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1
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Vogel M, Gil A, Galaz C, Urrejola P, Lacalle L, Jara R, Irribarra V, Letelier M, Costa D, Espinoza G. Virtually Accompanied Eating in the Outpatient Therapy of Anorexia Nervosa. Nutrients 2023; 15:3783. [PMID: 37686815 PMCID: PMC10489725 DOI: 10.3390/nu15173783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/27/2023] [Accepted: 08/28/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND Normalizing the eating pattern and weight recovery are the main objectives in treating anorexia nervosa (AN). Eating accompaniment through shared mealtimes is a common strategy in eating disorder management programs. This study aims to examine the impact on weight gain of an internet-delivered meal support group on patients with AN who were under ambulatory treatment with the Eating Disorders Unit of the UC Christus Health Network, Chile. METHODS An observational study of 54 female patients with AN diagnosis who participated in Online Meal Support Groups (OMSGs) three times a week was performed. Their weight, BMI and BMI%, was reviewed at the beginning of the sessions and at 45- and 90-day follow-up. RESULTS Patients showed significant weight gain during follow-up. At the 90-day follow-up, patients had gained 4.41 (SD ± 2.82) kg with an effect size of -1.563. CONCLUSIONS Statistically significant differences were found between the weight at the beginning of the intervention and at the 45- and 90-day follow-up, meaning that eating support online groups may be an effective intervention for weight gain and maintenance in patients with AN. These findings highlight the viability of developing cost-effective and more accessible interventions for AN and thus help reduce the duration of untreated disease and its consequences.
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Affiliation(s)
- Melina Vogel
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
- Psychiatry Department, Faculty of Medicine, Pontificia Universidad Catolica, Santiago 8330077, Chile
| | - Aurora Gil
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
| | - Camila Galaz
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
| | - Pascuala Urrejola
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
- Adolescent Unit, Pediatrics Department, Faculty of Medicine, Pontificia Universidad Catolica, Santiago 8330077, Chile
| | - Lucas Lacalle
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
| | - Raúl Jara
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
| | - Verónica Irribarra
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
- Nutrition and Diabetes Department, Faculty of Medicine, Pontificia Universidad Catolica, Santiago 8330077, Chile
| | - Matias Letelier
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
| | - Daniela Costa
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
| | - Gabriela Espinoza
- Eating Disorders Unit of the UC Christus Health Network, Santiago 8330077, Chile; (M.V.); (A.G.); (C.G.); (P.U.); (L.L.); (R.J.); (V.I.); (M.L.); (D.C.)
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Pagano N, Glasofer DR, Attia E, Ruggiero J, Eziri K, Goldstein CM, Steinglass JE. Perspectives on relapse prevention following intensive treatment of anorexia nervosa: A focus group study. Int J Eat Disord 2023; 56:1417-1431. [PMID: 37051854 PMCID: PMC10524497 DOI: 10.1002/eat.23952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/24/2023] [Accepted: 03/24/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Including the perspectives of individuals with lived experience of mental health issues is a critical step in research and treatment development. Focus groups with patients with a history of treatment for anorexia nervosa (AN) were conducted in anticipation of a clinical trial of Relapse Prevention and Changing Habits (REACH+). METHODS Seven female adults (23-51 years) who had previously received inpatient treatment for AN, now in remission, participated in one of two semistructured focus groups. Rapid qualitative analysis was used to examine participants' contributions and identify common topics. RESULTS Transcript analysis yielded three topics related to relapse prevention: (1) recovery aids, including a sense of agency in treatment decisions and finding new interests/passions, (2) recovery hindrances, such as lack of access to care, and (3) identification of members of support system. Aspects of REACH+ received positive feedback, such as continuity of care from the inpatient setting and the use of telehealth. Viewpoints differed with respect to the helpfulness of obtaining patient weights in treatment. The REACH+ online platform received positive comments regarding content and usability, as well as suggestions for additional content. DISCUSSION Qualitative feedback from patients with a history of AN highlighted the value of engaging patients in their own treatment decisions, as well as in treatment design and innovation. Within this small group, there were differences of opinion about treatment components, specifically weight assessment, that suggest the need for further data. User-centered design provides opportunities to improve the acceptability and, therefore, dissemination of novel treatments. PUBLIC SIGNIFICANCE Relapse prevention is a critical treatment need for patients with anorexia nervosa, as this illness too often follows a protracted course. There are challenges in both obtaining specialized care and in retaining patients in treatment. Here, patient perspectives on these challenges offer input to allow for optimization of relapse prevention treatment. Shared decision-making may be particularly valuable to support an individual's sense of agency and engagement in care.
