Abstract
BackgroundFamily-based treatments are first-line treatments for adolescents with restrictive eating disorders (ED) but have to be improved since outcome is poor for some. We have investigated the one-year outcome of a family-based intervention programme with defined and decisive interventions at the start of treatment.MethodData pertaining 201 adolescents with restrictive ED with features of anorexia nervosa but not fulfilling the weight criterion starting treatment 2010-2015, had a wide range of body mass index (BMI) and of weight loss at presentation, and completed a one-year follow-up was analysed. Recovery from the ED was defined as an Eating Disorder Examination-questionnaire (EDE-Q) score < 2.0 or as not fulfilling criteria for an ED at a clinical interview.ResultsBy EDE-Q 130 (65%) had recovered at 1 year and by clinical interview 106 (53%). According to the EDE-Q criterion recovery was independently associated with lower EDE-Q score at presentation, higher weight gain after 3 months of treatment and lower weight suppression at follow-up, weight suppression being defined as the difference between premorbid and current BMI. Not fulfilling criteria for an ED was associated with the same factors and also by higher BMI at presentation.ConclusionThe observations that low weight and high ED cognitions confer a poor prognosis but that rapid weight gain at the start of treatment predicts a better prognosis are presently extended to adolescents with restrictive ED with a wide range of BMI at presentation. High weight suppression at follow-up is associated with a poor prognosis and indicates the importance of taking premorbid BMI into account when setting weight targets for treatment.
Highlights
Family-based treatments are first-line treatments for adolescents with restrictive eating disorders (ED) but have to be improved since outcome is poor for some
According to the Eating disorders unit (EDE)-Q criterion recovery was independently associated with lower Eating Disorder Examination-questionnaire (EDE-Q) score at presentation, higher weight gain after 3 months of treatment and lower weight suppression at follow-up, weight suppression being defined as the difference between premorbid and current body mass index (BMI)
Not fulfilling criteria for an ED was associated with the same factors and by higher BMI at presentation
Summary
Family-based treatments are first-line treatments for adolescents with restrictive eating disorders (ED) but have to be improved since outcome is poor for some. This may be so if weight loss is small but could be the result of a greater weight loss starting from an overweight [10, 11] These adolescents all have to normalise eating behaviours but treatment goals in terms of weight gain may be subject to dispute and depend on how target weights are set [12,13,14]. This is a relevant problem since a considerable proportion of adolescents with restrictive ED start weight loss from a weight or body mass index (BMI) above population average and are not severely underweight at presentation [10, 11, 15, 16]
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