The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders

Crone, Catherine; Fochtmann, Laura J.; Attia, Evelyn; Boland, Robert; Escobar, Javier I.; Fornari, Victor; Golden, Neville H.; Guarda, Ángela S.; Jackson-Triche, Maga; Manzo, Laurie; Mascolo, Margherita; Pierce, Karen; Riddle, Megan; Seritan, Andreea L.; Uniacke, Blair; Zucker, Nancy; Yager, Joel; Craig, Thomas J.; Hong, Seung-Hee; Medicus, Jennifer

doi:10.1176/appi.ajp.23180001

Cited by 79 publications

(85 citation statements)

References 27 publications

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“…Our findings have some clinical and public health relevance and may help healthcare professionals to treat BESC. For example, patients could benefit from nutritional counseling to increase the variety and the quality of foods consumed, providing a healthy and regular eating pattern that may help to reduce/eliminate binge eating episodes [ 66 ]. Further, although clinicians must be aware of the role of highly palatable and energy-dense foods, such as chocolates, sweets, and sugar-sweetened beverages as triggers for binge eating episodes, they should also encourage patients to consume such foods moderately, as a part of a balanced diet, reducing the eating restriction which may lead to overeating.…”

Section: Discussionmentioning

confidence: 99%

“…Further, although clinicians must be aware of the role of highly palatable and energy-dense foods, such as chocolates, sweets, and sugar-sweetened beverages as triggers for binge eating episodes, they should also encourage patients to consume such foods moderately, as a part of a balanced diet, reducing the eating restriction which may lead to overeating. In addition, people with BESC may benefit from a person-centered multidisciplinary care, involving psychiatrists, psychologists, and dietitians [ 66 ]. Finally, middle-income countries (e.g., Brazil) should develop public health strategies focused on nutritional education and healthy lifestyle, which could help decrease the clinical and social impairment of these conditions in this setting [ 67 , 68 ].…”

Section: Discussionmentioning

confidence: 99%

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Food Consumption during Binge Eating Episodes in Binge Eating Spectrum Conditions from a Representative Sample of a Brazilian Metropolitan City

et al. 2023

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The prevalence of binge eating spectrum conditions (BESC) are increasing globally. However, there is a lack of data from general population samples in low- and middle-income countries. Thus, this study described the food consumption during objective binge eating episodes (OBE) in people with BESC from a metropolitan city in Brazil. Participants comprised 136 adults (18 years old–60 years old) with Binge Eating Disorder (BED), Bulimia Nervosa (BN), or recurrent binge eating (RBE) from a two-phase epidemiological survey. They were interviewed in their homes by trained lay interviewers using the Questionnaire on Eating and Weight Patterns updated for the DSM-5 to assess BESC diagnosis and food consumption during a typical OBE. Overall, participants consumed a mean of 1067 kcal during the episodes. For the most part, these calories were derived from carbohydrates (58%) and lipids (30%), irrespective of the diagnosis. Regarding food item consumption, individuals with BED and RBE consumed staple foods (mainly rice and beans) more frequently than those with BN. Conversely, participants with BN ingested sugar-sweetened beverages more frequently than the BED group. In conclusion, there were differences in the eating patterns of individuals with BESC in Brazil. BED and RBE participants consumed more typical foods, whereas those with BN preferred foods with a high content of energy during their OBE.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Food Consumption during Binge Eating Episodes in Binge Eating Spectrum Conditions from a Representative Sample of a Brazilian Metropolitan City

et al. 2023

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“…An individual's journey is unique and dependent on numerous factors, such as treatment availability, life stage, attitudes and beliefs about treatment, symptom severity, medical stability, residential location, and financial constraints of the individual 3,11,14,23 . Furthermore, recent North American clinical practice guidelines emphasise the need for person‐centred, recovery‐oriented and least restrictive care 12,13 . Improving access locally, individuals with a clinical diagnosis of anorexia nervosa, bulimia nervosa, binge eating disorder or OSFED (but not ARFID, which is a notable inequity) are eligible to access up to 40 psychological treatment sessions and 20 dietetic sessions in a 12‐month period through an eating disorder treatment and management plan under the Medicare Benefits Schedule (MBS) 10,40 …”

Section: Management Of Eating Disorders Overviewmentioning

confidence: 99%

“…Treatments for eating disorders typically encompass, but are not limited to, psychological, pharmacological, medical, nutritional, and physical activity interventions. As such, contemporary clinical practice guidelines recommend a multidisciplinary approach to optimise treatment outcomes 3,11,12,14,41 . Thus, the implementation of an eating disorder treatment and management plan often requires health care professionals working together as a formal (physically co‐located) or virtual (online) team through interprofessional collaborative practice, 41,42 with each clinician practising within their competency and scope of professional practice.…”

