Abstract
BackgroundFamily-Based Treatment (FBT) is considered the first-line intervention for adolescent anorexia nervosa. However, access to this treatment is limited. Treatment programs for other pediatric mental health conditions have successfully overcome barriers to accessing evidence-based intervention by integrating mental health services into primary care. This study evaluated the proof-of-concept of a novel modification of FBT, Family-Based Treatment for Primary Care (FBT-PC) for adolescent restrictive eating disorders designed for delivery by primary care providers in their practices.MethodsThis retrospective clinical cohort study evaluated 15 adolescents with restrictive eating disorders receiving FBT-PC and 15 adolescents receiving standard FBT. We examined improvement in BMI percentile, reduction in weight suppression, and clinical benchmarks of eating disorder recovery including weight restoration to > 95% of expected body weight (EBW) and resolution of DSM-5 criteria for eating disorders.ResultsIn both groups, effect sizes for increased BMI percentile exceeded Cohen’s convention for a large effect (FBT-PC: d = .94; standard FBT: d = 1.15) as did effect sizes for reduction in weight suppression (FBT-PC: d = 1.83; standard FBT: d = 1.21). At the end of treatment, 80% of the FBT-PC cohort and 87% in the standard FBT group achieved > 95%EBW and 67% in the FBT-PC group and 60% in the standard FBT group no longer met DSM-5 criteria for an eating disorder. There were no cohort differences in the number of treatment drop-outs or referrals to a more intensive level of eating disorder treatment.ConclusionsFindings suggest that primary care providers have potential to improve weight and clinical status in adolescents with restrictive eating disorders. Based on these results, more rigorous testing of the FBT-PC model is warranted.
Highlights
Over the last two decades, the field of eating disorders has made considerable progress in the development and evaluation of evidence-based treatment for adolescent eating disorders
This study evaluated the proof-of-concept of a novel modification of FBT, Family-Based Treatment for Primary Care (FBT-PC) for adolescent restrictive eating disorders designed for delivery by primary care providers in their practices
This study examined weight gain in 15 adolescents with restrictive eating disorders receiving FBTPC and 15 adolescents receiving standard FBT
Summary
Over the last two decades, the field of eating disorders has made considerable progress in the development and evaluation of evidence-based treatment for adolescent eating disorders. Family-Based Treatment (FBT) for anorexia nervosa [1] has amassed robust evidence supporting its effectiveness [2,3,4,5,6]. There are significant gaps in treatment access, especially for those in low-resourced areas This likely contributes to substantial delays in care [8], which have been shown to lead to more severe illness and poorer outcomes [9,10,11]. Family-Based Treatment (FBT) is considered the first-line intervention for adolescent anorexia nervosa. Treatment programs for other pediatric mental health conditions have successfully overcome barriers to accessing evidence-based intervention by integrating mental health services into primary care. This study evaluated the proof-of-concept of a novel modification of FBT, Family-Based Treatment for Primary Care (FBT-PC) for adolescent restrictive eating disorders designed for delivery by primary care providers in their practices
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