisposing and perpetuating healthcare professionals, therefore greater psychological and behavioural comorbidities. awareness of language and approach (e.g. weight scales/BMI charts etc.) is crucial OBESITY FACTS In contrast to treatment for those living with to limit the likelihood of eating disorder ≥≥27.9% Australians obese a larger size, treatments for eating disorders onset, particularly in teens. ≥≥35.5% overweight are based in psychological medicine and have 2. How to assess eating disorders in people moderate effects for outcomes. Discussing ≥≥1 in 5 present with obesity & eating disorder living in a larger size or at risk of obesity. comorbid obesity and eating disorder in a How to optimally treat comorbid eating ≥≥Estimated total cost - $8.6 billion supportive way also provides a platform to 3. disorders and obesity. discuss, assess and treat other mental and Since 1995 there has been: physical health problems. However, identifying 4. How to create non-obesogenic ≥≥7-fold increase in obesity with binge eating the underlying eating disorder can be an environments that do not then promote eating disorders. i.e. environments that ≥≥11-fold increase in obesity with strict dieting obstacle to such discussions. For example, many people presenting for treatment with promote healthy activity levels without exercise becoming compulsive or aversive. We contend that it is the neglect of problems bariatric surgery under-report their eating with disordered eating that have contributed to problems for fear of not being accepted for surgery. poor outcomes in obesity treatment. Research has found that over the past 20 years obesity comorbid with binge eating has grown 7-fold in Australia and obesity with very strict dieting/fasting 11-fold (da Luz et al., 2017). As a consequence there is a new eating disorder called Atypical AN (APA, 2013), reflecting So I got to a point where I was only eating about 1,000 starvation in normal weight people who were previously obese. calories a day and I was working out between five and eight hours a day . . . And my hair started to fall out. I was covered in bruises. I had dark circles under my eyes. Not to get too completely graphic, but my period stopped altogether and I was only sleeping three hours a night.

KAI HIBBARD, FORMER CONTESTANT ON ‘THE BIGGEST LOSER’. HER LOWEST BMI AT THE END OF THE SHOW WAS 23.2, WHICH IS CONSIDERED WITHIN THE NORMAL RANGE OF BETWEEN 18.5 AND 24.9

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SUBSECTION 1B – THE CHALLENGES AT THE OPPOSITE END OF THE WEIGHT SPECTRUM People with eating disorders such as anorexia THE TREATMENT GAP Critical questions to be investigated with an nervosa (AN), bulimia nervosa (BN) or binge It is a paradox that whilst people are highly integrated approach (i.e. questions combining eating disorder (BED) have as poor outcomes motivated for weight loss, appropriate help- issues relevant to obesity such as weight and increased mortality as people with other seeking and engagement in treatment is often stigma) include: major mental or physical health problems. lacking and consequently outcomes are often 1. How can fiscal, societal (e.g. stigma) and Whilst AN is at the extreme opposite end of poor. On the other hand, there is also a huge personal barriers to accessing care be the weight spectrum to obesity, it is also of shortfall in help-seeking for eating disorders reduced for people with eating disorders? high impact and cost, with onset in the key where there are evidence-based treatments 2. How can the eating disorder field more years of youth and often resulting in early and generally good outcomes. Reviews closely match the obesity field in terms of death (Treasure et al. 2015). It can be highly suggest that fewer than 25% of people with attention by policy makers, levels of public debilitating, challenging to treat and expensive an eating disorder ever seek treatment (Hart health concern and treatment-seeking? to manage, especially in adults who generally et al. 2011). This gap is particularly evident 3. How can the treatment experience for come late to treatment with a more enduring for people with comorbid obesity and eating people with eating disorders be better form of illness. There are widely varying disorder who are likely to present to a clinic understood and improved alongside people’s experiences of weight loss outcomes from very poor for around 1 in 10 requesting help to lose weight, possibly as it treatments? sufferers to complete recovery for an unknown involves less stigma (Star et al. 2015). Closing (as no good definition of recovery exists) these gaps is a major contemporary challenge 4. What is recovery for an individual with AN, and how can it be achieved? How can both minority, and many avoid treatment for fear of and requires action from community partners fields move away from a preoccupation weight gain or obesity. and government as much as from researchers. with weight gain/loss as key indices of However, eating disorder research has not recovery? traditionally attracted the same attention from 5. How can we prepare the health workforce EATING DISORDER FACTS policy-makers as obesity research. ≥≥Estimated 9% prevalence to appreciate the range and importance of eating disorders? ≥≥47% BED, 12% BN, 3% AN, 38% Other ≥≥Mortality rates twice as high as general pop. (5.86 times higher for AN) ≥≥Approx 700,000 untreated at any time ≥≥Total social & economic cost estimated $69.7 billion Source: nedc.org.au

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2. BACKGROUND: STRENGTHS AND LIMITATIONS OF EXISTING APPROACHES

SUBSECTION 2A- BEHAVIOURAL TREATMENTS WORK WELL IN EATING DISORDERS – WHY NOT FOR OBESITY?

Current behavioural approaches to obesity In contrast, medical and psychological Family-based therapy has been found highly treatment have been largely unsuccessful over therapies are the mainstay of effective effective in young people with AN (Jewell et the long term. These poor results are likely due treatments for eating disorders (Wilson al. 2016) and are being trialled to inform more to limited understanding of the biopsychosocial 2005; Hay et al. 2014). Therapies such as successful treatments for childhood obesity risks and maintaining factors of obesity. These interpersonal psychotherapy, family therapy, (Wilfley et al., 2017). Further, Western Sydney factors are almost all shared with eating cognitive remediation and dialectical behaviour research led by Dr Lucie Ramjan has shown disorders including mood disorder, genetic therapy have been successfully applied to the value of peer mentorship in the treatment predisposition to overweight, and childhood eating disorders yet are under-researched in of AN, and such mentoring by people with abuse (Raman et al. 2013; Shaw et al. 2005). obesity (Hay et al. 2014; Linardon et al., 2017; experience of living in a larger (and changing) Tanofsky-Kraff et al. 2017; Tchanturia et al., size could also be supportive for those living Globally the best evidence-based treatment 2017). Dr Evelyn Smith of WSU’s School of with a larger size (Fogarty, Ramjan & Hay 2016; for weight-loss is surgery (Cheng et al. Social Sciences and Psychology has led the Rieger et al.2014). 2016) followed by combination regimes, e.g. application of therapies such as cognitive pharmacotherapy with very low energy dietary remediation and schema therapy to obesity programs (Sumithran et al. 2016). Considerable with positive outcomes including improved time and money are spent on these treatments weight management (Raman 2015; Smith, Hay but little attention may be paid to the & Raman 2015). underlying psychological factors or to the need for ongoing psychological support as people emerge from a weight disorder, particularly when weight loss is rapid such as after bariatric surgery. Psychological Mental health Trauma

Obesity/ Eating Disorder Biological Social Genetics Family Metabolism Peers Culture

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SUBSECTION 2B – OVERCOMING AMBIVALENCE AND THE TREATMENT GAP IN EATING DISORDERS

