An evaluation of family-based treatment for restrictive-type eating disorders, delivered as standard care in a public mental health service

Abstract

Background Family-based treatment (FBT) has demonstrated efficacy for anorexia nervosa (AN) in youth in randomized, controlled trials. It is important to assess if it shows a similar effectiveness when implemented in standard care. Aim To evaluate outcomes of FBT for restrictive-type eating disorders, delivered as standard care in a public mental health service. Outcomes are remission, frequency of hospital admissions and day-patient treatment, and frequency of other adaptations within 12 months from commencement of treatment. Second, to compare the collaborative clinical decisions of successful treatment in standard care made by family therapist at the end of treatment, with more objective definitions of recovery. Methods The design is a prospective, uncontrolled study of a consecutive series of patients with restrictive-type eating disorders, treated with FBT in a specialty unit at the Child and Adolescent Mental Health Centre in the Capital Region of Denmark. Results FBT was successfully completed within 12 months by 57% of participants, and 47% completed with 20 sessions or fewer. Weight restoration was achieved by 75% within 12 months, and 46% achieved both normalisation of body weight and behavioural symptoms of AN within 12 months. A total of 20% needed intensified treatment. All aspects of remission were often not present simultaneously, and the collaborative clinical decisions of successful treatment only partly aligned with other parameters of remission. Conclusion FBT showed good results when implemented as standard care, and it can be adapted to the specifics of local service organisation without compromising effectiveness.

Case series of family‐based treatment for restrictive‐type eating disorders and comorbid autism: What can we learn? A brief report

“…It reflects the appraisal that the YP is well, and that the family can manage potential residual symptoms without further treatment. We found that this aligns well with, but is not completely identical with more objective definitions of remission in a prior study of this cohort (Bentz et al., 2021). 77% of YPs who reached successful ending of the treatment in the total sample were weight restored defined as ≥95% of IEBW, 79% of those with successful ending of the treatment had fully resumed age‐appropriate responsibility for eating, 95% of them no longer reported intention of dietary restraint, 84% reported normalised levels of weight and shape concerns, and 75% of girls after menarche in this group had resumed menstruation.…”

“…Treatment followed the manual by Lock and le Grange, albeit with few adaptations to fit local service context, as earlier described (Bentz et al., 2021). In accordance with the manual, families are not offered meal plans, but parents are guided regarding energy dense foods and are advised to rely on their knowledge of their child and their family culture when planning meals.…”

“…Moreover, clinical experience suggests that YPs with autism and R‐ED require a longer period of time to achieve weight gain, to reach remission or both, and they more often need intensified treatment modalities such as day programme or inpatient treatment. In an earlier publication, we have evaluated outcomes within 12 months of FBT in a prospective, uncontrolled study of a consecutive series of patients with R‐ED, treated with FBT as standard care in a specialised outpatient unit at a government funded Child and Adolescent Mental Health Centre (Bentz et al., 2021). In the present short report, we wish to focus on outcomes of the subgroup of YPs with autism in thes earlier described series to better understand this subgroup's response to FBT.…”

Examining clinicians' perceptions and experiences working with diverse families in family‐based treatment: Common adaptations and considerations for treatment engagement

“…Overall, the authors noted improvements such as reduced number of hospitalizations and reduced time needed for the patient to achieve 85%–90% expected body weight because of the adaptations (Iguchi et al, 2021). Other studies conducted in Denmark, where clinicians adapted FBT by devoting more time to address dilemmas within the family system throughout treatment, demonstrated positive treatment outcomes including weight restoration and treatment completion for 75% and 57% of patients with restrictive EDs within 12 months of FBT, respectively (Bentz et al, 2021).…”

What kind of illness is anorexia nervosa? Revisited: some preliminary thoughts to finding a cure

“…It is fair to say this picture is somewhat more optimistic for patients who are rapidly treated in adolescence, providing this treatment is in the outpatient domain where families are actively engaged in support of the young person’s recovery. Moreover, such family-based approaches can significantly reduce the need for inpatient treatment, the latter often associated with high rates of relapse and readmission to inpatient settings [ 9 , 10 ]. A precise explication for why treatment outcome in adolescence might be more favourable than in adulthood is complex.…”