Eating Disorder Day Programs: Is There a Best Format?

Abstract

The use of a Day Program (DP) format (i.e., intensive daily treatment with no overnight admission) has been shown to be an effective treatment for eating disorders (EDs). The disadvantages, however, include higher cost than outpatient treatment (including costs of meals and staff), greater disruption to patients’ lives, and the use of a highly structured and strict schedule that may interrupt the development of patients’ autonomy in taking responsibility for their recovery. This study investigated whether reducing costs of a DP and the disruption to patients’ lives, and increasing opportunity to develop autonomy, impacted clinical outcomes. Three sequential DP formats were compared in the current study: Format 1 was the most expensive (provision of supported dinners three times/week and extended staff hours); Format 2 included only one dinner/week and provision of a take-home meal. Both formats gave greater support to patients who were not progressing well (i.e., extended admission and extensive support from staff when experiencing feelings of suicidality or self-harm). Format 3 did not provide this greater support but established pre-determined admission lengths and required the patient to step out of the program temporarily when feeling suicidal. Fifty-six patients were included in the analyses: 45% were underweight (body mass index (BMI) < 18.5), 96.4% were female, 63% were given a primary diagnosis of anorexia nervosa (or atypical anorexia nervosa), and mean age was 25.57 years. Clinical outcomes were assessed using self-reported measures of disordered eating, psychosocial impairment, and negative mood, but BMI was recorded by staff. Over admission, 4- and 8-week post-admission, and discharge there were no significant differences between any of the clinical outcomes across the three formats. We can tentatively conclude that decreasing costs and increasing the opportunities for autonomy did not negatively impact patient outcomes, but future research should seek to replicate these results in other and larger populations that allow conclusions to be drawn for different eating disorder diagnostic groups.

A prospective observational study examining weight and psychosocial change in adolescent and adult eating disorder inpatients admitted for nutritional rehabilitation using a high-energy re-feeding protocol

“…The use of high-energy re-feeding protocols, such as ours, demonstrate that optimal weight change can be achieved within an acceptable time frame in patients with AN and ARFID who meet medical risk indicators for admission or who are unable to progress with nutritional rehabilitation in the community. We also acknowledge the evidence for effectively reducing length of hospitalisation and costs of treatment with outpatient treatments, such as FBT and ED day program treatment, and recognise that the choice of treatment setting may be dependent upon the availability of different treatments within specific geographical areas [46,47].…”

Improving programme‐led and focused interventions for eating disorders: An experts' consensus statement—A UK perspective

“…We recommend the need to embed PROMs as part of routine clinical practice, including session‐by‐session measures. When flexibility and responsivity is linked with robust evaluation, it has the potential to free up resources to more clients and patients, and to decrease staff burnout (Eshkevari et al., 2022 ).…”

An exploration of patient experiences of transitioning to a remote day programme following inpatient treatment in an adult eating disorder service

“…ED day programmes have been described as intensive outpatient care suitable for patients not at high medical risk (Olmstead et al, 2012). They have been shown to be an effective treatment with improvements in medical status and ED psychopathology (Eshkevari et al, 2022; Hay et al, 2019; McFarlane et al, 2015; Thaler et al, 2014). The use of a day programme format (i.e., intensive daily treatment with no overnight admission) is recommended where a patient does not require intense monitoring of medical risk, when physical health is not deteriorating and when the patient has adequate social support (National Institute for Health and Clinical Excellence, 2017).…”