Jocelyn Lebow1,2, Angela Mattke3, Cassandra Narr3, Paige Partain3, Renee Breland3, Janna R Gewirtz O'Brien4, Jennifer Geske5, Marcie Billings4, Matthew M Clark6, Robert M Jacobson7,3,5, Sean Phelan5, Cynthia Harbeck-Weber6, Daniel Le Grange8,9, Leslie Sim6. 1. Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. lebow.jocelyn@mayo.edu. 2. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA. lebow.jocelyn@mayo.edu. 3. Department of Pediatric and Adolescent Medicine, Mayo Clinic School of Medicine, Rochester, MN, USA. 4. Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA. 5. Department of Health Science Research, Mayo Clinic School of Medicine, Rochester, MN, USA. 6. Department of Psychiatry and Psychology, Mayo Clinic School of Medicine, 200 First Street SW, Rochester, MN, 55905, USA. 7. Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, MN, USA. 8. Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA. 9. Department of Psychiatry & Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA.
Abstract
BACKGROUND: Family-Based Treatment (FBT) is considered the first-line intervention for adolescent anorexia nervosa. However, access to this treatment is limited. Treatment programs for other pediatric mental health conditions have successfully overcome barriers to accessing evidence-based intervention by integrating mental health services into primary care. This study evaluated the proof-of-concept of a novel modification of FBT, Family-Based Treatment for Primary Care (FBT-PC) for adolescent restrictive eating disorders designed for delivery by primary care providers in their practices. METHODS: This retrospective clinical cohort study evaluated 15 adolescents with restrictive eating disorders receiving FBT-PC and 15 adolescents receiving standard FBT. We examined improvement in BMI percentile, reduction in weight suppression, and clinical benchmarks of eating disorder recovery including weight restoration to > 95% of expected body weight (EBW) and resolution of DSM-5 criteria for eating disorders. RESULTS: In both groups, effect sizes for increased BMI percentile exceeded Cohen's convention for a large effect (FBT-PC: d = .94; standard FBT: d = 1.15) as did effect sizes for reduction in weight suppression (FBT-PC: d = 1.83; standard FBT: d = 1.21). At the end of treatment, 80% of the FBT-PC cohort and 87% in the standard FBT group achieved > 95%EBW and 67% in the FBT-PC group and 60% in the standard FBT group no longer met DSM-5 criteria for an eating disorder. There were no cohort differences in the number of treatment drop-outs or referrals to a more intensive level of eating disorder treatment. CONCLUSIONS: Findings suggest that primary care providers have potential to improve weight and clinical status in adolescents with restrictive eating disorders. Based on these results, more rigorous testing of the FBT-PC model is warranted.
BACKGROUND: Family-Based Treatment (FBT) is considered the first-line intervention for adolescent anorexia nervosa. However, access to this treatment is limited. Treatment programs for other pediatric mental health conditions have successfully overcome barriers to accessing evidence-based intervention by integrating mental health services into primary care. This study evaluated the proof-of-concept of a novel modification of FBT, Family-Based Treatment for Primary Care (FBT-PC) for adolescent restrictive eating disorders designed for delivery by primary care providers in their practices. METHODS: This retrospective clinical cohort study evaluated 15 adolescents with restrictive eating disorders receiving FBT-PC and 15 adolescents receiving standard FBT. We examined improvement in BMI percentile, reduction in weight suppression, and clinical benchmarks of eating disorder recovery including weight restoration to > 95% of expected body weight (EBW) and resolution of DSM-5 criteria for eating disorders. RESULTS: In both groups, effect sizes for increased BMI percentile exceeded Cohen's convention for a large effect (FBT-PC: d = .94; standard FBT: d = 1.15) as did effect sizes for reduction in weight suppression (FBT-PC: d = 1.83; standard FBT: d = 1.21). At the end of treatment, 80% of the FBT-PC cohort and 87% in the standard FBT group achieved > 95%EBW and 67% in the FBT-PC group and 60% in the standard FBT group no longer met DSM-5 criteria for an eating disorder. There were no cohort differences in the number of treatment drop-outs or referrals to a more intensive level of eating disorder treatment. CONCLUSIONS: Findings suggest that primary care providers have potential to improve weight and clinical status in adolescents with restrictive eating disorders. Based on these results, more rigorous testing of the FBT-PC model is warranted.
Entities:
Keywords:
Adolescent; Anorexia nervosa; Feeding and eating disorders; Pediatrics; Primary health care
Authors: W Stewart Agras; James Lock; Harry Brandt; Susan W Bryson; Elizabeth Dodge; Katherine A Halmi; Booil Jo; Craig Johnson; Walter Kaye; Denise Wilfley; Blake Woodside Journal: JAMA Psychiatry Date: 2014-11 Impact factor: 21.596
Authors: Daniel Le Grange; Elizabeth K Hughes; Andrew Court; Michele Yeo; Ross D Crosby; Susan M Sawyer Journal: J Am Acad Child Adolesc Psychiatry Date: 2016-05-25 Impact factor: 8.829
Authors: Gabriëlle E van Son; Daphne van Hoeken; Eric F van Furth; Gé A Donker; Hans W Hoek Journal: Int J Eat Disord Date: 2010-03 Impact factor: 4.861