Positive endorsement of weight loss behaviours Challenges for eating disorder interventions is prevalent in our community and is heightened include: to extreme degrees in people with eating ≥≥Encouraging those with an eating disorder disorders. Due to this positive regard for to access treatment in an obesogenic thinness many are ambivalent about treatment environment that promotes thinness and those who do present, particularly those ≥≥Reducing fears around losing control over with AN, are often at an early stage of change, weight (for people of all sizes) or not yet contemplating change (Vitousek, ≥≥Accessing hard to reach groups such as Watson & Wilson 1998). This, coupled with people from culturally and linguistically high dropout rates, makes recovery from diverse backgrounds (CALD) and Aboriginal AN challenging. Professor Hay was a lead and Torres Strait Islander people researcher in a unique RCT of people with AN ≥≥Balancing the need for experiencing that was highly criticised by one peer reviewer personal safety with a sense of personal for its “unbelievably” low attrition rate. The agency in therapeutic interventions program involved a unique shift in the focus of (particularly when the person is medically therapy from weight regain to improved quality at risk). of life for people with at least seven years of Qualitative research, a major strength of WSU illness (Touyz et al. 2013). researchers in this field, can be useful in: There is a need for more empirical evidence to ≥≥Determining from a recovered patient’s distinguish aspects of interventions for eating perspective the aspects of treatment that disorders that are helpful to recovery from were most useful those that impede recovery. Whilst specialist ≥≥Identifying aspects that positively and psychological interventions are effective for AN negatively impacted recovery treatment, there is no one psychotherapeutic ≥≥Complementing quantitative investigations, approach that is superior to another yet there and vice versa, to achieve triangulation in is very little research into commonalities, i.e. the literature the non-specific effects of therapy (Geller & Srikameswaran 2015) and how to avoid the potential for harm with better alignment of evidence based treatments to individuals and their families (Conti e t al., 2017). Further, there is no agreed definition of recovery.

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3. THE OPPORTUNITY: NEW APPROACHES

Australian Health Ministers (NSW and Federal) An alliance of key stakeholders has similarly have nominated obesity and eating disorders called for action to improve the nutrition and as health priorities and have proposed the reverse the obesogenic lifestyles of young following initiatives: Australians (opc.org.au/tippingthescales). We welcome attention by policy makers to weight 1. Mandatory weighing of every child and related conditions, but the broader impacts adolescent admitted to . must be considered. For example, mandatory http://www.dailytelegraph.com.au/news/ weighing to identify overweight/obesity may nsw/no-escaping-weighty-truth-nsw-to- bring-in-mandatory-tests-for-fat-kids-to- lead to an emphasis on shape and weight over tackle-obesity/news-story/130a0d0565fa health. Such overvaluing of shape and weight f1b9b2eb03e29bf07a18 is a causal and maintaining factor of eating 2. An expansion of Medicare supported disorders. It is also unclear how improved treatment for eating disorders. http:// access to services will be linked to other www.canberratimes.com.au/act-news/ strategies to improve the mental health of expanding-medicaresupported- Australians and reduce suicide. However, failure treatment-for-eating-disorder-patients- to understand the weight disorder spectrum 20170507-gvzz0r.html and integrate approaches has potentially http://www.news.com.au/national/ adverse clinical consequences such as: breaking-news/mayday-to-stop-eating- ≥≥Continued or new onset of obesity after disorder-deaths/news-story/8372f9536f3 treatment for BED & BN c23fec3f0cfe3d5809002 ≥≥Overweight after weight regain in AN 3. NSW Health statewide service plan to expand and establish new services for ≥≥Eating disorders as a consequence of people with eating disorders 2013-2018. obesity treatments http://www.health.nsw.gov.au/ ≥≥Promoting eating disorders during public mentalhealth/publications/Publications/ health campaigns for obesity service-plan-eating-disorders-2013-2018. ≥≥Obesity and eating disorders as pdf consequences of inadequately supervised 4. Eating Disorders included in the dieting Fifth National Mental Health Care ≥≥Obesity as a consequence of ‘permissive’ Plan. www.coaghealthcouncil.gov.au/ eating disorder health promotion Portals/0/FifthNationalMentalHealth andSuicidePreventionPlan.pdf ≥≥Weight rebound when BED is untreated in obesity 5. Continued funding ($1.2 million) for workforce development and other NEDC (Foo et al. 2013; Hay et al. 2009; Locke et al. projects – noting the recently launched 2015; Stice et al. 2016; Wilson et al. 2010; Witt National Agenda for Eating Disorders. et al. 2014) https://thebutterflyfoundation.org.au/ assets/Uploads/National-Agenda-for- Eating-Disorders-2018.pdf

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SUBSECTION 3A – NOVEL INTEGRATED THERAPEUTIC INTERVENTIONS FOR OBESITY AND EATING DISORDERS

The way forward is to translate established Model: Optimising Health and Well-being for approaches for the treatment of eating People with Weight and Eating Disorders. disorders into treatments for those with weight disorders. We propose an integrated program of research across Western Sydney and beyond involving key stakeholders and partners in the areas of eating disorders and obesity. Closing the treatment gap The research will include evaluations of the across the Improved effectiveness of therapeutic interventions treatments for developed by the researchers and their weight disorder longstanding collaborators. We will build upon approaches spectrum already developed by WSU researchers weight and eating and focus on translating these into clinical disorder practice. The aim is to promote widespread understanding of the key issues and the urgent need for action in reducing the twin burdens of obesity and eating disorders. Eectual WSU researchers have already devised and advocacy and implemented several novel programs for policy change people with eating disorders and obesity Reduced including but not limited to: HAPIFED (da morbidity from Luz et al., 2017b), an integrated cognitive eating disorders behavioural (CBT) and weight management and obesity therapy, use of new technologies to promote healthy exercise (Kolt et al. 2012; 2017) and cognitive remediation therapy (Raman, 2015) Increased Our proposed research will address the key productivity and features of the Model by having a focus well-being on working with stakeholders to develop referral pathways and improved training of professionals in assessment, management, and therapeutic interventions for eating disorders, obesity and their comorbidity. A key aspect of these trials will be a mixed methods approach, i.e. utilising both qualitative research to engage the community in discussion of, for example, how parents can talk to children about weight and eating, and quantitative measures of determinants and outcomes. The research program will be an ideal opportunity to understand how integrated and collaborative care can work.