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Affiliation(s)
- Nikki Pagano
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Deborah R. Glasofer
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Evelyn Attia
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
- Weill Cornell Medical College, New York, New York,
USA
| | - Julia Ruggiero
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Kelechi Eziri
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
| | - Carly M. Goldstein
- Weight Control and Diabetes Research Center, The Miriam
Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode
Island, USA
| | - Joanna E. Steinglass
- New York State Psychiatric Institute, Columbia University
Irving Medical Center, New York, New York, USA
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3
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Novack K, Dufour R, Picard L, Taddeo D, Nadeau PO, Katzman DK, Booij L, Chadi N. Canadian pediatric eating disorder programs and virtual care during the COVID-19 pandemic: a mixed-methods approach to understanding clinicians' perspectives. Ann Gen Psychiatry 2023; 22:16. [PMID: 37101241 PMCID: PMC10132795 DOI: 10.1186/s12991-023-00443-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 03/26/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND As a result of the public health measures put in place during the COVID-19 pandemic in Canada, many health services, including those for the treatment of eating disorders, were provided at a distance. This study aims to describe the adaptations made in specialized pediatric eating disorder programs in Canada and the impact of these adaptations on health professionals' experience of providing care. METHODS A mixed-methods design was used to survey healthcare professionals working in specialized pediatric eating disorder programs about adaptations to treatment made during the pandemic and the impact of these adaptations on their experience of providing care. Data were collected between October 2021 and March 2022 using a cross-sectional survey comprising 25 questions and via semi-structured interviews. Quantitative data were summarized using descriptive statistics and qualitative data were interpreted using qualitative content analysis. RESULTS Eighteen healthcare professionals in Canada completed the online survey, of whom six also participated in the semi-structured interviews. The cross-sectional survey confirmed that, unlike in pre-pandemic times, the majority of participants provided medical care (15/18) and mental health care (17/18) at a distance during the pandemic, with most participants using telephone (17/18) and videoconferencing (17/18). Most (16/18) health professionals indicated that virtual care would continue to be used as a tool in pediatric ED treatment after the pandemic. Participants used a combination of virtual and in-person care, with most reporting weighing patients both in clinic (16/18) and virtually (15/18). Qualitative content analysis generated five themes: (1) responding to increased demand with insufficient resources; (2) adapting to changes in care due to the COVID-19 pandemic; (3) dealing with uncertainty and apprehension; (4) virtual care as an acceptable and useful clinical tool, and (5) optimal conditions and future expectations. Most interview participants (5/6) had globally positive views of virtual care. CONCLUSIONS Providing virtual multidisciplinary treatment for children and adolescents with eating disorders seemed feasible and acceptable to professionals during the pandemic. Moving forward, focusing on health professionals' perspectives and providing appropriate training in virtual interventions is essential given their central role in successful implementation and continued use of virtual and hybrid care models.
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Affiliation(s)
- Kaylee Novack
- Department of Psychiatry and Addictology, Université de Montréal, Montréal, Canada
| | - Rachel Dufour
- Department of Psychology, Concordia University, Montreal, Canada
| | - Louis Picard
- Department of Psychology, Sainte-Justine University Hospital Centre, Montreal, Canada
| | - Danielle Taddeo
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, Université de Montréal, 3175 Chemin de la Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada
| | | | - Debra K Katzman
- Division of Adolescent Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Linda Booij
- CHU Sainte-Justine Hospital Research Centre, Montreal, Canada
- Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montreal, Canada
| | - Nicholas Chadi
- Division of Adolescent Medicine, Department of Pediatrics, Sainte-Justine University Hospital Centre, Université de Montréal, 3175 Chemin de la Côte-Ste-Catherine, Montreal, QC, H3T 1C5, Canada.
- CHU Sainte-Justine Hospital Research Centre, Montreal, Canada.
