Obesity, anorexia and diabetes: developing a new appetite
“Anorexia nervosa is a relapsing illness, and people often end up being treated the same way with each relapse,” explains Professor Stephen Touyz, Associate Head (Clinical) in the School of Psychology. “This approach is not working for those with chronic anorexia nervosa. People know what’s coming, and they become disillusioned and drop out of treatment programmes.”
In a world first, Touyz and colleagues from London and Chicago are currently conducting a landmark international trial comparing two psychological approaches in patients who have had anorexia nervosa for seven years or more: a conventional form of treatment versus a relatively new method, nonspecific supportive management, which relies more on the person’s own desire to change.
“We have no proven effective treatments for people with longstanding anorexia nervosa. The outcome of the trial could help us determine the best way to manage people with chronic anorexia nervosa and help them to lead better lives,” believes Touyz.
Management of adolescents with this disorder is another challenging area that Touyz and team are investigating. A new trial underway at the Children’s Hospital, Westmead, aims to define the optimal length of hospitalisation prior to outpatient treatment in young people with severe anorexia nervosa.
“At present we don’t know whether it’s more effective to treat adolescents for a protracted time in hospital until they reach a healthy weight, or whether a limited hospital stay followed by more prolonged outpatient therapy is a better approach,” says Touyz. “Taking adolescents out of their home environment and away from family and friends may or may not be the ideal solution. We do know that gaining weight is a slow process, so hospitalisation may cause significant discontinuity with life outside.”
Looking at the bigger picture, Touyz and colleague Jessica Swinbourne are examining the comorbidity between eating disorders and anxiety disorders. While anxiety disorders are certainly more frequent in people with eating disorders compared to the general community, the available research investigating the prevalence of anxiety in people with eating disorders reveals strikingly inconsistent findings. “Using well standardised, internationally accepted diagnostic instruments and questionnaires, we hope to reveal more about the comorbidity of these two conditions. These findings may have significant therapeutic implications,” says Touyz.
In future research, Touyz is planning to use new technologies such as brain imaging and genetics to examine the aetiology of anorexia nervosa. “Very little is known about the underlying causes of the illness, and we’re aiming to look into this aspect with the hope of providing better outcomes for people with this debilitating disease,” reveals Touyz.
In their endeavours to develop more effective treatments for obesity and eating disorders, researchers at the University of Sydney are discovering new strategies that may well change the way these conditions are managed. Long-term solutions pose considerable challenges, but significant inroads are being made in the quest for better health outcomes.