Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study

Abstract

Background Family-Based Treatment (FBT) is considered the first-line intervention for adolescent anorexia nervosa. However, access to this treatment is limited. Treatment programs for other pediatric mental health conditions have successfully overcome barriers to accessing evidence-based intervention by integrating mental health services into primary care. This study evaluated the proof-of-concept of a novel modification of FBT, Family-Based Treatment for Primary Care (FBT-PC) for adolescent restrictive eating disorders designed for delivery by primary care providers in their practices. Methods This retrospective clinical cohort study evaluated 15 adolescents with restrictive eating disorders receiving FBT-PC and 15 adolescents receiving standard FBT. We examined improvement in BMI percentile, reduction in weight suppression, and clinical benchmarks of eating disorder recovery including weight restoration to > 95% of expected body weight (EBW) and resolution of DSM-5 criteria for eating disorders. Results In both groups, effect sizes for increased BMI percentile exceeded Cohen’s convention for a large effect (FBT-PC: d = .94; standard FBT: d = 1.15) as did effect sizes for reduction in weight suppression (FBT-PC: d = 1.83; standard FBT: d = 1.21). At the end of treatment, 80% of the FBT-PC cohort and 87% in the standard FBT group achieved > 95%EBW and 67% in the FBT-PC group and 60% in the standard FBT group no longer met DSM-5 criteria for an eating disorder. There were no cohort differences in the number of treatment drop-outs or referrals to a more intensive level of eating disorder treatment. Conclusions Findings suggest that primary care providers have potential to improve weight and clinical status in adolescents with restrictive eating disorders. Based on these results, more rigorous testing of the FBT-PC model is warranted.

Adoption of inpatient family‐based treatment for anorexia nervosa: A case report

“…The usefulness of modified FBT based on its principles in the context of various cultural and social limitations has also been studied. For example, FBT in primary care (PC‐FBT) has been modified to omit sibling participation and meal sessions in areas where access to treatment is limited, and its usefulness has been demonstrated 11,12 . There are also reports that guided self‐help FBT (GSH‐FBT) and videoconference FBT (FBT‐V) are helpful in improving symptoms 13 .…”

A Clinical Overview of Anorexia Nervosa and Overcoming Treatment Resistance

“…Thus, family physicians can potentially combine the treatment of secondary symptoms with FBT, while also focusing on restoring weight . 24…”

“…23 Majority of times, patients suffering with AN are noticed first by primary care providers. 24 Lebow et al conducted a retrospective clinical cohort study and exemplified the role that primary care physicians can play in the treatment of adolescents trying to recover from restrictive eating disorders, along with facilitating weight gain. 24 This study placed emphasis on the pertinent role that physicians' play in helping to restore AN patients' body weight and improve their overall clinical status by focusing on family-based treatment (FBT) for AN.…”

“…Thus, family physicians can potentially combine the treatment of secondary symptoms with FBT, while also focusing on restoring weight . 24 AN is a multidimensional disorder that shares significant signs and symptoms with multiple medical conditions. Bulimia nervosa (BN), MDD, body dysmorphic disorder (BDD), and hypothyroidism should be on the differential diagnostic radar due to their shared similarities with AN.…”

“…They found a significant improvement in adolescents' BMI following FBT by primary care physicians. 24 While AN patients may not present to their family physician to help treat their anorexia, patients often present to their family physician for secondary complaints such as amenorrhea or extreme fatigues. Thus, family physicians can potentially combine the treatment of secondary symptoms with FBT, while also focusing on restoring weight .…”