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Couturier J, Norris M. The Shadow Pandemic: Eating Disorders, Youth, and COVID-19. J Adolesc Health 2023; 72:321-322. [PMID: 36803848 PMCID: PMC9935426 DOI: 10.1016/j.jadohealth.2022.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 02/19/2023]
Affiliation(s)
| | - Mark Norris
- Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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5
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Couturier J, Pellegrini D, Grennan L, Nicula M, Miller C, Agar P, Webb C, Anderson K, Barwick M, Dimitropoulos G, Findlay S, Kimber M, McVey G, Lock J. Multidisciplinary implementation of family-based treatment delivered by videoconferencing (FBT-V) for adolescent anorexia nervosa during the COVID-19 pandemic. Transl Behav Med 2023; 13:85-97. [PMID: 36327378 PMCID: PMC9972350 DOI: 10.1093/tbm/ibac086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Family-Based Treatment (FBT)-the most widely supported treatment for pediatric eating disorders-transitioned to virtual delivery in many programs due to COVID-19. Using a blended implementation approach, we systematically examined therapist adherence to key components of FBT and fidelity to FBT by videoconferencing (FBT-V), preliminary patient outcomes, and team experiences with our FBT-V implementation approach as well as familial perceptions of FBT-V effectiveness. We examined our implementation approach across four pediatric eating disorder programs in Ontario, Canada, using mixed methods. Participants included therapists (n = 8), medical practitioners (n = 4), administrators (n = 6), and families (n = 5; 21 family members in total). We developed implementation teams at each site, provided FBT-V training, and offered clinical and implementation consultation. Therapists submitted video recordings of their first four FBT-V sessions for fidelity rating, and patient outcomes. Therapists self-reported readiness, attitudes, confidence, and adherence to FBT-V. Focus groups were conducted with each team and family after the first four sessions of FBT-V. Quantitative data were analyzed using repeated measures ANOVA. Qualitative data were analyzed using directed and summative content analysis. Therapists adhered to key FBT components and maintained FBT-V fidelity. Changes in therapists' readiness, attitudes, and confidence in FBT-V over time were not significant. All patients gained weight. Focus groups revealed implementation facilitators/barriers, positives/negatives surrounding FBT-V training and consultation, suggestions for improvement, and effectiveness attributed to FBT-V. Our implementation approach appeared to be feasible and acceptable. Future research with a larger sample is required, furthering our understanding of this approach and exploring how organizational factors influence treatment fidelity.
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Affiliation(s)
- Jennifer Couturier
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Eating Disorder Program, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Danielle Pellegrini
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Laura Grennan
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Maria Nicula
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Catherine Miller
- Eating Disorder Program, Canadian Mental Health Association, Waterloo Wellington, Kitchener, ON, Canada
| | - Paul Agar
- Eating Disorder Program, McMaster Children’s Hospital, Hamilton, ON, Canada
| | - Cheryl Webb
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
- Eating Disorder Program, McMaster Children’s Hospital, Hamilton, ON, Canada
| | | | - Melanie Barwick
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, ON, Canada
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Sheri Findlay
- Eating Disorder Program, McMaster Children’s Hospital, Hamilton, ON, Canada
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Melissa Kimber
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Gail McVey
- Social and Behavioural Health Sciences Division, Dalla Lana School of Public Health, University of Toronto, ON, Canada
- Ontario Community Outreach Program for Eating Disorders, University Health Network, Toronto, ON, Canada
| | - James Lock
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
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6
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Couturier J, Pellegrini D, Grennan L, Nicula M, Miller C, Agar P, Webb C, Anderson K, Barwick M, Dimitropoulos G, Findlay S, Kimber M, McVey G, Paularinne R, Nelson A, DeGagne K, Bourret K, Restall S, Rosner J, Hewitt-McVicker K, Pereira J, McLeod M, Shipley C, Miller S, Boachie A, Engelberg M, Martin S, Holmes-Haronitis J, Lock J. Correction: A qualitative evaluation of team and family perceptions of family-based treatment delivered by videoconferencing (FBT-V) for adolescent Anorexia Nervosa during the COVID-19 pandemic. J Eat Disord 2022; 10:191. [PMID: 36482292 PMCID: PMC9733240 DOI: 10.1186/s40337-022-00714-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Affiliation(s)
- Jennifer Couturier
- McMaster University, Hamilton, ON, Canada. .,McMaster Children's Hospital, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.
