Implementation of family‐based treatment for Asian adolescents with anorexia nervosa: A consecutive cohort examination of outcomes

Chew, Chu Shan Elaine; Kelly, Siobhán; Tay, Elaine; Baeg, Amerie; Khaider, Khairunisa Binte; Oh, Jean Yin; Rajasegaran, Kumudhini; Saffari, Seyed Ehsan; Davis, Courtney

doi:10.1002/eat.23429

Cited by 13 publications

(18 citation statements)

References 42 publications

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“…In the field of EDs, data is now emerging regarding how evidence-based treatments perform in everyday clinical practice. For adolescents with AN, results from naturalistic studies in private and public healthcare settings indicate outcomes are similar to those reported in RCTs [ 11 – 14 ]. Approximately 44–57% of young people reach weight restoration (when this is defined as achieving 95% mBMI) at one year from the start of FBT [ 11 – 14 ].…”

Section: Introductionmentioning

confidence: 64%

“…For adolescents with AN, results from naturalistic studies in private and public healthcare settings indicate outcomes are similar to those reported in RCTs [ 11 – 14 ]. Approximately 44–57% of young people reach weight restoration (when this is defined as achieving 95% mBMI) at one year from the start of FBT [ 11 – 14 ]. Furthermore, consistent with findings from RCTs, FBT in the community may be superior to other treatments at achieving weight restoration for adolescent AN [ 14 ].…”

Section: Introductionmentioning

confidence: 64%

“…Approximately 44–57% of young people reach weight restoration (when this is defined as achieving 95% mBMI) at one year from the start of FBT [ 11 – 14 ]. Furthermore, consistent with findings from RCTs, FBT in the community may be superior to other treatments at achieving weight restoration for adolescent AN [ 14 ]. Very little is known about bulimia nervosa and whether treatment outcomes in real world clinical settings matches RCTs findings.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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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.

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Section: Introductionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

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

et al. 2022

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“…Family-based therapy (FBT) has been shown to improve patient outcomes in children/adolescents with anorexia nervosa (AN) in Singapore13 15 and globally 16–18. Early diagnosis is also a critical prognostic factor 19 20…”

Section: Introductionmentioning

confidence: 99%

Evolution of paediatric eating disorders in Singapore: a historical cohort study

2022

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ObjectiveMost eating disorders (EDs) develop during adolescence, impacting a critical period of development. There is limited research on EDs in children in Singapore or the rest of South-East (SE) Asia.DesignWe analysed a hospital-based cohort of paediatric patients (≤18 years) with EDs (n=177) in Singapore between 2011 and 2021. Historical trends, over three decades, were obtained by comparison with two previously published Singapore studies.ResultsOf the 177 patients, the majority 158 (89%) were females, with anorexia nervosa (AN) 151 (85%). The mean age at diagnosis was 14.6 (SD 1.8) years. For AN, the mean duration of illness before diagnosis was 8.3 (SD 6.3) months and this has decreased by 8.4 months (95% CI 4.5 to 12.3 months, p=<0.0001) from the 2003 to 2010 cohort, and 17.7 months (95% CI 12.6 to 22.8 months, p=<0.0001) from the 1994 to 2002 cohort. Avoidant/restrictive food intake disorder (ARFID) cases are increasing, and the clinical profile differs from other EDs. Since family-based therapy (FBT) was introduced for patients with AN, the remission rate at 1 year improved from 30% to 79%, and time to remission has decreased from 16 to 7.5 months.ConclusionsAN is the most common ED in paediatric patients in Singapore. Over the past three decades, EDs are being diagnosed earlier. FBT has emerged as the most effective treatment for AN. ARFID is being diagnosed more frequently. Data suggest that EDs are prevalent and increasing among adolescents in SE Asia. Singapore is a good test case for SE Asia, but research and attention to the problem in the region is needed.

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“…Therefore, early diagnosis and the provision of timely and effective treatment is highly cost-effective. However, it should be noted that the psychological therapies provided in a western context may not be suitable in a different cultural setting [ 53 ], meaning that therapies may need to be adapted to accommodate different social norms and cultural beliefs [ 54 , 55 ]. Furthermore, visiting mental health facilities is still a cultural taboo in the Middle East and many patients resort to self-diagnosis and self-medication [ 56 , 57 ], often seeking help from herbal remedies or alternative medicine [ 58 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of the burden of anorexia nervosa in the Middle East and North Africa region between 1990 and 2019

et al. 2022

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Background Anorexia nervosa (AN) is a complex and heritable psychiatric disorder, which imposes significant mortality and morbidity on sufferers globally. We aimed to report the prevalence, incidence and disability-adjusted life-years (DALYs) attributable to AN in the Middle East and North Africa (MENA) region by age, sex and socio-demographic index (SDI), between 1990 and 2019. Methods The disease burden attributable to AN was obtained for the 21 countries located in the MENA region between 1990 and 2019 using publicly available data from the Global Burden of Disease (GBD) 2019 study. All estimates were provided as counts and age-standardized rates per 100,000 population, along with 95% uncertainty intervals (UIs). Results In 2019, the estimated age-standardised point prevalence and incidence rate of AN (per 100,000) in MENA were 49.3 (95% UI: 34.6–70.4) and 16.0 (11.3–22.0), which were 11.4% (7.3–15.4) and 5.9% (2.6–9.1) higher than in 1990, respectively. Furthermore, the regional age-standardised DALY rate was 10.6 (6.3–17.0) per 100,000 in 2019, which was 11.8% (5.2–19.1) higher than in 1990. In 2019, Kuwait [17.3 (10.3-27.9)] and Afghanistan [6.3 (3.7-10.3)] had the highest and lowest age-standardised DALY rates, respectively. In addition, Iran showed the largest increases in the age-standardised point prevalence [30.0% (24.1–36.2)], incidence [24.6% (18.6–30.4)] and DALY [30.5% (22.6–38.9)] rates between 1990 and 2019. In 2019, the number of prevalent cases and prevalence estimates peaked in the 15–19 age group for males and the 20–24 age group for females, with females having a higher number of cases and prevalence in all age groups. In 2019, the age-standardised DALY rates in MENA were higher than the global rates among males aged 10–34 years, but were lower than the global estimates among females in almost all age groups. In addition, the burden of AN was positively associated with the level of socio-economic development during the measurement period. Conclusions The burden of AN in the MENA region increased between 1990 and 2019, which indicates that it is likely to become a more serious public health issue in the future. Up-to-date information about the epidemiological trends in the region would allow health policymakers to make informed and appropriate decisions to help address this issue. Plain English summary The findings of the present study showed that the point prevalence and incidence rate of anorexia nervosa have increased in the Middle East and North Africa region between 1990 and 2019. The highest burden in 2019 was found in Kuwait, while Afghanistan had the lowest attributable burden. In addition, between 1990 and 2019 Iran had the largest increase in the point prevalence of anorexia nervosa. Also in 2019, anorexia nervosa was more prevalent in females and peaked in the 15–19 age group for males and the 20–24 age group for females. Furthermore, as the level of socioeconomic development increased, so did the burden attributable to anorexia nervosa.

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Implementation of family‐based treatment for Asian adolescents with anorexia nervosa: A consecutive cohort examination of outcomes

Cited by 13 publications

References 42 publications

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

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

Evolution of paediatric eating disorders in Singapore: a historical cohort study

Comparison of the burden of anorexia nervosa in the Middle East and North Africa region between 1990 and 2019

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