Family-based intervention in adolescent restrictive eating disorders: early treatment response and low weight suppression is associated with favourable one-year outcome

Abstract

BackgroundFamily-based treatments are first-line treatments for adolescents with restrictive eating disorders (ED) but have to be improved since outcome is poor for some. We have investigated the one-year outcome of a family-based intervention programme with defined and decisive interventions at the start of treatment.MethodData pertaining 201 adolescents with restrictive ED with features of anorexia nervosa but not fulfilling the weight criterion starting treatment 2010-2015, had a wide range of body mass index (BMI) and of weight loss at presentation, and completed a one-year follow-up was analysed. Recovery from the ED was defined as an Eating Disorder Examination-questionnaire (EDE-Q) score < 2.0 or as not fulfilling criteria for an ED at a clinical interview.ResultsBy EDE-Q 130 (65%) had recovered at 1 year and by clinical interview 106 (53%). According to the EDE-Q criterion recovery was independently associated with lower EDE-Q score at presentation, higher weight gain after 3 months of treatment and lower weight suppression at follow-up, weight suppression being defined as the difference between premorbid and current BMI. Not fulfilling criteria for an ED was associated with the same factors and also by higher BMI at presentation.ConclusionThe observations that low weight and high ED cognitions confer a poor prognosis but that rapid weight gain at the start of treatment predicts a better prognosis are presently extended to adolescents with restrictive ED with a wide range of BMI at presentation. High weight suppression at follow-up is associated with a poor prognosis and indicates the importance of taking premorbid BMI into account when setting weight targets for treatment.

The impact of weight suppression and weight loss speed on baseline clinical characteristics and response to treatment

“…Moreover consistently with the present study, several studies have shown that WS may not be associated with treatment outcome such as binge/purge abstinence, response, remission, in patients with BN (Carter et al, 2008;Dawkins et al, 2013;Zunker et al, 2011), nor with treatment compliance or drop-out rates (Carter et al, 2008). On the other hand, other evidence suggests a role of WS in determining clinical outcome (Butryn et al, 2011;Swenne, Parling, & Salonen Ros, 2017), included maintenance of bulimic syndromes (Keel & Heatherton, 2010), resumption of menses (Seetharaman et al, 2017), at follow-up as long as 20 years (Bodell, Brown, & Keel, 2017;Witt et al, 2014). Notably, we originally also show that WLS is associated with a better prognosis, suggesting that rapidly evolving clinical pictures may have a favorable outcome compared with those with insidious onset.…”

“…Moreover consistently with the present study, several studies have shown that WS may not be associated with treatment outcome such as binge/purge abstinence, response, remission, in patients with BN (Carter et al, ; Dawkins et al, ; Zunker et al, ), nor with treatment compliance or drop‐out rates (Carter et al, ). On the other hand, other evidence suggests a role of WS in determining clinical outcome (Butryn et al, ; Swenne, Parling, & Salonen Ros, ), included maintenance of bulimic syndromes (Keel & Heatherton, ), resumption of menses (Seetharaman et al, ), at follow‐up as long as 20 years (Bodell, Brown, & Keel, ; Witt et al, ). Several factors may underlie such discrepancies about the role of WS in determining clinical outcomes, included the population on which outcomes are measured (completers vs. intention‐to‐treat), diagnostic criteria defining EDs (DSM‐IV vs. DSM‐5 vs. subthreshold syndromes), covariates considered in the analyses (adjusted vs. unadjusted analyses), and WS calculation (weight [kg] vs. BMI).…”

Weight gain trajectories during outpatient family‐based treatment for adolescents with anorexia nervosa

“…Because it has been well established that early weight gain within the first 4 weeks of treatment is strongly linked to an increased probability of success in FBT (Doyle et al, 2010;Le Grange et al, 2014;Madden et al, 2015;Swenne et al, 2017), in addition to the potential for family burnout and diminished quality of life associated with longer treatment duration, this profile might represent a subset of adolescents who would ultimately benefit from more intensive or adapted interventions, but who advance-albeit more slowly-in FBT. Without outcome data, it is unclear whether this class is associated with treatment success or failure, though the group had significantly more patients fail to reach an early weight gain cut-off point of 6.5 pounds in 4 weeks.…”

“…Without outcome data, it is unclear whether this class is associated with treatment success or failure, though the group had significantly more patients fail to reach an early weight gain cut-off point of 6.5 pounds in 4 weeks. Because it has been well established that early weight gain within the first 4 weeks of treatment is strongly linked to an increased probability of success in FBT (Doyle et al, 2010;Le Grange et al, 2014;Madden et al, 2015;Swenne et al, 2017), in addition to the potential for family burnout and diminished quality of life associated with longer treatment duration, this profile might represent a subset of adolescents who would ultimately benefit from more intensive or adapted interventions, but who advance-albeit more slowly-in FBT.…”

“…Similarly, research on predictors of outcome in Family Based Treatment (FBT)-the gold-standard treatment for adolescent AN-has consistently found early weight gain to be associated with good prognosis (Doyle, Le Grange, Loeb, Celio Doyle, & Crosby, 2010; Le Grange, Accurso, Lock, Agras, & Bryson, 2014;Madden et al, 2015;Swenne, Parling, & Salonen Ros, 2017).…”