| | | | | | | | - Catherine Miller
- Canadian Mental Health Association - Waterloo Wellington, Kitchener, ON, Canada
| | - Paul Agar
- McMaster Children's Hospital, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | - Cheryl Webb
- McMaster University, Hamilton, ON, Canada.,McMaster Children's Hospital, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | - Melanie Barwick
- University of Toronto, Toronto, ON, Canada.,Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Sheri Findlay
- McMaster University, Hamilton, ON, Canada.,McMaster Children's Hospital, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | - Gail McVey
- University of Toronto, Toronto, ON, Canada.,University Health Network, Toronto, ON, Canada
| | | | - Aylee Nelson
- St. Joseph's Care Group, Thunder Bay, ON, Canada
| | | | | | - Shelley Restall
- Canadian Mental Health Association - Waterloo Wellington, Kitchener, ON, Canada
| | | | - Kim Hewitt-McVicker
- Canadian Mental Health Association - Waterloo Wellington, Kitchener, ON, Canada
| | | | - Martha McLeod
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | | | - Sherri Miller
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Ahmed Boachie
- University of Toronto, Toronto, ON, Canada.,Southlake Regional Health Centre, Newmarket, ON, Canada
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Couturier J, Pellegrini D, Grennan L, Nicula M, Miller C, Agar P, Webb C, Anderson K, Barwick M, Dimitropoulos G, Findlay S, Kimber M, McVey G, Paularinne R, Nelson A, DeGagne K, Bourret K, Restall S, Rosner J, Hewitt-McVicker K, Pereira J, McLeod M, Shipley C, Miller S, Boachie A, Engelberg M, Martin S, Holmes-Haronitis J, Lock J. A qualitative evaluation of team and family perceptions of family-based treatment delivered by videoconferencing (FBT-V) for adolescent Anorexia Nervosa during the COVID-19 pandemic. J Eat Disord 2022; 10:111. [PMID: 35883167 PMCID: PMC9321306 DOI: 10.1186/s40337-022-00631-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 07/17/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, outpatient eating disorder care, including Family-Based Treatment (FBT), rapidly transitioned from in-person to virtual delivery in many programs. This paper reports on the experiences of teams and families with FBT delivered by videoconferencing (FBT-V) who were part of a larger implementation study. METHODS Four pediatric eating disorder programs in Ontario, Canada, including their therapists (n = 8), medical practitioners (n = 4), administrators (n = 6), and families (n = 5), participated in our study. We provided FBT-V training and delivered clinical consultation. Therapists recorded and submitted their first four FBT-V sessions. Focus groups were conducted with teams and families at each site after the first four FBT-V sessions. Focus group transcripts were transcribed verbatim and key concepts were identified through line-by-line reading and categorizing of the text. All transcripts were double-coded. Focus group data were analyzed using directed and summative qualitative content analysis. RESULTS Analysis of focus group data from teams and families revealed four overarching categories-pros of FBT-V, cons of FBT-V, FBT-V process, and suggestions for enhancing and improving FBT-V. Pros included being able to treat more patients and developing a better understanding of family dynamics by being virtually invited into the family's home (identified by teams), as well as convenience and comfort (identified by families). Both teams and families recognized technical difficulties as a potential con of FBT-V, yet teams also commented on distractions in family homes as a con, while families expressed difficulties in developing therapeutic rapport. Regarding FBT-V process, teams and families discussed the importance and challenge of patient weighing at home. In terms of suggestions for improvement, teams proposed assessing a family's suitability or motivation for FBT-V to ensure it would be appropriate, while families strongly suggested implementing hybrid models of FBT in the future which would include some in-person and some virtual sessions. CONCLUSION Team and family perceptions of FBT-V were generally positive, indicating acceptability and feasibility of this treatment. Suggestions for improved FBT-V practices were made by both groups, and require future investigation, such as examining hybrid models of FBT that involve in-person and virtual elements. Trial registration ClinicalTrials.gov NCT04678843 .
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Affiliation(s)
- Jennifer Couturier
- McMaster University, Hamilton, ON, Canada.
- McMaster Children's Hospital, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada.
| | | | | | | | - Catherine Miller
- Canadian Mental Health Association - Waterloo Wellington, Kitchener, ON, Canada
| | - Paul Agar
- McMaster Children's Hospital, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | - Cheryl Webb
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | - Melanie Barwick
- University of Toronto, Toronto, ON, Canada
- Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Sheri Findlay
- McMaster University, Hamilton, ON, Canada
- McMaster Children's Hospital, 1200 Main St W, Hamilton, ON, L8N 3Z5, Canada
| | | | - Gail McVey
- University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| | | | - Aylee Nelson
- St. Joseph's Care Group, Thunder Bay, ON, Canada
| | | | | | - Shelley Restall
- Canadian Mental Health Association - Waterloo Wellington, Kitchener, ON, Canada
| | | | - Kim Hewitt-McVicker
- Canadian Mental Health Association - Waterloo Wellington, Kitchener, ON, Canada
| | | | - Martha McLeod
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | | | - Sherri Miller
- Southlake Regional Health Centre, Newmarket, ON, Canada
| | - Ahmed Boachie
- University of Toronto, Toronto, ON, Canada
- Southlake Regional Health Centre, Newmarket, ON, Canada
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