The Present Medical System for the Treatment of Eating Disorders in Japan and Proposals for Future Improvements

Abstract

The medical response to the increase in cases of eating disorders has been slow to come in Japan and therefore there is at this moment an urgent need to create an adequate medical system to properly address these disorders. In order to clarify the current medical treatment situation, we conducted an inquiry among psychiatrists, medical practitioners and practioners of psychosomatic medicine between 1995 and 1997, collecting questionnaires with answers and valuable comments from 769 responders. In this report we present the results obtained as well as our personal interpretation and comments. In Japan, specialty centers for eating disorders are of great importance and are in high demand ; however, the concentration of patients in these specialty institutions presents many problems. Expanded treatment facilities are necessary to cope with an increasing number of patients, and for that purpose, adequate provisions for reimbursement of diagnosis and treatment are also desirable. Since there is a shortage in the number of medical doctors who specialize in the treatment of eating disorders in Japan, it is clear that there is a need to distribute treatment roles and responsibilities among different professionals based on the level of severity of the disorders. Eating disorders comprise a complex disease entity that include a broad and heterogeneous gruou of patients. It is therefore extremely important to be albe to address the therapeutical needs of different types of patients. In this respect, it would be desirable to have treatment guidelines conforming to the peculiarities of the Japanese health insurance system. Family therapy is also very important and improvements in this area are required. Advancements in providing guidance to patients on dental hygiene, education of the dentists themselves, group therapy and self-help groups, as well as adequate education of local clinics and support at the local district level will constitute topics for consideration in the near future. Other future needs of the medical system comprise the education of medical practitioners and the implementation of both post-graduate programs and training programs under the supervision of medical specialists. In addition, due to the fact that the treatment of eating disorders require a team-treatment approach, proper staff training including nurses, psychotherapists, nutritionists, and others. Nutritionists' understanding of the disease and how counseling on nutrition fits within the health insurance setting are also important issues. Finally, other activities that were considered necessary included demographic research such as information on the number of patients in a certain area or the clarification of incidence of events not usually observed in the treatment scene, discussion on the choice of therapy, evaluation of the efficacy of the treatment, consideration on long-term prognosis, and performance of clinical research directly related to this therapeutic area. These activities should be actively promoted in the future.