This chapter examines FBT, which is a separate Commonwealth tax payable by employers on fringe benefits provided to their employees. Fringe benefits cover most kinds of non-salary benefits provided in respect of employment (eg the use of a car, free housing and discounted goods or services). Australia is one of only two OECD countries (the other is New Zealand) that tax employers on the provision of fringe benefits. Most other countries simply assess employees on the value of the fringe benefits that they receive under their general income tax systems. Before the introduction of FBT in 1986, Australia also used to assess employees on fringe benefits under former s 26(e) ITAA36. FBT was introduced because employees had a poor record of complying with s 26(e) and because the provision suffered from various valuation and other technical problems. This meant that, in practice, the income tax system did not adequately capture all types of fringe benefits. FBT was also introduced because it is more efficient to administer since there are far fewer taxpayers to deal with.

The primary empirically supported treatments for EDs are CBT-E and FBT. Both recommend a limited treatment team that includes a primary therapist who focuses on changing eating behaviors, weight, and related body image concerns; a medical provider to monitor stability; and a psychiatrist for medication management of any comorbid diagnoses. Dietitians may be used as consultants, and other types of therapy should be suspended during treatment. This approach aims to reduce the risk of conflicting messages among providers, treatment fatigue, and reinforcing of safety behaviors, but it has not yet become standard practice in ED treatment (particularly in the United States). Despite evidence supporting the efficacy of CBT-E and FBT, outdated ideas about ED maintenance and treatment persist in the healthcare community, which can be a challenge in treatment, especially when the patient also has a co-occurring diagnosis of OCD.

While there is a high rate of comorbidity between EDs and OCD, there is limited research on how to treat this comorbidity. Evidence-based treatments for EDs share many core tenets, though it is unclear which treatment features are necessary. CBT-E and FBT both focus on maintenance mechanisms, alliance building and providing a strong rationale for change. For underweight patients, they target weight gain and use in-session, collaborative weighing and weight graphs to document progress. Both focus on dietary restraint and restriction early on, and FBT indirectly and CBT-E directly target body checking, body avoidance, and social comparison behaviors. Both treatments prepare for relapse prevention and termination. There are similarities between the treatments for OCD and EDs, such as focusing on session agendas, providing structure and expectations for treatment, psychoeducation, a collaborative therapeutic relationship, and self-monitoring. CBT-E uses hierarchies and targets body checking and body avoidance similar to therapy for OCD. Both CBT-E and OCD treatments include elements of cognitive therapy, using corrective learning and behavioral experiments.

Extracts from Fringe Benefits Tax Assessment Act 1986 (Cth); Fringe Benefits Tax Act 1986 (Cth); Fringe Benefits Tax (Application to the Commonwealth) Act 1986 (Cth)

Dieticians play an important role in managing eating disorders – not just looking at nutrition but providing psychoeducation around nutrition, helping patients begin to normalise eating and making sure nutrition is adequate for growth, development and life-style. The reader is introduced to the depth and range of work that a dietician is able to provide.

This chapter focusses on presentations in children and adolescents. Although ARFID (avoidant restrictive food intake disorder) is not covered in many guidelines yet, it is discussed here – due to being both a risk factor for anorexia nervosa and important to clinically distinguish from anorexia nervosa.