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PARTNERSHIPS metabolic rehab clinic at Camden Hospital. The Trials will be based in clinics of industry Diabetes, Obesity and Metabolism group at partners such as the Wesley Hospital Day WSU are helping to shape the work underway. Program, SWS Local Health District at Camden A central question for stakeholders and policy and Campbelltown and the WSU Eating makers is the cost-effectiveness of treatment Disorders and Obesity psychology research programs and required level of investment Clinic (EDOC). We will link into the Sydney needed to have a significant and sustained Partnership for Health Education Research impact. THRI researchers at WSU, notably and Enterprise (SPHERE) Diabetes, Obesity A/Professor Kenny Lawson, have expertise and Metabolism Clinical Academic Group. This in: economic evaluation (including, cost- program focusses on secondary prevention utility, cost-effectiveness and cost benefit and early intervention for people with diabetes analysis), assessing inter-sectoral impacts, and and those at risk, such as women planning estimating the overall return on investment of pregnancy, Aboriginal and Torres Strait treatment programmes which policy-makers Islander and CALD young people aged 16 – 25 require before implementing new services and years. SWS Local Health District has already community interventions. Research at Deakin established an academic unit (the Diabetes, University (Le et al. 2017), has highlighted the Obesity, Metabolism Translational Research paucity of research into the cost- effectiveness Unit-DOMTRU), which includes several WSU of even the most established treatments for researchers, to study population-wide and AN and BN. More local research in this area will clinical interventions to promote healthy ensure EDs with obesity are put to the fore of lifestyles and treat diabetes and obesity. policy-making. Camden and Campbelltown is set to develop obesity services, building upon the

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SUBSECTION 3B – IMPROVING THE TREATMENT EXPERIENCE ACROSS THE WEIGHT AND EATING DISORDER SPECTRUM

At WSU, health professionals are working at Researchers (PH, JC, LR) are also collaborating Other research includes: the cutting edge of research into closing the with the AN lab of the Clinical and Health ≥≥A study highlighting the importance of the treatment gap and improving outcomes for Psychology Research Initiative (CaHPRI) on therapeutic relationship in AN recovery people with AN or other eating disorders. a number of studies exploring treatment (LR). Similar dynamics may impact These initiatives range from identifying people experiences for eating disorders through: treatment outcomes for obesity and other eating disorders. pre-treatment to ensuring the best outcomes ≥≥a meta-synthesis of qualitative research in during and post treatment. We are conducting adults who experience AN treatments ≥≥An examination of the non-specific effects of underused therapies such as narrative research into how to target people with ≥≥survey research that explores treatment therapy and family therapy (JC). eating disorders during the critical periods experiences for eating disorders. of pregnancy and early motherhood when ≥≥Research exploring peer mentoring and motivation is generally high (RE, VS, PH). In the This foundational research will inform future peer support as a way to enhance current area of treatment, we are working closely with treatment interventions for AN. One of these approaches – See Appendix 2 (LR, PH), collaborators and stakeholders such as Wesley could be narrative therapy which is a promising including culturally tailored strategies (FM, DS). Private Hospital to improve the experience of psychological intervention that may address inpatients. An example is a current study of issues identified in the Insights into Recovery ≥≥Study of the role of complementary blind vs. non-blind weighing where patients are project such as: the significance of safety medicine (PH with WSU Professor Smith), which was highly rated in the Butterfly given the choice of knowing their weight or not and trust in the therapeutic relationship; Foundation’s Insights into Recovery study. (Franzisca Froreich ACTRN12616000816459). interventions prioritising language, questions Choice was highlighted in the Butterfly of identity and a sense of personal agency; and Each of these studies addresses issues that Foundation’s Insights to Recovery study as a therapist understanding that recovery can be may also be applied to the management and key element for facilitating better outcomes a long-term process that involves addressing treatment of people with obesity. (see https://thebutterflyfoundation.org.au/ both cognitive difficulties and quality of life. about-us/information-and-resources/insights- in-recovery/).

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4. WORKING TOGETHER FOR SYSTEMIC CHANGE: THE ROLE OF STAKEHOLDERS Future collaborative research in the area Meetings have already taken place with some of obesity and eating disorders will ensure key stakeholders including the Butterfly comorbidity is identified, managed positively Foundation. Below are details of other groups and appropriately, and pathways to services that have expressed an interest in future put in place. A close working relationship with collaboration. Professor Phillipa Hay (chair) other stakeholders is vital in order to translate and others at WSU worked with the Butterfly and evaluate research findings into real world Foundation on the Insights into Recovery settings and optimises the likelihood of project (2016) and co-authored a recent findings evolving into policy guidelines. Such relevant scientific paper with their researchers relationships also enable us to understand (Peckmezian & Hay, 2017). HAPIFED (da Luz the reception and relevance of our research et al., 2017b) has been an important outcome to people with the lived experience of eating of this collaboration with researchers at the disorders and obesity. Charles Perkins Centre.

We recognize that there are major gaps Approximately twenty organisations and in health professional training regarding leading individuals from across the spectrum the understanding of eating disorders of eating and weight disorders who impact on and the management of people with both research, practice and policy have confirmed weight problems and eating disorders. Our their interest in the work of this WSU White stakeholders are essential to facilitating and Paper (Box). They all have direct activity in one delivering improved training and experience, or more of the areas pertinent to our Model e.g. through dissemination of education by of Optimising Health and Well-being (p. 20) webinars and other educational opportunities i.e. development of referral pathways, delivery for health care practitioners. Professor Hay of health care and training of professionals was involved in a MHPN webinar on the case in assessment, management and therapeutic of a young person with an eating disorder interventions for eating disorders, obesity and and obesity, which was broadcast to over their comorbidity. four hundred general and other primary health practitioners across Australia in September 2017.

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STAKEHOLDERS Australian and New Zealand Obesity Healthways Australia The Sydney Partnership for Health Society (ANZOS) http://www.healthwaysaustralia.com.au Education Research and Enterprise http://anzos.com/ Provider of personalised programs for (SPHERE) Diabetes, Obesity and Metabolism Lead national scientific organisation of individuals, workplaces and communities Clinical Academic Group health care professionals interested in designed to help Australians gain control http://www.thesphere.com.au/initiatives/ obesity research, treatment or public health over their health and well-being. clinical-academic-groups/ initiatives directed at the prevention of obesity. Mental Health Professional Network Weight Management Services (Children’s (MHPN) Hospital at Westmead) & Centre for The Australia & New Zealand Academy for https://www.mhpn.org.au Research Excellence in the Early Prevention Eating Disorders (ANZAED) MHPN is national and provides two of Obesity in Childhood (EPOCH CRE) http://anzaed.org.au interdisciplinary programs: MHPN www.schn.health.nsw.gov.au/parents-and- Lead national scientific organisation practitioner networks and the National online carers/our-services/weight-management/ representing and supporting the activities of professional development program. chw & http://www.earlychildhoodobesity.com professionals working in the field of eating EPOCH CRE brings together researchers, disorders and related issues in prevention, Western and South Western Sydney LHDs practitioners and policy-makers from treatment and research. including Metabolic Rehabilitation Program, Australia, New Zealand and England to work Camden/Campbelltown (NSW) and obesity collaboratively on approaches to prevention The Butterfly Foundation services at Campbelltown Hospital and of obesity in children aged 0 to 5 years. https://thebutterflyfoundation.org.au Bariatric service at Blacktown. Lead national organisation for all people Notable Western Sydney Wesley Hospital Ashfield and Kogarah affected by eating disorders and negative practice providing a multidisciplinary wesleymission.org body image. approach to weight loss/management. Healthcare provider offering both inpatient and day programs for people suffering from Centre for Eating and Dieting Disorders Northside West Clinic (The Northside Eating Disorders; multi-disciplinary training (CEDD) - cedd.org.au & Charles Perkins Group) and research in partnership with WSU and Centre (CPC) www.northsidegroup.com.au other Universities. http://sydney.edu.au/charles-perkins-centre/ Healthcare provider offering both inpatient CEDD is a collaboration between The Boden and day programs for people suffering from Institute (CPC, University of Sydney) and Eating Disorders and multi-disciplinary Sydney Local Health Network with the training and research in partnership with purpose of developing and implementing WSU and other Universities. strategic planning for eating disorders in NSW. Shire Pharmaceuticals https://www.shireaustralia.com.au Gastric Balloon Australia (GBA) Leading international biotechnology http://www.gastricballoonaustralia.com.au company focused on people with Significant GBA is the largest Australian practice and Unmet Medical Need providing a multidisciplinary approach to weight loss/management.

