Dietary interventions in family-based treatment for eating disorders: results of a randomized comparative effectiveness study

Abstract

ABSTRACT Family-based treatment (FBT) is a first-line treatment for adolescents with eating disorders (ED’s) for which weight gain early in treatment and caregiver empowerment are predictive of success. A variety of dietary interventions are used in practice, but little is known about their effectiveness. We compared clinical outcomes of patients (N = 100) undergoing eating disorder treatment, and user experience across two virtually delivered interventions: (1) Daily calorie target and (2) Plate-by-Plate™ approach. The calorie group gained more weight on average, though the difference was small (β = 1.62 [−0.02, 3.26]). Participants in both groups improve their eating disorder symptoms at roughly the same rate (β = 0.09 [−0.83, 1.04]). Caregivers in the Plate-by-Plate group increased confidence at a slower rate (β = 0.05 [−0.002, 0.09]). Caregivers rated the daily calorie target as more effective (β = 2.18 [0.94, 3.6]), and rated the two approaches equally for ease of use (β = -0.73 [−1.92, 0.48]). The daily calorie target approach was rated as more effective and was preferred overall by caregivers and dietitians. Findings challenge long-standing assumptions underlying FBT and suggest that clinicians should consider using a calorie framework with caregivers to guide renourishment efforts.