Evaluation of family treatment models for eating disorders

PURPOSE OF REVIEW

Interest in the effectiveness of family interventions for eating disorders has increased over the past 5 years. This review considers the theoretical justification and current evidence base for the use of family treatments for eating disorders in children and adolescents.

RECENT FINDINGS

Family-based treatment is the best studied treatment. It has the strongest evidence base for effectiveness for anorexia nervosa in adolescents. Family-based treatment can be delivered in several formats and doses, and preliminary data suggest it can be disseminated by training and manuals. There is a more limited evidence base demonstrating the usefulness of family interventions for bulimia nervosa in adolescents.

SUMMARY

The implications of the findings of this review are that family interventions are the current first-line treatment for adolescent anorexia nervosa and promising for adolescent bulimia nervosa. Pilot studies suggest that family interventions can be disseminated in diverse clinical settings.

What predicts maintenance of weight for adolescents medically hospitalized for anorexia nervosa?

We assessed the relationship between outcomes at one year and a variety of possible predictors among a group of adolescents who were hospitalized for medical complications associated with adolescent onset AN. We reviewed the 12 month outcomes of 41 adolescent patients admitted for medical complications associated with AN to our center. Data on initial percent ideal body weight, length of initial hospitalization, and percent ideal body weight at discharge from first admission were collected. Our primary outcome measure was percent ideal body weight obtained 12 months after initial discharge. Using multiple linear regression to predict percent ideal body weight achieved at 12 months postdischarge, we found that only percent of ideal body weight at discharge predicted better outcomes. Response to initial hospitalization in terms of weight gain, rather than admission weight or length of initial hospital stay, predict better outcomes at 12 months. These results suggest the need for further study of predictors of response to intensive hospital treatment in order to improve initial response rates and ultimately to better outcomes postdischarge.