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5. THE OUTCOMES: IMPACTING HEALTH AND WELLBEING IN GREATER WESTERN SYDNEY AND BEYOND

SUBSECTION 5A: POLICY

WSU researchers have a strong record of Associate Professor Kenny Lawson of THRI led attracting external funding and building the development of the highly cost-effective relationships that translate into tangible health Scottish Cardiovascular Disease Policy Model benefits for the people of Greater Western which has a focus on socially deprived areas. Sydney. We consider it imperative that research Locally, he is working with WentWest Primary from WSU be brought to the attention of key Health Network to assess the implementation policy makers and jurisdictions in New South of a new integrated model of primary care Wales, Australia and the international arena. for chronic disease patients. Professor David These policy-makers include, for example, the Simmons of Macarthur Clinical School and International Academy for Eating Disorders, THRI has led policy development in Gestational which has developed guidelines and criteria for Diabetes in Australasia, been a member of credentialing eating disorder programs around technical and working groups into gestational the world. diabetes at the World Health Organisation and the National Institute of Diabetes, Digestive More closely, the Australian federal government and Kidney diseases in the USA and a range has been working with the National Eating of lifestyle and peer support programs in Disorder Foundation of which Professor New Zealand and the United Kingdom. He Phillipa Hay is Deputy Chair of the Steering is working with Dr Freya Macmillan and the Committee. Their aim is to develop a range DOMTRU team in Greater Western Sydney on of resources, policies and documents related a number of healthy lifestyle and peer support to closing the eating disorder treatment gap. programs involving local primary health These include addressing workforce deficits networks and other stakeholders. in the understanding of eating disorders and deficits across health professionals in the We anticipate our integrated research Model - provision of clinical services and treatment. Optimising Health and Well-being for People WSU researchers are also contributing to the with Weight and Eating Disorders (p. 20) NSW statewide eating disorder program which will have significant input into both current is addressing the huge gaps in assessment and and new policy directives. For example, our care for people with eating disorders in public research directly relates to the review of hospitals across New South Wales. Medicare items and rebating for people with eating disorders. Our collaborative studies will evolve into policy guidelines when working in the area of obesity and/or eating disorders, to ensure comorbidity is identified, managed positively and appropriately, and pathways to services put in place.

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SUBSECTION 5B: SUBSECTION 5C: PRACTICE RESEARCH

As an outcome of this paper, we anticipate WSU’s research ethos is about impact. We Future collaborative research between working with stakeholders to improve health believe excellent research is research that WSU researchers and relevant community professional training and experience through effects real-world change and results in stakeholders will ensure our research continues targeted educational opportunities such as practical, measurable outcomes. We support to be revolutionary and published in peer- the development of online resources, training multidisciplinary, collaborative research that reviewed scientific publications. Findings will modules and activities. The possibility of literally changes lives. Our pioneering research be presented at key forums and conferences to developing apps and an online information in the fields of obesity and eating disorders ensure they translate into best-practice policy portal will also be explored. Further, we intend has already impacted upon the well-being of and treatment guidelines. A major symposium to play an important role in the evaluation people in Western Sydney and further afield was held at WSU in 2018 to communicate of programs and resources developed and nationally and internationally. and discuss the translation of our research disseminated by stakeholders including The initiatives with key partners and stakeholders Butterfly Foundation and other private and The academic track record of our team is into policy and practice. An emphasis will also public sector health care providers. outstanding. We have attracted millions of be placed on disseminating results beyond the dollars in research funding to conduct ground- scientific community via the media. WSU researchers have a history of effecting breaking longitudinal and epidemiologic changes to best practice. Dr Lucie Ramjan’s studies and randomised controlled trials. The ultimate goal of our research is to improve 2004 paper, Nurses and the 'therapeutic Between us we have published countless outcomes for those living with an eating relationship': Caring for adolescents with articles in internationally recognised journals; disorder or larger size. The development of anorexia nervosa has been used as evidence individually we have achieved recognition by consumer resources will be another important in the production of nursing best practice being awarded positions within some of the research outcome. Further, we aim to translate guidelines in Canada (Registered Nurses' country’s leading research centres. Our roles our findings into empirically supported Association of Ontario 2006). Professor supervising doctoral students ensure that online/internet based self-help programs Hay led the RANZCP national guidelines research within our university remains relevant for consumers, and educational portals for for treatments in EDs (Hay et al. 2014), and advances collective knowledge. treatment providers. This will be achieved while Professor Virginia Schmied has made with the participation and engagement with significant contributions to national policy and people with lived experience. service development in the field of maternal child and family health at the local, state and national levels. Her research on women’s and midwives’ experiences of addressing weight issues in pregnancy has informed training and education for staff. The research also shaped the implementation of pregnancy weight management guidelines in a range of services and the development of interventions for obese women in pregnancy. Professor Gregory Kolt has effectively harnessed the capacity of the internet to improve the activity levels and health of Australians (Kolt et al. 2017).

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6. FUTURE DIRECTIONS

Australia has the capacity to lead the world in Our collaborative Model (p 20) aims to bring translating empirical research into real-world together both fields of research and have practice, thereby improving outcomes for significant implications for those suffering from people with eating disorders and obesity. At an eating disorder or obesity and, importantly, WSU, our leading expertise in both fields places the increasing number who struggle with both. us in a unique position to drive that movement and bring the two fields together. As editors This can be accomplished by WSU researchers and associate editors of internationally working with stakeholders and partners to: recognised peer-reviewed journals, members 1. Radically change current approaches for of national and international committees and the behavioural management of people regular keynote speakers at plenaries and with obesity by addressing concurrent conferences, we can ensure our research is disordered eating and mental health problems (including but not limited to widely disseminated and effectual. eating disorders and depression) in trials of innovative integrated interventions for We also will draw on the broader strengths weight loss management. of the University including (but not limited to): Business; Computing, Engineering and 2. Close the gap in eating disorder treatment and improve the extreme Mathematics; Education; Humanities and personal and social impacts of AN and Communication Arts; and Law. Of particular other eating disorders by harnessing relevance are the participatory action research the opportunities provided by new and digital promotion of mental health and technologies to (i) improve access and well-being programs in the Institute for Culture outcomes in interventions for obesity and and Society, and the program within the School eating disorders, (2) redress deficiencies of Business on health service management in health literacy and training of health research, notably, knowledge translation. For professionals at all levels of care, and (3) example, Dr Ann Dadich uses the innovative test new approaches that improve the methodology of POSH VRE to understand treatment experience for all. and promote pockets of brilliance within 3. Enable the eating disorder field to learn health services. POSH VRE coalesces positive from the obesity field in order to achieve organisational scholarship in healthcare and the same levels of public health impact and positive regard for treatment by video reflexive ethnography to award primacy working together. to positive practices and experiences, as deemed by non-academic experts notably, managers, clinicians, consumers, and their families. POSH VRE focuses on which services, and those therein, that do exceptionally well, if not brilliantly. This focus has proven to be of scholarly, methodological, and organisational value.

