From efficacy to effectiveness: child and adolescent eating disorder treatments in the real world (part 1)—treatment course and outcomes

Abstract

Background Findings from randomised control trials inform the development of evidence-based eating disorder (ED) practice guidelines internationally. Only recently are data beginning to emerge regarding how these treatments perform outside of research settings. This study aimed to evaluate treatment pathways and outcomes for a specialist child and adolescent ED service across a five-year period. Methods All consecutive referrals between August 2009 and January 2014 seen at the Maudsley Centre for Child and Adolescent Eating Disorders in London were included. Data are reported on for all young people who were offered treatment (N = 357). Results Most young people referred to the service were diagnosed with anorexia nervosa (AN)/Atypical AN (81%). Treatment for AN/Atypical AN (median 11 months) was predominantly ED focused family therapy (99%). Treatment for bulimia nervosa (BN)/Atypical BN (median seven months) was most commonly a combination of cognitive behavioural therapy and ED focused family therapy (87%). At discharge, 77% of the AN/Atypical AN group had a good or intermediate outcome and 59% of the BN/Atypical BN group reported no or fewer than weekly bulimic episodes. 27% of the AN/Atypical AN group had enhanced treatment with either day- and/or inpatient admissions (AIM group). The %mBMI at 3 months of treatment was strongest predictor of the need for treatment enhancement and more modestly EDE-Q and age at assessment. The AIM group at assessment had significantly lower weight, and higher ED and comorbid symptomatology and went on to have significantly longer treatment (16 vs. 10 months). At discharge, this group had significantly fewer good and more poor outcomes on the Morgan Russell criteria, but similar outcomes regarding ED and comorbid symptoms and quality of life. When analysis was adjusted for %mBMI at assessment, 1 and 3 months of treatment, differences in Morgan Russell outcomes and %mBMI were small and compatible with no difference in outcome by treatment group. Conclusions This study shows that outcomes in routine clinical practice in a specialist community-based service compare well to those reported in research trials. The finding from research trials that early weight gain is associated with improved outcomes was also replicated in this study. Enhancing outpatient treatment with day treatment and/or inpatient care is associated with favourable outcome for most of the young people, although a longer duration of treatment is required.

Characterizing changes in obsessive–compulsive symptoms over the course of treatment for adolescent bulimia nervosa

“…Results probing changes in general OC symptoms suggested no significant decreases over the course of treatment and follow‐up. Although this finding contrasts with prior research suggesting that comorbid symptoms (e.g., anxiety; depression) may decrease in FBT and CBT (Le Grange et al, 2020; Simic et al, 2022; Trainor et al, 2020), the focus in FBT and CBT is intently on ED symptoms; therefore, additional intervention is likely required to bring about change in obsessions or compulsions more generally; it is also possible that these findings are related to the relatively low levels of general OC symptoms in our sample and would be different in a larger sample with greater symptom elevations or clinically‐diagnosed OCD. It is finally possible that despite some work suggesting that OCD is present in BN samples, they may be less clinically important or present differently in BN samples than they do in AN samples.…”

Perceived change mechanisms in multi‐family therapy for anorexia nervosa: A qualitative follow‐up study of adolescent and parent experiences

“…All participants in this study received outpatient MFT for anorexia nervosa (MFT‐AN; Simic et al., 2021) alongside single‐family therapy for anorexia nervosa (FT‐AN; Eisler, Simic, Blessitt, et al., 2016). MFT‐AN groups of up to eight families per group are delivered five to six times per year at MCCAED (see Simic et al., 2022 for service description and outcomes). Not all young people who receive FT‐AN attend MFT‐AN.…”

Implementing service transformation for children and adolescents with eating disorders across England: the theory, politics, and pragmatics of large-scale service reform

“…Initially, this was a small team providing outpatient treatment which was informed by findings showing the efficacy of family therapy for EDs. Over 90% of referrals were treated purely as outpatients with audit data showing good clinical outcomes and relatively low relapse rates (a recent case series and 7-year follow-up shows results that compare favourably with findings reported in RCTs [ 51 , 52 ]). As the service expanded into a more comprehensive multidisciplinary team (including psychiatry, psychology, family therapy, paediatrics, nursing, dietetics) it established itself as the main treatment provider for child and adolescent EDs for seven London boroughs covering a population catchment area of approximately 2.2 million.…”