Family-based therapy for anorexia nervosa: results from a 7-year longitudinal Singapore study

Wong, Lisa; Goh, Lee Gan; Ramachandran, Rajeev

doi:10.1007/s40519-019-00654-3

Cited by 4 publications

(4 citation statements)

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“…So we may only be seeing the tip of the iceberg in terms of the community need. Local data on EDs in children are scant,2 8–13 and there are no studies on children with EDs in the rest of South-East (SE) Asia. A population study14 of SE Asian university students found high risk for EDs in 6.8%–20.6% of participants.…”

Section: Introductionmentioning

confidence: 99%

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Evolution of paediatric eating disorders in Singapore: a historical cohort study

2022

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ObjectiveMost eating disorders (EDs) develop during adolescence, impacting a critical period of development. There is limited research on EDs in children in Singapore or the rest of South-East (SE) Asia.DesignWe analysed a hospital-based cohort of paediatric patients (≤18 years) with EDs (n=177) in Singapore between 2011 and 2021. Historical trends, over three decades, were obtained by comparison with two previously published Singapore studies.ResultsOf the 177 patients, the majority 158 (89%) were females, with anorexia nervosa (AN) 151 (85%). The mean age at diagnosis was 14.6 (SD 1.8) years. For AN, the mean duration of illness before diagnosis was 8.3 (SD 6.3) months and this has decreased by 8.4 months (95% CI 4.5 to 12.3 months, p=<0.0001) from the 2003 to 2010 cohort, and 17.7 months (95% CI 12.6 to 22.8 months, p=<0.0001) from the 1994 to 2002 cohort. Avoidant/restrictive food intake disorder (ARFID) cases are increasing, and the clinical profile differs from other EDs. Since family-based therapy (FBT) was introduced for patients with AN, the remission rate at 1 year improved from 30% to 79%, and time to remission has decreased from 16 to 7.5 months.ConclusionsAN is the most common ED in paediatric patients in Singapore. Over the past three decades, EDs are being diagnosed earlier. FBT has emerged as the most effective treatment for AN. ARFID is being diagnosed more frequently. Data suggest that EDs are prevalent and increasing among adolescents in SE Asia. Singapore is a good test case for SE Asia, but research and attention to the problem in the region is needed.

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Section: Introductionmentioning

confidence: 99%

“…Family-based therapy (FBT) has been shown to improve patient outcomes in children/adolescents with anorexia nervosa (AN) in Singapore13 15 and globally 16–18. Early diagnosis is also a critical prognostic factor 19 20…”

Section: Introductionmentioning

confidence: 99%

Evolution of paediatric eating disorders in Singapore: a historical cohort study

2022

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“…In a second study from Hong Kong, a sample of patients with eating disorders showed increases in BMI and improved EDI scores after participation in family therapy (Ma & Lai, 2009). To date, one study has found improved rates of weight restoration and time to weight restoration among Southeast Asian adolescents with AN with FBT in comparison with individualized therapy (Wong, Goh, & Ramachandran, 2019). While these outcomes were promising, the study sample was limited to patients who had continued treatment for a minimum of a year which may limit the applicability of these results.…”

Section: Introductionmentioning

confidence: 99%

Implementation of family‐based treatment for Asian adolescents with anorexia nervosa: A consecutive cohort examination of outcomes

Chew

Kelly

Tay

et al. 2020

Intl J Eating Disorders

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Objective: This study describes the implementation of family-based treatment (FBT) in an eating disorder program in Asia as well as clinical outcomes of Asian adolescents with anorexia nervosa (AN) treated with FBT. Method: This retrospective consecutive cohort study of 147 Asian adolescents with AN was compared between those in FBT (n = 65) versus treatment as usual (TAU) (n = 82). Variables associated with weight restoration were analyzed between groups. Results: Participants' mean age was 14.2 (SD = 1.5) years and 93% were female. Mean presenting %mBMI was 74.0 (SD = 7.8) and average illness duration was 7.7 (SD = 6.1) months. The two groups' baseline characteristics were not significantly different. Weight restoration rates in the FBT group were significantly higher than the TAU group at 6-, 12-, and 24-month time points. A linear mixed model showed the mean %mBMI was significantly higher at 0, 6, 12, and 24 months in the FBT group. The median time to weight restoration for patients on FBT was shorter (FBT: 7.0 months, TAU: 19.0 months; 95% CI [14.5, 23.5] χ 2 = 15.84, p < .001). Within the FBT group, those that completed ≥9 FBT sessions had significantly higher rates of weight restoration at 12 months. Across all participants, those with a lower starting %mBMI were less likely to achieve weight restoration by 12 months. Conclusion: FBT can be effectively implemented in a multidisciplinary eating disorder program managing Asian adolescents with AN with improved rates of weight restoration. Further research is needed to understand the predictors and moderators of remission using FBT in Asian adolescents with AN.

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“…Family Based Therapy (FBT) has emerged as the first line treatment for AN and has shown promising results in a recent Singapore study. 13 Full remission from AN is achieved when weight restoration has been successfully completed and there is an absence of distorted body image and other abnormal eating behaviours, psychological comorbidities, and any social or functional impairments.…”

Section: Refeeding Syndromementioning

confidence: 99%

Eating Disorders in Adolescents – Physical and Psychiatric Perspectives

2022

SFP

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Eating disorder (ED) referrals of school-going children and adolescents by their parents and schoolteachers have become more common. Such youth are now presenting at an earlier age with physical, medical, and psychological symptoms to primary care and school systems. Nevertheless, there is an average of six months to two years between the onset of symptoms to formal assessment and treatment by a specialist team. There are also more cases presenting to ED specialist clinic services, especially pre-pubertal children, with early onset and presentation before 14 years old. Mid-and late-adolescent presentations (after 14 years old) continue to make up more than two-thirds of cases. More than 60 percent of cases seen in specialist clinics are of the restrictive type, anorexia nervosa, and are often associated with persistent and excessive exercise. While thirty percent of cases are bulimia nervosa, which tend to be episodic.The majority of single-episode bulimia cases do not present themselves early to medical services but take on an open-source self-directed management. For patients with bulimia who comply with the treatment programme and recover after 6-12 months of therapy, they may experience high relapse rate as they often discontinue their follow-up.Avoidant-restrictive food intake disorder is more closely related to pre-pubertal onset eating disorder with arrested sexual maturity and growth failure, if left untreated. Psychiatric co-morbidities such as anxiety, avoidance behaviour, obsessive rumination, depression, and suicidal ideation and attempt may arise from body image disturbance, high achievement needs, prior exposure to adverse childhood experiences (ACE), dysfunctional families, or peer relationships. Death can arise from acute presentation and chronic state of ED, when associated with medical complications from refeeding syndrome, severe malnourishment, accidents, and suicide. Early identification, assessment and referral to ED specialist services by family physicians would significantly improve the prognosis and mitigate long-term complications from these disorders.

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Family-based therapy for anorexia nervosa: results from a 7-year longitudinal Singapore study

Cited by 4 publications

References 9 publications

Evolution of paediatric eating disorders in Singapore: a historical cohort study

Evolution of paediatric eating disorders in Singapore: a historical cohort study

Implementation of family‐based treatment for Asian adolescents with anorexia nervosa: A consecutive cohort examination of outcomes

Eating Disorders in Adolescents – Physical and Psychiatric Perspectives

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