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7. REFERENCES

American Psychiatric Association, 2013, Hay, P.J., Bacaltchuk, J., Stefano, S. and Locke, A.E., Kahali, B., Berndt, S.I., …Croteau- Diagnostic and statistical manual of mental Kashyap, P., 2009. Psychological treatments Chonka, D.C. 2015, Genetic studies of body disorders: DSM-5, Author, Washington, D.C. for bulimia nervosa and bingeing. Cochrane mass index yield new insights for obesity Database Syst Rev, 4(4). biology, Nature, vol. 12, no. 518 (7538), pp. 197- Cheng, J., Gao, J., Shuai, X., Wang, G. and 206. Tao, K., 2016. The comprehensive summary Hay, P., Chinn, D., Forbes, D., Madden, S., of surgical versus non-surgical treatment for Newton, R., Sugenor, L., Touyz, S. & Ward, Mulders-Jones, B., Mitchison, D., Girosi, F. obesity: a systematic review and meta-analysis W. 2014, ‘Royal Australian and New Zealand & Hay, P. 2017, Socioeconomic correlates of of randomized controlled trials. Oncotarget, College of Psychiatrists clinical practice eating disorder symptoms in an Australian 7(26), p.39216. guidelines for the treatment of eating population-based sample, PloS one, vol. 12, no. disorders, Australian & New Zealand Journal of 1, 1:e0170603. Conti, J., Calder, J., Cibralic, S., Rhodes, Psychiatry, vol. 48, no. 11, pp. 977-1008. P., Meade, T., Hewson, D. Somebody else’s O’Brien, K.S., Latner, J.D., Puhl, R.M., Vartanian, roadmap: Lived experience of Maudsley and Hay, P., Girosi, F. & Mond, J. 2015, Prevalence L.R., Giles, C., Griva, K. & Carter, A. 2016, The Family Based Therapy for Adolescent Anorexia and sociodemographic correlates of DSM-5 relationship between weight stigma and Nervosa. Australian and New Zealand Journal eating disorders in the Australian population, eating behavior is explained by weight bias of Family Therapy. Article Accepted August Journal of Eating Disorders, vol. 3, no. 19. internalization and psychological distress, 2017. Appetite, no. 102, pp. 70-6. Jantaratnotai, N., Mosikanon, K., Lee, Y., & da Luz, F.Q., Sainsbury, A., Mannan, H., Touyz, McIntyre, R.S. 2017, The interface of depression Palavras, M.A., Hay, P., Claudino, A., 2017, The S., Mitchison, D. and Hay, P., 2017a. Prevalence and obesity, Obesity Research & Clinical efficacy of psychological therapies in reducing of obesity and comorbid eating disorder Practice, vol. 11, no. 1, pp. 1-10. weight and binge eating in people with bulimia behaviors in South Australia from 1995 to 2015. nervosa and binge eating disorder who are International Journal of Obesity. vol.41, pp. Kolt, G.S., Rosenkranz, R.R, Vandelanotte, C., overweight or obese - A critical synthesis and 1148-55. Duncan, M.J. 2017. Using Web 2.0 applications meta-analyses. Nutrients, vol. 9, no. 3, p. 299. to promote health-related physical activity: da Luz, FQ, Swinbourne, J, Sainsbury, A, Touyz, findings from the WALK 2.0 randomised Peckmezian, T. & Hay, P. 2017, A systematic S, Palavras, M, Claudino, A & Hay, P 2017b, controlled trial. British Journal of Sports review and narrative synthesis of interventions ‘HAPIFED: a Healthy APproach to weIght Medicine, vol.51, no.19, pp. 1433-1440. for uncomplicated obesity: weight loss, well- management and Food in Eating Disorders: a being and impact on eating disorders, Journal case series and manual development, Journal Kolt GS, Schofield GM, Kerse N, Garrett N, of Eating Disorders, vol. 5, no. 1, p. 15. of Eating Disorders, vol. 5, no. 1, p. 29. Ashton T, Patel A 2012, Healthy steps trial: pedometer-based advice and physical activity Raman, J. 2015, ‘The clinical obesity Fogarty, S., Ramjan, L., & Hay, P. 2016, ‘A for low-active older adults. Annals of Family maintenance model (COMM) and the efficacy systematic review and meta-synthesis of the Medicine, vol. 10, no. 3, pp. 206-212. doi:10.1370/ of cognitive remediation therapy in obesity. effects and experience of mentoring in eating afm.1345. Thesis WSU Supervisors Phillipa Hay & Evelyn disorders and disordered eating’, Eating Smith. http://researchdirect.westernsydney.edu. Behaviors, vol. 21, pp. 66-75. Le, K.D., Hay, P., Wade, T., Touyz, S., au/islandora/object/uws%3A36713/ Mihalopoulos, C. 2017. The Cost-Effectiveness Foo, L.L., Vijaya, K., Sloan, R.A., Ling., A of Cognitive Behavioural Therapy for Bulimia Registered Nurses’ Association of 2013, ‘Obesity prevention and management: Nervosa in the Australian context. International Ontario 2006, Establishing Therapeutic Singapore’s experience’, Obesity Reviews, vol. Journal of Eating Disorders. International Relationships. (rev.suppl.). Toronto, Canada: 14, no. S2, pp. 106-13. Journal of Eating Disorders. Accepted 27 Sept. Registered Nurses’ Association of Ontario

Geller, J. & Srikameswaran, S. 2015, ‘What Linardon, J., Fairburn, C.G., Fitzsimmons-Craft, Registered Nurses’ Association of effective therapies have in common’, Advances E.E., Wilfley, D.E. and Brennan, L., 2017. The Ontario, 2006, Establishing Therapeutic in Eating Disorders: Theory, Research and empirical status of the third-wave behaviour Relationships. (rev.suppl.), Registered Nurses’ Practice, vol. 3, no. 2, pp. 191-7. therapies for the treatment of eating disorders: Association of Ontario, Toronto, Canada. A systematic review. Clinical Psychology Review. Early view online. Rieger, E., Treasure, J., Swinbourne J., Adam, B., Manns, C. & Caterson, I. 2014. The effectiveness

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of including support people in a cognitive Vitousek, K., Watson, S. & Wilson, G. 1998, behavioural weight loss maintenance program Enhancing motivation for change in treatment- for obese adults: study rationale and design, resistant eating disorders, Clinical Psychology Clinical Obesity, vol. 4, no. 2, pp. 77-90. Review, vol. 18, no. 4, pp. 391-420.

