National Lilac Bow Day for eating disorders. We need 700 beds, but there are 403

National Lilac Bow Day for eating disorders.  We need 700 beds, but there are 403

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OfChiara Daina

3 million people in Italy suffer from it and after Covid the cases are constantly increasing: by 20% per year among 10-13 year olds. Five Regions totally without beds

Continue to “make noise” against the eating disorders (DCA) is necessary. Not only because tomorrow, March 15th, is celebrated National Day of Lilac bowdedicated to raising awareness about anorexia, bulimia, binge eating and other nutrition issues. But also because the requests for help are dramatically increasing growing after Covid, especially among the very young.

The overall numbers

«The figure is constantly increasing of 20% per year between 10 and 13 years» highlights Laura Dalla Ragionedirector of the network of services for eating disorders of the Umbria 1 local health authority and coordinator of the technical table on nutrition and eating disorders of the Ministry of Health.
In 2023, new diagnosed cases reached a peak 1.6 million (there were 680 thousand in 2019) with a total number of people affected greater than three millions (it was 300 thousand in the early 2000s).

Insufficient places

The second reason why this rampant epidemic should cause concern is that i welfare services who should rehabilitate this long list of patients are in trouble and still poorly distributed in the country. “Of the 135 centers registered in January by the Higher Institute of Health, the majority, 68, are concentrated in the North, 26 in the Center and 41 between the South and the Islands – reports Dalla Ragione -. However, the general number of centers remains insufficient. Not even three out of ten have a residential facility for intensive rehabilitation and 40% of residences do not accept minors under 14″. With this consequence: «Today almost all applications for residential facilities come from child neuropsychiatry departments, where the most critical children end up, who are fed with a nasogastric tube and who after the most acute phase should not be sent home but placed in a rehabilitation process in one of these specialized structures in which, however, pre-adolescents struggle more than anyone to find a place – reports the expert -. If assistance is interrupted the risk of recurrence is very high. In fact, we cannot imagine that serious cases who receive artificial nutrition in hospital will return home and start eating by mouth around the table with mum and dad without first having recovered a healthy relationship with food.”

The fund will not be enough

The refinancing of the fund for eating disorders there remains one for 2024 as well buffer measurement. «We will probably be able to renew staff contracts until the end of 2025 but there is enormous difficulty in all the Regions in recruiting candidates for fixed-term employment contracts, especially among doctors, psychiatrists, endocrinologists and dieticians. In order for the network of centers to function properly throughout the territory, eating disorders must be addressed become an autonomous Leawith stable and tied financing” insists Dalla Ragione.

The levels of care

The levels of care that the centers should guarantee are: specialist clinic, day hospital or day center (for assisted meals, psychoeducational groups, psychotherapy, nutritional therapy), intensive residential rehabilitation and life-saving hospital admission. But the child neuropsychiatry departments, which should also take care of patients with eating disorders, suffer from a historic shortage of beds. «There are 403 in all of Italy but at least 700 would be needed. Today in five regionsi.e. Calabria, Umbria, Valle d’Aosta, Molise and Abruzzo, there is none not even one – he reports Elisa Fazzi, director of child and adolescent neuropsychiatry at the Asst Spedali civili of Brescia and president of the Italian society of child and adolescent neuropsychiatry -. As a result, the wards are always clogged, with around 20% of the beds occupied by girls with severe anorexia. Those who don’t find a place end up in pediatrics or adult departmentssuch as psychiatry and internal medicine, where, however, he risks receiving assistance that is incomplete and different from that which neuropsychiatry would guarantee with a multidisciplinary team, made up of a neuropsychiatrist, dietician, dietician, psychologist, educator and rehabilitation therapist, who in addition dealing with the organic aspects is also able to manage the psychological aspects and educational needs of those who have pathological relationships with food.”

Home educators

Emilia Romagna is among the regions that has focused most on home educators to rehabilitate adolescents and pre-adolescents with eating disorders by reducing hospital admissions and the use of residential facilities. «The boy is taken care of by the “day service”, a specialist outpatient service which, in addition to assisted meals, psychoeducational groups and psychotherapy, provides an educator for interventions at home and in the patient’s living places to facilitate his relationship with family and peers and inclusion in school – he explains Marinella Di Stani, responsible for the eating disorders path of the Romagna Local Health Authority and coordinator of the regional technical table on eating disorders -. In the event of hospitalization, the educator can support the patient already in hospital to facilitate the return home in a more relaxed and collaborative atmosphere with the parents. Of the 536 cases followed in 2023 by our healthcare company, approximately 30% benefited from home interventions.”

The alarm bells

There are some signals which may indicate the presence of an eating disorder and which parents should warn. «Abnormal eating behaviors aimed at weight loss, which persist over time, at least since three monthsand include: eliminating numerous categories of foods, often going to the bathroom after meals, eating very slowly chopping the food into very small pieces, do a lot of physical activity, alternate binge eating with fasting, use laxatives and diuretics repeatedly – explains Dalla Ragione -. But alongside these behaviors there must simultaneously be something conspicuous character change: girls and boys who were cheerful, cheerful and bright become sad, antisocial and impatient. So the abnormal eating behaviors associated with the change in character must make us suspect that something is going on.”

Who to ask for help

In these cases it is a good idea to talk to your doctor or pediatrician who will be able to direct the family to center for eating disorders nearest, where a multidisciplinary team operates, made up of a psychiatrist or neuropsychiatrist, psychologist, educator, dietician, specialist in clinical nutrition and food science, internal medicine specialists, paediatricians, psychiatric rehabilitation technician, nurse.
For the first visit you can access it directly (by making a telephone appointment) or upon prescription from your doctor. At the cost of just one ticket. All other services provided along the treatment path are completely free.

It is also available online map created by the Higher Institute of Health to geolocalize the dedicated centers in your region.
At the national toll-free number «SOS eating disorders», 800.180.969, anonymous and free, active from Monday to Friday, from 9am to 9pm, with psychologists and nutritionists offering a counseling service and information on specialized centers in the area. «Calls doubled in 2020 and tripled in 2023» informs Dalla Ragione, who manages the toll-free number.

The consequences

Eating disorders are a complex pathology. Relying on an expert team and reaching the diagnosis early is essential to reduce the physical and psychological consequences triggered by the increasingly intense obsession with food. Among these: depression, limitation of social and working life, impairment of systems (cardiac, gastrointestinal, endocrine, hematological, dermatological), osteoporosis, up to death in the most serious cases. «The causes of death are linked to medical complications and the high suicide rate – underlines Dalla Ragione -. Only in 2023 deaths from illnesses linked to eating disorders were 3,780 and they are now the second cause of death among adolescents after road accidents. The data shows that more people die in regions where there are no specialized structures.”

March 14, 2024

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