Feasibility, acceptability, and effectiveness of family-based treatment for adolescent anorexia nervosa: an observational study conducted in Brazil

Abstract

Objective: There is strong evidence that family-based treatment is effective in cases of adolescent anorexia nervosa. Although family-based treatment has been studied in English-speaking countries, there is a need to examine the generalizability of this approach to non-English speaking cultures. This pilot-study aimed to examine the feasibility, acceptability, and effectiveness of family-based treatment in Brazil. Method: Observational study of adolescents with anorexia nervosa (excluding menstrual criteria), as determined with the Diagnostic and Well-Being Assessment, referred for treatment at a specialized center in São Paulo, Brazil. The following data were collected at baseline, at the end of treatment, and after six months of follow-up: weight; height; body mass index; menstrual status; Eating Disorder Examination Questionnaire score; and Children Global Assessment of Functioning Scale score. Results: Of 11 eligible patients/families, 9 (82%) enrolled in the study, and 7 (78%) completed the treatment. The mean patient age was 14.64 ± 1.63 years (range, 12.33-17.00 years). The Wilcoxon signed rank test showed statistically significant improvement in weight and body mass index at the end of treatment, as well as after six months of follow-up, at which point none of the patients met the diagnostic criteria for any eating disorder. Conclusion: The results suggest that family-based treatment is acceptable and feasible for Brazilian families. Outcomes suggest that the approach is effective in this cultural context, leading to improvements similar to those reported in previous studies conducted in other cultures. (DP = 1,63;12,00 Descriptors IntroductionAnorexia nervosa (AN) is a serious psychiatric disorder with a prevalence rate of 0.3% in adolescent females.1 AN is associated with a high mortality rate and is often complicated by psychiatric and medical comorbidity. The accumulated evidence supports the hypothesis that outcomes are better when adolescent patients and their parents are treated together. Studies suggest that family-based treatment (FBT), a method developed and described in a manual written specifically for AN by Lock (J.L.), is an effective treatment for AN.2-4 However, those studies were all conducted in Englishspeaking countries. The purpose of the current study is to examine the feasibility, acceptability, and effectiveness of this approach in Brazil.To date, there have been no studies examining FBT for AN in Brazil. Specialized clinical treatment for adolescent AN in Brazil in public care is limited to a multidisciplinary program either as an inpatient or outpatient in the hospital where this study was conducted and other outpatient programs in university hospitals. The alternative is treatment at private clinics, which are not accessible for most of the population. There is a need to examine treatment alternatives for AN in Brazil because of high costs, long waiting lists, and limited public resources. For example, the estimated average waiting time for treatment in a specialized ...

[RETRACTED ARTICLE] A review of recent pediatric research published in Brazilian indexed journals

“…A total of 2,457 subjects were screened. Turkiewicz et al 83 examined the feasibility, acceptability and effectiveness of family-based treatment for anorexia nervosa for patients aged 12-17 years in Brazil, through an observational study.…”

Estudo sobre a anorexia e bulimia nervosa em universitárias

“…Por força do desajuste da autoimagem, a pessoa acredita sempre estar acima do peso, controlando obsessivamente a dieta, mesmo que seu organismo esteja à beira de um colapso provocado pela inanição. Por isto, a abordagem há de ser multidisciplinar (Turkiewicz, Pinzon, Lock & Fleitlich-Bilyk, 2010).…”

Evidence-based psychotherapy for treatment of anorexia nervosa in children and adolescents: systematic review

“…Several methodological limitations were identified in the studies assessed: lack of description regarding the inclusion and exclusion criteria 29,30 , loss of a significant number of participants (> 25%) during treatment and follow-up 9,24 , lack of clarity regarding the remission criteria or remission assessed exclusively on the basis of biological markers 12,25,[29][30][31] , difficulty in randomizing baseline participants 26,31 , presence of confounding variables, such as the need for hospitalization, the use of antidepressants for the treatment of comorbidities, which were not necessarily controlled in the analyses 18,22,26,27,30,31 and non-probabilistic samples 20,25,29,30 . In only one study no methodological limitations were found 28 .…”

“…Only one article (7.1%) was published in Brazil 22 . No study was found in other Latin American countries.…”

“…The number of participants in each intervention ranged from nine 22 to 167 28 with a median of 43 and a mean of 63.7 (SD = 51.8). In all studies, the criterion for the diagnosis of AN was DSM-III, IV or V, depending on the time of the study.…”