Shaw, K., O’Rourke, P., Del Mar, C., Kenardy, Wilfley, D.E., Saelens, B.E., Stein, R.I., Best, J.R., J. 2005, ‘Psychological interventions for Kolko, R.P., Schechtman, K.B., Wallendorf, M., overweight or obesity. Cochrane Database of Welch, R.R., Perri, M.G. and Epstein, L.H., 2017. Systematic Reviews 2, no. 4. Dose, Content, and Mediators of Family-Based Treatment for Childhood Obesity: A Multisite Smith, E., Hay, P. & Raman, J. 2014, Cognitive Randomized Clinical Trial. JAMA pediatrics. remediation therapy for obesity in K Tchanturia 2017 Oct 30. [Epub ahead of print] (ed.), Cognitive Remediation Therapy (CRT) for Eating and Weight Disorders, Routledge, Wilson, G.T., Wilfley, D.E., Agras, W.S. & Bryson, London. S.W. 2010, Psychological treatments of binge eating disorder, Archives of General Psychiatry, Stice, E., Gau, J.M., Rohde, P. & Shaw, H. 2016, vol. 67, no. 1, pp. 94-101. Risk factors that predict future onset of each DSM–5 eating disorder: predictive specificity Witt, A.A., Berkowitz, S.A., Gillberg, C., in high-risk adolescent females, Journal of Lowe,.M.R., Råstam, M. & Wentz E. 2014, Weight Abnormal Psychology, vol. 126, no. 1, pp. 38-51. suppression and body mass index interact to predict long-term weight outcomes in Sumithran, P., Prendergast, L.A., Haywood, C.J., adolescent-onset anorexia nervosa, Journal of Proietto, J. 2016, Review of 3-year outcomes Consulting and Clinical Psychology, no. 82, p. of a very-low-energy diet-based outpatient 1207. obesity treatment program, Clinical Obesity, vol. 6, pp. 101–107. Zaitsoff, S., Pullmer, R., Menna, R. & Geller, J 2016, A qualitative analysis of aspects of Tanofsky-Kraff, M., Shomaker, L.B., Wilfley, D.E., treatment that adolescents with anorexia Young, J.F., Sbrocco, T., Stephens, M., Brady, identify as helpful, Psychiatry Research, no. S.M., Galescu, O., Demidowich, A., Olsen, C.H. 238, pp. 251-6. and Kozlosky, M., 2017. Excess weight gain prevention in adolescents: Three-year outcome following a randomized controlled trial. Journal of consulting and clinical psychology, 85(3), p.218.

Tchanturia, K., Giombini, L., Leppanen, J. and Kinnaird, E., 2017. Evidence for Cognitive Remediation Therapy in Young People with Anorexia Nervosa: Systematic Review and Metaanalysis of the Literature. European Eating Disorders Review, 25(4), pp.227-236.

Treasure, J., Zipfel, S., Micali, N., Wade, T., Stice, E., Claudino, A., Schmidt, U., Frank, G.K., Bulik, C.M. & Wentz, E. 2015. Anorexia Nervosa, Nature Primer Disease Reviews vol. 1, no. 15074. doi:10.1038/nrdp.2015.74

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APPENDIX 1 – CONTRIBUTOR BIOGRAPHIES

Dr Penelope Abbott, School of Medicine Dr Ann Dadich is a Senior Lecturer within Dr Rakime Elmir, School of Nursing & Penelope Abbott is a Senior Lecturer in General the Western Sydney University School of Midwifery Practice within the School of Medicine. In the Business, a registered psychologist, and a Rakime Elmir is a Registered Midwife and past five years she has received over $4.5 full-member of the Australian Psychological Lecturer in the School of Nursing and million in research funding of which $4.2 million Society. Prior to her academic career, Ann Midwifery. For several years Rakime has is Category 1 grants, has published 35 papers worked with different populations in the worked in a variety of maternity settings. and contributed to two professional guidelines. community, including young people and people She completed her PhD in 2012 focussing on She works in multiple roles with researchers, with mental health issues. These experiences women’s experiences of severe postpartum clinicians and policy makers, including in the continue to inform her approach to conducting haemorrhage and emergency hysterectomy. areas of Aboriginal and Torres Strait Islander research that is both empirical and respectful. Following on from her doctoral work, Rakime Health, child health and chronic disease. She Since entering academe, Ann has accumulated has led several research projects exploring works as a general practitioner in clinical and considerable research experience in health fathers’ experiences of birth trauma, midwives’ academic roles and has particular interest service management, particularly knowledge experiences of obstetric emergencies and in promoting quality primary care including translation –the ways in which different women’s experiences of eating disorders for Aboriginal people, people involved with forms and sources of knowledge coalesce to in the perinatal period. Rakime has been the criminal justice system and people with inform practice. This is demonstrated by her published in high impact Journals and has chronic disease. Her external affiliations include publishing record, which includes 130 refereed been successful attracting competitive internal the Western Sydney and South West Sydney publications; the research grants she has University grants. She has nine publications Primary Health Networks, the Royal Australian secured; and her awards received to date. In and 13 presentations in the past five years and College of General Practitioners, Justice Health addition to teaching undergraduate students received two early career research grants. & Forensic Mental Health Network and the and supervising doctoral scholars, Dr Dadich Aboriginal Health & Medical Research Council. holds editorial appointments with leading Prof Golo Ahlenstiel, School of Medicine, academic journals, including the Australian Gastroenterologist and Hepatologist Dr Janet Conti, School of Social Sciences and Health Review and the International Journal of Golo graduated and received his doctorate Psychology Healthcare. from the University of Bonn, Germany and Janet Conti is a Lecturer and Academic subsequently undertook a Liver Fellowship Professor Michael Edye Course Advisor for the Master of Clinical and at world renowned National Institutes of Professional Psychology programs at WSU. Michael Edye is Professor of Surgery at Health (NIH) in Washington, DC in the United She is also a Clinical Psychologist (MAPS) and WSU and Divisional Director of Surgery States. Since coming to Australia he has Dietician (MDAA). Her research is in the area and Anaesthetics at Blacktown and Mount completed basic and advanced training in of qualitative research, particularly critical Druitt Hospitals. His chief clinical interest is in Gastroenterology & Hepatology in 2013 and discursive methods, and in the area of eating minimally invasive upper GI surgery. In recent has worked as a staff specialist at Westmead disorders and their treatment. Janet completed negotiations with the NSW Ministry of Health Hospital since 2014. Golo currently leads her PhD in 2013 - a longitudinal research study he was successful in establishing a new publicly the Liver Immunology group at Storr Liver into women’s experiences of anorexia nervosa funded metabolic surgery program based Centre at The Westmead Institute for Medical over ten years. In 2015, Janet received a WSU at Blacktown with capacity to provide much Research. As the incoming Chair of Medicine ECR grant and in 2016, a WSU Women’s needed surgical interventions for people with at Blacktown Hospital, Golo pursues an active Research Fellowship to continue her research severe obesity. Other notable achievements interest in research and education with more into narratives of anorexia nervosa. This has include initiation of the first laparoscopic donor than 60 publications with more than 2500 included mixed methods research into people’s nephrectomy program in the Northeast of the citations. He is regular reviewer for international eating disorder treatment experiences, with a United States at The Mount Sinai Hospital in medical and scientific journals. particular focus on treatment experiences of New York in 1996, development of techniques first-line treatments for adolescent anorexia to increase the durability of laparoscopic repair Golo is a VMO Gastroenterologist at the nervosa. Janet has had six peer-reviewed of paraoesophageal hiatal hernia and research Hospital for Specialist Surgery and has regular publications over the past two years and into kidney volume imaging to optimise donor endoscopy lists there and at Blacktown/Mt presented at the International Congress of renal function after live kidney donation. Druitt hospitals. Golo is a strong believer in Qualitative Inquiry at the University of Illinois high quality, accessible medical services and in 2016. No-Gap bills all private procedures (as does the anaesthetist), bulk bills aged pensioners and provides discounts for HCC holders.

