Treatment outcomes for eating disorders in Sweden: data from the national quality registry

Abstract

ObjectiveTo report the outcomes of eating disorders treatment in Sweden in 2012–2016.DesignThe number of patients treated and the number of patients not fulfilling an eating disorders diagnosis (remission) at 1 year of follow-up at the clinics listed in the National Quality Registry for Eating Disorders Treatment were analysed. The published outcomes at three clinics, which used survival analysis to estimate outcomes, were compared with their outcomes in the registry. Outcomes at the three biggest clinics were compared.SettingAll eating disorders clinics.ParticipantsAll patients treated at eating disorders clinics.InterventionCognitive–behavioural therapy at most clinics and normalisation of eating behaviour at the three clinics with published outcomes.Outcome measureProportion of patients in remission.ResultsAbout 2600 patients were treated annually, fewer than half were followed up and remission rates decreased from 21% in 2014 to 14% in 2016. Outcomes, which differed among clinics and within clinics over time, have been publicly overestimated by excluding patients lost to follow-up. The published estimated rate of remission at three clinics that treated 1200 patients in 1993–2011 was 27%, 28% and 40% at 1 year of follow-up. The average rate of remission over the three last years at the biggest of these clinics was 36% but decreased from 29% and 30% to 16 and 14% at the two other of the biggest clinics.ConclusionsWith more than half the patients lost to follow-up and no data on relapse in the National Quality Registry, it is difficult to estimate the effects of eating disorders treatment in Sweden. Analysis of time to clinically significant events, including an extended period of follow-up, has improved the quality of the estimates at three clinics. Overestimation of remission rates has misled healthcare policies. The effect of eating disorders treatment has also been overestimated internationally.

Temperature but not leptin prevents semi-starvation induced hyperactivity in rats: implications for anorexia nervosa treatment

“…Bearing in mind the current absence of effective treatments for AN [53][54][55] , the findings of this study reinforce previous research performed with the ABA procedure [25][26][27] , and call for translational research exploring the therapeutic utility of heat in the treatment of hyperactivity in AN 56 . Notably, providing patients with a warming environment of 32 °C has also shown to be useful in reducing postprandial anxiety in AN patients 57 , strengthening previous evidence of the beneficial effect of adding active warming in the treatment of hyperactivity in AN patients [58][59][60][61][62] .…”

Eating Behavior and the Evolutionary Perspective on Anorexia Nervosa

“…In Sweden, 15,411 patients were similarly treated in years 2012–2017 with a rate of remission of 18.4% at one year follow-up (Birgegård and Norring, 2019). There are no major differences between these outcomes and the outcomes in the specialized clinics in Sweden and other countries (Södersten et al, 2017, 2019).…”

“…More patients go into remission in the long-term by re-learning how to eat than if treated with CBT (Södersten et al, 2017, 2019). The difference in outcome is unlikely due to difference in the state of the patients at admission.…”

“…Our patients are followed for 5 years after treatment, including eleven appointments (Bergh et al, 2002, 2013) and, at present, we are examining if their physical characteristics and their eating behavior more closely resembles those of healthy women once they have completed the follow-up program. Yet, at the present state of knowledge, it is reasonable to suggest that patients with eating disorders should be offered the chance to practice eating using the device that has now restored the physical and mental health of hundreds of patients (Bergh et al, 2013; Södersten et al, 2017, 2019). Eating behavior thus treated makes it less important, albeit perhaps not unimportant, to treat cognitive processes (Södersten et al, 2017), although evidence that these interventions are redundant was presented 31 years ago (Freeman et al, 1988).…”

Treating Eating: A Dynamical Systems Model of Eating Disorders

“…Mainstream treatments are often unsuccessful in treating either the disordered eating behaviors or the psychological problems associated with them. Outcome studies and systematic reviews of psychotherapeutic and inpatient treatments (some also including drug treatment) for eating disorders typically show that although some patients may experience symptomatic improvement in the short term, dropouts from treatment are high, many patients relapse after the end of treatment, long-term outcomes are often unknown, and deaths during or after treatment are not uncommon, especially in AN ( Steinhausen, 2002 , 2009 ; Lock et al, 2006 ; Berkman et al, 2007 ; Keel and Brown, 2010 ; Kass et al, 2013 ; Watson and Bulik, 2013 ; Södersten et al, 2017 , 2019a ; Zeeck et al, 2018 ; Fisher et al, 2019 ).…”