Section: Management Of Eating Disorders Overviewmentioning

confidence: 99%

Current approaches in the recognition and management of eating disorders

Hay

Rankin

Ramjan

et al. 2023

Medical Journal of Australia

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Summary Eating disorders are now well acknowledged mental health problems that are common and present in people from diverse sociodemographic backgrounds. The past decade has seen a rapid expansion in research into eating disorder interventions. In response to the increasing burden of eating disorders, the Australian Government Department of Health and Aged Care has implemented significant policy changes to improve patient access to Medicare and inpatient treatment facilities. There are several international clinical practice guidelines and a robust evidence base particularly for first line care with specific psychological therapies, including guidelines for the management of eating disorders in individuals with a high weight. Medications play an important adjunct role in care, and novel neuromodulating treatments, such as psychostimulants, are under study. There is emerging evidence for increased person‐centred care, with more choice in the form of alternatives to hospital inpatient programs and more respectful consideration of care for all who experience an eating disorder, including people with high weight.

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“…Current recommendations for LCR start around 1200 kcal/day and advance by 200 kcal every other day (American Dietetic Association, 2006). Higher calorie refeeding, starting between 1500 and 2000 kcal/day, advances more quickly—by 200 kcal/day (Crone et al, 2023). Building on numerous studies demonstrating the feasibility of HCR (Maginot et al, 2017; Parker et al, 2016; Smith et al, 2016), recent evidence from the Study of Refeeding to Optimize iNpatient Gains (StRONG)—the first randomized clinical trial (RCT) comparing HCR to LCR—demonstrated that HCR is more efficacious than LCR for adolescents and young adults hospitalized with AN and atypical AN (AAN), with significantly briefer hospitalizations (by an average of 4 days; Garber et al, 2021) and without increased safety events or hospital readmissions (Golden et al, 2021).…”

Section: Introductionmentioning

confidence: 99%

Hospital‐based higher calorie refeeding and mealtime distress in adolescents and young adults with anorexia nervosa or atypical anorexia nervosa

Accurso

Cheng

Machen

et al. 2023

Intl J Eating Disorders

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Objective The StRONG study demonstrated that higher calorie refeeding (HCR) restored medical stability faster in patients hospitalized with anorexia nervosa (AN) and atypical AN (AAN), with no increased safety events compared with standard‐of‐care lower calorie refeeding (LCR). However, some clinicians have expressed concern about potential unintended consequences of HCR (e.g., greater mealtime distress). The purpose of this study was to examine patient treatment preference and compare mealtime distress, food refusal, and affective states between treatments. Method Participants (N = 111) in this multisite randomized clinical trial were ages 12–24 years, with AN or AAN, admitted to hospital with medical instability who received assigned study treatment (HCR or LCR). Treatment preference was assessed prior to randomization in the full sample. In a subset of participants (n = 45), linear mixed effect models were used to analyze momentary ratings of mealtime distress (pre, during, and post‐meals) and daily affective state during the hospitalization. Results About half (55%) of participants reported a preference for LCR. Treatment assignment was not associated with food refusal, mealtime distress, or affective states in the subsample. Food refusal increased significantly over the course of refeeding (p = .018). Individuals with greater depression experienced more negative affect (p = .033), with worsening negative affect over time for individuals with higher eating disorder psychopathology (p = .023). Discussion Despite understandable concerns about potential unintended consequences of HCR, we found no evidence that treatment acceptability for HCR differed from LCR for adolescents and young adults with AN and AAN. Public Significance The efficacy and safety of higher calorie refeeding in hospitalized patients with anorexia nervosa has been demonstrated. However, it is not known whether higher calorie refeeding (HCR) increases meal‐time distress. This study demonstrated that HCR was not associated with increased mealtime distress, food refusal, or affective states, as compared with lower calorie refeeding. These data support HCR treatment acceptability for adolescents/young adults with anorexia nervosa and atypical anorexia nervosa.

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The American Psychiatric Association Practice Guideline for the Treatment of Patients With Eating Disorders

Cited by 79 publications

References 27 publications

Food Consumption during Binge Eating Episodes in Binge Eating Spectrum Conditions from a Representative Sample of a Brazilian Metropolitan City

Food Consumption during Binge Eating Episodes in Binge Eating Spectrum Conditions from a Representative Sample of a Brazilian Metropolitan City

Current approaches in the recognition and management of eating disorders

Hospital‐based higher calorie refeeding and mealtime distress in adolescents and young adults with anorexia nervosa or atypical anorexia nervosa

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