THED brings together a new approach to eating disorders

But it’s not that simple. These complex conditions require multifaceted solutions. But in 60 years, little has changed in the treatment of eating disorders, which range from disordered eating to anorexia nervosa.

Anorexia has a high mortality rate and very high morbidity, but the main treatments are psychotherapies such as cognitive behavioral therapy (CBT), which often do not work for long.

These “talking therapies” are the gold standard treatment for many eating disorders, but they do not address the big picture or the possibility of biological causes.

A new eating disorder research program at Monash University will focus on the biological causes and potential treatments, including antipsychotic drugs, brain stimulation, and hormones.

Li’s Center for Transformational Research in Eating Disorders (THRED) will be based at the Australian HER Centre, which was established in 2022 to consolidate and expand research and treatment of women’s mental illness.

The THRED program will have three main pillars: providing new, effective treatments; improving current treatments; and uncovering biological causes.

We believe this approach is unique in Australia and possibly the first in the world to combine multiple neurological tests in a clinical setting.

In addition, Monash’s Dr. Leo Chen, who has worked with Harvard University in Boston, will investigate transcranial magnetic stimulation (TMS) and whether it can’reprogram’ the brain of someone with an eating disorder.

This is made possible by a generous donation from our founders, Melbourne Symphony Orchestra Chairman and former professional violinist David Li AM and his pianist wife Angela Li. They have provided seed funding and will work with Monash University to find other sponsors to provide the remainder.

Effects of eating disorders

An estimated one million Australians, or 4%, live with an eating disorder (ED), such as anorexia nervosa, bulimia nervosa, binge eating disorder, or “eating disorder—not otherwise specified.”.

A recent systematic review of more than 63,000 participants published in JAMA Pediatrics found that about 22% of children and adolescents worldwide experience disordered eating. Australian studies estimate that up to 31.6% of teenagers are affected.

Disordered eating includes dieting, binge eating, self-induced vomiting, excessive exercise, and the use of laxatives or diuretics, although not to the extent that an eating disorder is diagnosed.

The impact of eating disorders has worsened during the pandemic, with some people overeating and others developing anorexia. Although men and boys can develop them, they are mostly experienced by young girls and women.

The physical and psychological impact of these conditions on the sufferer and their loved ones can be devastating.

The need for change

Although the causes are not well understood, people with eating disorders often have extensive histories of trauma. A person who has it believes that controlling their food intake is the only way to control their life.

They can also develop from a poorly understood organic origin around 13–14 years of age, giving the impression of being too fat, even as they become skeletal due to a lack of energy and basic nutrients.

Anorexia nervosa, which involves a fear of food and/or eating, is the most severe ED and results in death in approximately 20% of people diagnosed with it, often after a prolonged and traumatic struggle.

The death rate has decreased in recent years, but people still die. Hospitals can give patients short-term admission and treat the symptoms of severe cases, keeping them alive but not curing them.

Given the urgency of the situation and the lack of successful treatments, it makes sense to focus all of this on the role of biology.

These life-threatening disorders can develop as a result of changes involving genes, RNA, and proteins. However, little has been done to develop treatments that target brain biology or other biological factors.

Few studies have been conducted on biological treatments for eating disorders, and those that have been have been very mixed. A holistic approach that complements existing psychotherapies can help.

A new way of thinking

THRED will conduct clinical trials of new treatments for serious eating disorders, which will hopefully lead to more effective treatments. The first series of trials deals with anorexia nervosa, the most serious of the eating disorders.

Its clinical trials are expected to begin in the second quarter of 2023. side, it will look at brain stimulation, hormone manipulation, and new drug therapies, as well as treatment methods that will build on their own and other research in Australia and around the world.

This will involve discovery science revealing the role of genes and proteins in personalized medicine, and tying it all together will be new AI-powered smartphone technologies to provide personalized care for people with eating disorders.

Finding answers through biology

The study will also examine the use of estrogen in women with anorexia nervosa to see if it can disrupt pathological systems and improve secondary problems such as weakened bones.

We know that there are hormones that stimulate our appetite, so there must be a neurobiological “X” factor that alters the action of the hormones and peptides that determine appetite. Once this is identified, medications can be used to correct the imbalance.

The next trial will build on previous research overseas to test whether antipsychotic drugs can disrupt the distorted thought process in which anorexics believe they are overweight when they are actually very underweight. Such thoughts are not rational, so taking antipsychotics along with other neuroactive products can help.

Ultimately, THRED hopes to move into a second phase of research in collaboration with other researchers at Monash University to explore biomarkers that could help define ED subtypes and pave the way for other new treatments.

It won’t be a silver bullet for eating disorders, which are notoriously difficult to treat. But our new research center is an unprecedented opportunity to bring together the best minds and use their combined expertise to deliver world-class, innovative, evidence-based mental health solutions that make a tangible difference to the well-being of people with eating disorders and their families.