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Professor Phillipa Hay, Translational Health has an academic background that spans policies and health inequalities, and has Research Institute several disciplines including psychology, generated approximately $2m in grant revenue. Phillipa Hay is Professor of Mental Health in the physiotherapy, and education. He holds a PhD Dr Haider Mannan, Translational Health School of Medicine at WSU. She has extensive in Psychology, is a Registered Psychologist, Research Institute expertise in longitudinal and epidemiologic and has worked extensively in academic, studies as well as randomised controlled research, and practice settings in Australia Dr Haider Mannan is a Lecturer in biostatistics trials in eating disorders and related mental and New Zealand. His research achievements at Centre for Health Research and the School health problems of young people. She has are recognised internationally with around of Medicine, Western Sydney University. He has a unique body of work reporting the point $5.65 million of research grant funding and three roles-research, teaching and providing prevalence of eating disorders and their the publication of several books and book statistical consulting service to staffs and burden in the Australian general population, chapters, and over 150 journal publications. students. He has a research track record in the only representative population data on Professor Kolt is a recognised senior academic the field of lifestyle factors (e.g. smoking, eating disorders in Aboriginal and Torres Strait leader and manager with extensive experience diet, eating disorders), chronic conditions Islander peoples, as well as the increase in in University settings. His leadership across (e.g. obesity, diabetes) and treatments (e.g. these problems, concomitant with increases the broad health science, science, and human CABG, angioplasty stenting) associated with in obesity. Her studies have provided key science disciplines has led to the significant cardiovascular disease with a focus on risk information to guide jurisdictions in planning expansion, growth, and strengthening of these prevention using policy modelling. His other health care services for eating disorders areas in his current role at Western Sydney areas of expertise include functioning and across Australia. In 2015 she received the University, and in his prior role at Auckland disability among the elderly and evaluation Lifetime Leadership Award from the ANZ University of Technology (New Zealand). of population health interventions. His Academy for Eating Disorders and in 2013 biostatistical expertise is wide including A/Professor Kenny Lawson, Translational was elected Fellow of the (international) regression models for clustered and Health Research Institute Academy for Eating Disorders. In 2014 she longitudinal data (e.g. multilevel mixed effects, was awarded a “Science Without Borders” Kenny Lawson is Associate Professor in Health GEE models), continuous, binary (e.g. logistic Visiting Professorship from the CAPES research Economics at Western Sydney University. regression), survival (e.g. Cox regression, foundation in Brazil. Her work has also been Kenny’s research interests centre mainly on Weibull regression), categorical and ordinal funded by NHMRC, ARC and Rotary Health. economic evaluation, and decision analysis, outcomes, nonparametric methods, analysis She has over 200 peer reviewed scientific to inform the priority setting of both research of small studies and state transition models publications. Professor Hay has led the funding to enhance the ‘value of information’ (e.g. Markov simulation/model, latent Markov introduction of the first online journal in her generated, and the translation of research model), all in the context of epidemiological/ research areas (Journal of Eating Disorders). into policy to generate value for money, and medical studies. He has published software She has extensive community engagement especially to reduce health inequalities. He for disease risk modelling using SAS macros. and in addition to service on committees for entered academia seven years ago, and has He is widely published in epidemiology and the International and ANZ AED, she is Deputy extensive industry experience as an applied biostatistics with 21 as first authored and 12 Chair of the Steering Committee for National economist in public (e.g. Central Government) in category ‘A’ journals including American Collaboration for Eating Disorders. and private sectors (e.g. banking, consultancy) Journal of Epidemiology, Preventive Medicine, across four continents directly influencing European Journal of Preventive Cardiology, Professor Gregory Kolt, School of Science his policy applied research interests. He International Journal of Obesity, Obesity, and Health has published 27 articles, including the Lancet Annals of Epidemiology, European Journal of Professor Gregory Kolt is the Dean of Science (physical activity), Heart (CVD), Preventative Nutrition, Accident Analysis and Prevention and Health, Professor of Health Science, and Medicine (CVD), and International Journal of and Statistical Methods in Medical Research Lead Dean Workforce Development at WSU. Health Equity (multimorbidity). He collaborates Dr Freya McMillan, School of Nursing & Prior to joining the University at the end of widely, nationally and internationally, and is Midwifery 2006 he was Associate Dean (Research), an Adjunct Associate Professor at James Professor of Health Science, and Founder and Cook University, external advisor to Canadian Freya MacMillan is a Lecturer in Director of the Centre for Physical Activity and Institutes of Population and Public Health Interprofessional Health Science at WSU. Nutrition Research in the Faculty of Health and (IPPH), fellow of Centre for Excellence in Her research focuses on the development, Environmental Sciences at Auckland University Intervention Prevention Science (CEIPS), implementation and translation of diabetes of Technology, New Zealand. Professor Kolt Melbourne. He has been an invited speaker prevention interventions. In particular she at several international events in prevention uses community-engaged approaches to westernsydney.edu.au 25 WHITE PAPER

