food disorders,

Eating disorders are not a voluntary choice, a whim or a bad habit, «they are one disease real, serious and complex, which must be faced like any physical illness. A punitive and aggressive attitude towards people with eating disorders serves no purpose except to aggravate the situation by increasing the person’s sense of isolation,” says Stefano Erzegovesi, psychiatrist and nutritionist.

The steps to take

To get out of the disease, therefore «a early diagnosis and adequate treatment, requiring intervention multidisciplinary
involving the child psychiatrist or neuropsychiatrist for younger patients, the psychotherapist and the nutritionist,” explains the expert. Who is the first figure to go to? “If the symptoms persist four weeks it is advisable to talk about it in the first place with the family doctor or pediatrician of trust, who can help the family find the nearest specialized center for eating disorders,” says Laura Dalla Ragione, psychiatrist and psychotherapist, who runs the network of services for Eating Disorders Lead Eating Disorders from the Local Health Authority of Umbria 1. The center is generally accessible directly, by telephone appointment or prescription from the attending physician, for a ticket or free of charge, and in some cases intramoenia. «If it is not present in the area – emphasizes Dalla Ragione – it is advisable not to waste time and appointment with a psychotherapist, at the consultation office or GGZ centre where no medical referral is required, and at the same time have a specialist visit on prescription from the general practitioner or pediatrician with a expert nutritionist of eating disorders, which the patient can take over immediately”.

Mapped centers

A helpful resource for researching eating disorder treatment centers is the Higher Institute of Health’s online map launched in January 2022. They are currently registered 126 structures spread across the national territory, of which 112 are public and 14 are private accredited to the National Health Service. With a great lack of homogeneity in the offer given that half of the centers (63) are in the north. The largest number is concentrated in Emilia Romagna (20) and Lombardy (15). In the central regions there are 23 structures (of which 8 are in Lazio and 6 in Umbria), while between the south and the islands there are 40 (of which 12 are in Campania and 7 in Sicily). Almost seven out of ten grant access by paying for the ticket. 33% in free mode and 11% in intramoenia regimen. The map is constantly being implemented, but already represents a fairly comprehensive reality. For each service, a detailed file is provided with address, contacts, type of interventions offered, beds, access procedures for the first visit.

The risk of delays

“Unequal care is forcing many families into one stressful and costly migration. Not only from the south but also from some areas in the north of the country because the distribution of services is not so widespread,” says Dalla Ragione, who is also the Ministry of Health’s contact for research projects on eating disorders. The network of services dedicated to these pathologies of the Umbria 1 Local Health Authority, which he directs and which he founded, is one of the few that is completely public and has two residential structures, four outpatient services and four day hospitals (also for children 0 -10 years). «70% of the guests in the structure come from outside the region. There are parents who rent a house to be close to their child – he says –. The faster we get to the diagnosis and treatment, the greater the chance of recovery – he emphasizes –. Too many cases arrive late. This can determine complications organically and psychologically resulting in an extension of treatment time, the risk of the disease becoming chronic and, in the most severe situations, fatal consequences. The timeliness of the intervention therefore strongly depends on the presence of a network of dedicated services in the area, as laid down in the 2017 guidelines of the Ministry of Health, in which the Regions must invest in order to guarantee adequate treatment everywhere”.

The four types of surgery and where they are performed

Based on the severity of the eating disorder, there are four levels of support of varying intensity.

The First and the outpatient service: «After a clinical evaluation, including blood work, nutritional and bone status, electrocardiogram and echocardiogram, gastroscopy if necessary, and a psychiatric evaluation for the diagnosis of any comorbidities such as anxiety disorder, borderline or obsessive-compulsive, conducts a treatment project in which the entire family is involved – explains Roberta Covezzi, head of the AUSL center in Modena -. The patient agrees to a nutritional plan, attends individual or group sessions of psychotherapy and, if necessary, drug therapy. The sessions are one to three a week».

The second-line helpfor those who need more support, the day shiftfive or seven days a week, for accompanied meals (i.e. with the empathic support of an operator), psychotherapy, food psychoeducational activities (to overcome food phobias and dispel false myths about ingredients) and body image, art therapy and the possibility of distance learning. Among the proposed activities, there is also group counseling for parents, “to inform them about the disease and its relapses and help them recognize reactions, of anger or complicity, in the face of their child’s behavior, and suggest how they can adjust them for better interaction”. explains Covezzi. Depending on the availability of resources, other services can be added to the basic offer. For example, in the center of Ulss 4 in Portogruaro (Venice), there are also «pet therapy, gardening, holidays by the sea, outings in the city, music therapy, swimming pool, digital literacy, learning to recognize misleading messages on the web» says Pierandrea Salvo, the director from the center.

The teathird level of help is represented by rehabilitation homes, which offer more intensive treatments. The duration of the recovery varies from a few months to a year. Those coming from outside the region must have a permit from the ASL of residence. “We receive early or prolonged cases with organic complications, psychiatric pathologies, subjects with broken bones, in artificial feeding,” explains Salvo (in the center of Portogruaro there are two structures, one for minors and the other for adults).

finally, the fourth type of intervention is the hospitalization when the vital parameters (respiratory rate, heart rate, blood pressure) change and the patient’s life may be endangered. Some regions, such as Molise and Calabria, still lack rehabilitation facilities.

Green number

There has also been one since 2011 national toll-free number 800 180 969
active Monday to Friday from 8 a.m. to 8 p.m. and managed directly by the local health authority Umbria 1. Psychologists and nutritionists answer the phone by providing scientific information about eating problems, advice to understand if the person has an eating disorder, psychological support for those suffering from it (but also from family and friends) and indications about specialized health structures throughout the national territory.