By Aya Nishizono-Maher MD, PhD, Japan
‘Are there people with anorexia in Japan?’ As eating disorder specialists we are often asked this question from overseas. Yes. We do have people with anorexia and also bulimia. They are very much a reality. In fact, the prevalence of eating disorders is considered to be fairly similar to that in the ‘Western’ world.
On the contrary, however, there is one important aspect in which Japan is dissimilar to the Western world. We do not yet have eating disorder specialist hospitals or units. They simply do not exist in Japan. Eating disorders tend to be either dismissed as trivial or hidden or misunderstood. Yes, we do have dedicated specialists who work in general medical/psychiatric settings.
However, the number of such specialists is extremely small compared to the number of patients.
We are concerned about the quality of treatment. Who are the specialists? As well as a small number of psychiatrists there are also pediatricians, gynecologists, physicians who specialize in psychosomatic medicine. We also have dietitians, clinical psychologists, nurses, school nurses, family therapists and occupational therapists who are interested in eating disorders. The number of these co-medical professionals with experience of the treatment of eating disorders is even smaller.
Lack of Expertise Partly Due to Medical System
The problem of the lack of expertise is partly due to the nature and organization of the medical system in Japan. For example, psychotherapy provided by clinical psychologists is not, in fact, covered by national insurance. Therefore, unless patients can afford the high cost of this treatment or perhaps join some research project as a research subject of a study, they are unable to receive cognitive-behavioral therapy for bulimia nervosa: a standard treatment with positive evidence outside Japan. In addition, psychiatric clinics in Japan are pharmacotherapy-oriented and eating disorders do not nicely fit the treatment model and the daily routine of outpatient clinics. In the era of evidence-based medicine and manual- oriented medicine, hospitals try to provide standardized treatment for underweight patients. However, the interests of professionals have not reached patients in the milieu of their lives in the community.
New Association to Build Bridge
Japan Society for Eating Disorders is an academic association which celebrates its 20th anniversary this year. It has been very active in the promotion of research in the field. The Society is convinced of the need for a bridge between patients/carers and professionals. For this reason, in 2016, the Japan Association of Eating Disorders has been established.
The aim of the Japan Association of Eating Disorders is to unite the knowledge and expertise of these specialists, to liaise with patients and carers and promote the proper understanding of eating disorders among the general public as well as among various professionals.
JAED was established this March. On the 2nd of June, we will give press conferences, series of public lectures by founding members in Tokyo.
* Note: BBC Webnews article featuring eating disorders in Japan in April 2016;
The webpage for JAED (http://www.jafed.jp) is currently in preparation.
About Aya Nishizono-Maher MD, PhD
Aya is a psychiatrist, a founding member of JAED, and member of the Japan Society for Eating Disorders. Her clinical work and research interests include disordered eating among schoolgirls, eating disorders among women in the postnatal period, and severe and chronic eating disorders. She has experience of working in the UK.
Aya is currently involved in compiling a liaison manual for school nurses and primary care physicians, for the early detection of eating disorders and for the improvement of school life of young people who are already in treatment. She also is engaged in data-based research on how out-of-treatment patients are supported in community health centers.
Join Aya in supporting World Eating Disorders Action Day. Be sure to follow along on Twitter @WorldEDDay and hashtag #WeDoAct, #WorldEDActionDay, @WorldEatingDisordersAction on Instagram and World Eating Disorders Action Day on Facebook.