Treatment of Anorexia Nervosa—New Evidence-Based Guidelines

Abstract

Anorexia nervosa is the most severe eating disorder; it has a protracted course of illness and the highest mortality rate among all psychiatric illnesses. It is characterised by a restriction of energy intake followed by substantial weight loss, which can culminate in cachexia and related medical consequences. Anorexia nervosa is associated with high personal and economic costs for sufferers, their relatives and society. Evidence-based practice guidelines aim to support all groups involved in the care of patients with anorexia nervosa by providing them with scientifically sound recommendations regarding diagnosis and treatment. The German S3-guideline for eating disorders has been recently revised. In this paper, the new guideline is presented and changes, in comparison with the original guideline published in 2011, are discussed. Further, the German guideline is compared to current international evidence-based guidelines for eating disorders. Many of the treatment recommendations made in the revised German guideline are consistent with existing international treatment guidelines. Although the available evidence has significantly improved in quality and amount since the original German guideline publication in 2011, further research investigating eating disorders in general, and specifically anorexia nervosa, is still needed.

Treatment resistance in eating disorders: a question of uncertain targets or insufficient personalization?

“…Although there is a plethora of clinical guidelines which aim to describe the current status of treatment for eating disorders because the underpinning research evidence is weak, their power to have a marked impact on clinical practice is limited. The recent German guidelines (Resmark, Herpertz, Herpertz-Dahlmann, & Zeeck, 2019) have taken a big picture perspective including an overview of other guidelines and built their recommendation upon newer techniques such as a network metaanalysis in order to synthesize the evidence. Despite these sophisticated approaches, there remains much uncertainty because of the weak foundations.…”

Using Using Brief Experimental Analysis to Increase Food Consumption for an Adult with an Eating Disorder: A Case Study

“…Anorexia Nervosa (AN) is characterized by extreme patterns of restricted eating resulting in significant weight loss, fear of gaining weight, and body image disturbances (APA, 2013). AN is considered the most severe eating disorder, as it has high morbidity and mortality rates, is chronic, and requires intensive and ongoing intervention (Resmark, Herpertz, Herpertz-Dahlmann, & Zeeck, 2019). Unfortunately, research on the treatment of AN is mixed.…”

“…Specifically, the researchers identified several therapeutic models, including CBT and family-based treatment, that demonstrated strong positive effects. However, methodological limitations including a lack of untreated comparison groups plague the literature and many experts on AN have called for more research on treatment approaches (e.g., Resmark et al, 2019).…”

“…Evidence-based treatment models of AN generally begin with weight gain and weight management through meal planning, self-monitoring, and psychoeducation (Resmark et al, 2019;Stefano, Bennett, Bozsik, Hudson, & Whisenhunt, 2018). These intervention features attempt to address caloric restriction, although cognitive features of AN (e.g., distorted body image) and specific motivational variables (e.g., not believing the problem is serious) are likely to interfere with progress and overall outcomes (Fitzsimmons-Craft et al, 2019).…”

Evaluation of Refeeding Outcomes Over 5-Years in A Specialist Adolescent Eating Disorder Center in The UK: A Retrospective Chart Review Study.

“…Disparities in refeeding recommendations worldwide have led to a lack of consensus on how to refeed these individuals safely 6 . Large variations in recommendations on starting energy intakes, prophylactic phosphate supplementation and the use of oral nutritional supplements exist in guidance documents across countries [15][16][17][18][19] . However, an association between the initial degree of malnutrition and development of hypophosphatemia, a predictor of RS, has been widely reported 8,20−22 .…”