ensure interventions are culturally-tailored Professor Virginia Schmied, School of and was chief investigator for the RAPSID RCT and appropriate, to ensure acceptability Nursing and Midwifery of peer support in type 2 diabetes (the largest and usability by communities most at risk. Virginia Schmied is Professor of Midwifery RCT of diabetes peer support to date). He has Currently, she is leading a church-based and Director of Research in the School of over 270 publications, has won several national lifestyle intervention for Samoan communities Nursing and Midwifery, Western Sydney and international awards for his work in across South Western Sydney, which utilises University and holds a Visiting Professorship at diabetes epidemiology, diabetes in pregnancy peer-support for diet and physical activity University of Central Lancashire (UK). Professor and diabetes service development and has sat change. Additionally, she is involved in a Schmied has a strong national and international on national, WHO and NIDDK working groups peer-support based intervention being built- reputation in the field of maternal and child relating to gestational diabetes. up across an entire semi-rural Shire in South health and her research addresses the social Dr Evelyn Smith, School of Social Sciences Western Sydney (the Wollondilly Diabetes and emotional health and well-being of women and Psychology program), for the management and prevention and men in the transition to parenthood, of diabetes. perinatal mental health, infant feeding, and Evelyn Smith is a Senior Lecturer in Clinical researching improvements in service delivery Psychology and heads the Eating Disorders Dr Lucie Ramjan, School of Nursing and and professional practice. She is particularly and Obesity psychology research Clinic Midwifery interested in how relationship-based care (EDOC) at WSU. EDOC treats clients with Lucie Ramjan is an Associate Professor and leads to improved health outcomes for women eating disorders and weight issues, serves as Academic Course Advisor for the Master of and families. Professor Schmied has held a training facility for students, and performs Primary Health Care Program and International ten national competitive grants from ARC research aiming to improve outcomes. There Programs in the School of Nursing and and NHMRC and has conducted consultancy are preliminary but ongoing discussions with Midwifery at WSU. She is also a member of work including leading the development of Nepean Hospital about the possibility of the Centre for Applied Nursing Research and the national framework for universal health partnering with EDOC to develop outpatient an affiliate member of the Ingham Institute of and development services to children and care to the area. Since arriving at WSU in Applied Medical Research. Lucie graduated families the Australian Government. She 2015, Dr Smith has secured over $1.2 million st with a Bachelor of Nursing (Honours – 1 Class) has published over 170 refereed journal in internal, national and international grants, in 2003 and was awarded a PhD in 2007. Her articles, book chapters and published reports including a Ramaciotti grant of AU$300,000. research area is mental health, with a focus and regularly presents (including as a key She has led three RCTs and has had 25 on eating disorders. In 2014 Lucie received note speaker) at national and international publications, 10% of which are in the top 10% funding from The Ian Potter Foundation to conferences. Her research has been translated of citations in the field. She collaborates with develop a mentoring program for people with to policy and practice, for example through the academics interested in eating disorder and anorexia nervosa. In 2015 Lucie was awarded development of health policy, models of care, obesity at UNSW, USYD, MQ and WSU, and a UWS Women’s Research Fellowship to teaching resources for consumers and health is currently involved in over 30 projects. She extend the latter pilot to all eating disorders. professionals. currently supervises 4 PhD students, 1 DPsych, Lucie has cross-disciplinary and international and has supervised 20+ honours and master collaborations with Nursing, Medicine, NICM, Professor David Simmons, School of Medicine students. As a clinical psychologist she sees and ICS. Lucie has 31 peer-reviewed publications David Simmons is Professor of Medicine at around 5 clients a week and is passionate and 1 book chapter in the last five years. the Macarthur Clinical School at WSU, Head about educating primary care specialists, of the Campbelltown Hospital Endocrinology educators and counsellors, among others, on Dr Milan Piya – Senior Lecturer in Diabetes at Department, and Chair of the Campbelltown assessment and treatment of eating disorders the Macarthur Clinical School Hospital Clinical Council and Director of the and obesity. Dr Smith was an invited plenary Dr Piya is widely published in obesity and Diabetes, Obesity and Metabolism Translational speaker on obesity at the 2017 national related biomarkers, chronic inflammation as Research Unit. Between 2007-2014, he was ANZAED conference. well as diabetes complications. He has been the lead diabetes consultant at Cambridge involved in bariatric research programs in the University Hospitals NHS Foundation Trust, UK for the last 10 years and has recently joined a service that included a level 3 obesity the team at WSU and is setting up the bariatric program. He also coordinated the Cross- research program at Camden /Campbelltown Europe DALI study, focusing on gestational hospitals to work in partnership with the WSU/ weight gain limitation and gestational diabetes Blacktown program. prevention among overweight/obese women

26 Western Sydney University OBESITY 2018

APPENDIX 2 – MENTORING STUDY

MENTORING – A NOVEL APPROACH TO Further research is needed however the SUPPORT HOPE FOR RECOVERY IN PEOPLE results provide preliminary support for the WITH EATING DISORDERS mentoring program’s benefits as an adjunct Mentoring support has been found to be to treatment. We found that having someone important in improving quality of life and hope who understands, to talk and share with, met for recovery in eating disorders. Mentorship a clear need for people with eating disorders. has the potential to support resilience and the Mentoring programs that focus on improving development of skills to avoid admission or hope may provide a value support for those in relapse to hospital. Dr Lucie Ramjan, Dr Sarah treatment for an eating disorder. Fogarty, Dr Daniel Nicholls and Professor Funding: The Ian Potter Foundation (2014) and Phillipa Hay piloted a successful community Western Sydney University Women’s Research mentorship program for women with anorexia Fellowship (2015) nervosa in NSW in 2015 (Pilot 1). The project was innovative and the first mentorship Publications to date: program of its type, in that stakeholders were Ramjan, L.M., Fogarty, S., Nicholls, D., & Hay, partners in the development and design of the P. (2018). Instilling hope for a brighter future: A program. Funding was received from The Ian mixed-method mentoring support programme Potter Foundation in 2014 for this work and for individuals with and recovered from findings are being disseminated at conferences anorexia nervosa. Journal of Clinical Nursing, 27, and in peer-reviewed publications. The research e845-857. received media attention on ABC 702 during , & . (2017). Mental Health Week in 2015 – http://www.abc. Ramjan, L.M., Hay, P. Fogarty, S Benefits of a mentoring support program for net.au/news/2015-10-07/anorexia-recovery- individuals with an eating disorder: A proof of project-partners-women-with/6834140 concept pilot program. BMC Research Notes,10: With further funding from a Women’s Research 709. https://doi.org/10.1186/s13104-017-3026-6 Fellowship in 2015 (Pilot 2), Drs Ramjan, Fogarty, S., Ramjan, L., & Hay, P. (2016). A Fogarty and Professor Hay extended the work systematic review and meta-synthesis of to include people of any gender and with any the effects and experience of mentoring type of Eating Disorder. in eating disorders and disordered eating. Results: The preliminary data from Pilot 1 Eating Behaviors, 21, 66-75. doi: 10.1016/j. showed no significant quantitative results for eatbeh.2015.12.004 mentors or mentees although the qualitative Nicholls, D., Fogarty, S., Hay, P., & Ramjan, L. M. data from interviews and focus groups (2016). Participatory action research for women identified promising findings for the value of with anorexia nervosa. Nurse Researcher, 23(5), mentoring. 26-30. doi: 10.7748/nr.23.5.26.s6.

The preliminary data from Pilot 2 showed Project Team: Dr. Lucie Ramjan (School of significant results in the Domain Hope Scale Nursing and Midwifery, WSU), Dr. Sarah Fogarty for mentees. Significant results were found (School of Medicine, WSU), Prof. Phillipa Hay between pre and post program scores for (School of Medicine, WSU). http://www.abc.net. mentees in increasing hope overall (p = au/news/2015-10-07/anorexia-recovery-project- 0.003) and in the following hope domains: partners-women-with/6834140 Social Relationships (p = 0.027); Romantic With further funding from a Women’s Research Relationships (p = 0.032); Family Life (p = Fellowship in 2015 (Pilot 2), Drs Ramjan, 0.047) and Work (p = 0.003). There were no Fogarty and Professor Hay extended the work significant results for the mentors. The mentors’ to include people of any gender and with any outcome measures remained stable from pre to type of Eating Disorder. post program completion.

westernsydney.edu.au 27 WESTERNSYDNEY.EDU.AU