Research: Medical Complications
Research: The Maudsley Method/FBT
- Moderators and mediators of remission in family-based treatment and adolescent focused therapy for anorexia nervosa. from Behaviour Research and Therapy, February 2012 "Taken together, these results indicate that patients with more severe eating related psychopathology have better outcomes in a behaviorally targeted family treatment (FBT) than an individually focused approach (AFT)."
- Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa, from the Archives of General Psychiatry, October 2010
- Psychotherapy approaches for adolescents with eating disorders, in Current Opinion in Pediatrics, August 2009. "Regardless of the modality used, some degree of family involvement is important in limiting dropout and improving outcomes"
- The Maudsley Model of Family-Based and Parent-to-Parent Consultation, Journal of Marital and Family Therapy, April 2009. "Parents described parent-to-parent consultations as an intense emotional experience that helped them to feel less alone, to feel empowered to progress, and to reflect on changes in family interactions. These results suggest that parent-to-parent consultations are seen as a useful augmentation to the Maudsley model of family-based treatment for anorexia nervosa."
- Family therapy in the treatment of adolescent anorexia nervosa: current research evidence and its therapeutic implications. Eating and Weight Disorders, December 2008. "This article summarizes present empirical evidence concerning both family functioning (explanatory dimension) and the effectiveness of family therapy (therapeutic dimension) in anorexia nervosa, and describes resulting changes in theoretical and clinical perspectives."
- Family Interventions in Adolescent Anorexia Nervosa, by Daniel le Grange, PhD, and Ivan Eisler, PhD, 2008 (pre-press copy by special permission of the publisher)
- The Assessment of the Family of People with Eating Disorders, from the European Eating Disorders Review, 2008. "The National Institute for Clinical Excellence (NICE) guidelines for eating disorders recommend that carers should be provided with information and support and that their needs should be considered if relevant. The aim of this paper is to describe how to structure an assessment of carers needs so that the family factors that can contribute to the maintenance of eating disorder symptoms are examined."
F.E.A.S.T. is honored to make available, by permission of the authors and Elsvier, pre-press text of:
Family Interventions in Adolescent Anorexia Nervosa, Daniel le Grange, PhD, and Ivan Eisler, PhDc. Child Adolesc Psychiatric Clin N Am 18 (2008) 159-173
Research: Early Intervention
- The relevance of body weight in the medium-term to long-term course of adolescent anorexia nervosa. Findings from a multisite study. from the International Journal of Eating Disorders, January 2009. "Higher BMI prior to onset of AN, higher BMI at first discharge, and lower age at first admission predicted a normal BMI (>17.5) at follow-up in a model of logistic regression."
- The case for early intervention in anorexia nervosa: theoretical exploration of maintaining factors from The British Journal of Psychiatry, July 2011 "Moreover, the group with an onset in adolescence but who had been ill for over 3 years had a poor response to both family and individual therapy, suggesting that unless effective treatment is given within the first 3 years of illness onset, the outcome is poor."
- Early identification and treatment of eating disorders: prodrome to syndrome from Early Intervention in Psychiatry
Volume 1, Issue 1, pages 27–39, February 2007 "The onset of eating disorder psychopathology is most common in the adolescent age group with acute psychopathology perhaps less intractable in these young patients. However, the maintenance of dysfunctional eating patterns over time appears to increase the likelihood for chronicity to develop. With chronicity appearing to be a reliable predictor for poor outcome, prevention through early intervention in younger age groups would likely lead to better outcomes with the prevention of chronicity as a key goal."
- Early intervention in eating disorders: a parent group approach. Early Interv Psychiatry. 2012 Nov;6(4):357-67. doi: 10.1111/j.1751-7893.2012.00373.x. Epub 2012 Jul 3. "Early intervention in eating disorders (EDs) has been a neglected area. Peak onset is in adolescence, suggesting that early intervention should include parents. We synthesize findings from five key theoretical domains, and present pilot data from a phase-specific early intervention for new onset EDs in young people."
Research: Malnutrition and Re-feeding
- The slippery slope: prediction of successful weight maintenance in anorexia nervosa
By special permission, Practice Paper of the American Dietetic Association: Nutrition Intervention in the Treatment of Eating Disorders
- Why is Food Medicine? The Functional Role of Nutrition by Dr. Sarah Ravin for FEAST
- They Starved So That Others Be Better Fed: Remembering Ancel Keys and the Minnesota Experiment
- Refeeding syndrome – awareness, prevention and management, full text article from Head & Neck Oncology 2009; 1: 4. Published online 2009 January 26.
- Abnormal distribution normalizes within a 1-y period of weight maintenance, American Journal of Clinical Nutrition, November 2009 AJCN.27820 Conclusions: "In adult women with AN, normalization of weight in the short term is associated with a distribution of adipose tissue that is consistent with a central adiposity phenotype. This abnormal distribution appears to normalize within a 1-y period of weight maintenance."
- "Does Percent Body Fat Predict Outcome in Anorexia Nervosa", Am J Psychiatry 2007;164:970-972. doi:10.1176/appi.ajp.164.6.970 Results: In a binary logistic regression model examining the effect of percent body fat, body mass index, anorexia nervosa subtype, waist-to-hip ratio, and serum cortisol and leptin levels on treatment outcome, only percent body fat was significantly associated with outcome. Conclusions: In recently weight-restored women with anorexia nervosa, lower percent body fat was associated with poor long-term outcome.
- "intake of energy-dense foods and a greater variety of foods may be crucial to relapse prevention"
- Seasonality and the prediction of weight at resumption of menses in anorexia nervosa
Research: AN Outcome Predictors
The following factors seem to predict better recovery rates for patients with Anorexia Nervosa:
Research: EDs and Sports
- Sport and Eating Disorders - Understanding and Managing the Risks, A. Currie, MD, Asian J Sports Med. June 2010
- Prevalence of eating disorders in elite athletes is higher than in the general population, Clin J Sport Med. January 2004
- The Female Athlete Triad: An Emerging Role for Physical Therapy, P. Papanek, J Orthop Sports Phys Ther. 2003, "Briefly, when coupled with inadequate nutrition, the high caloric expenditure of exercise training results in a sustained negative caloric balance or low energy availability, which is exquisitely sensed by the hypothalamus, initiating a complex neuroendocrine adaptive cascade. This cascade is associated with changes in the hypothalamic-pituitary-ovarian axis, such that estrogen levels are decreased, resulting in reproductive dysfunction that may include amenorrhea, oligomenorrhea, or anovulation. Low estrogen in otherwise young healthy women, like menopause, is associated with decreased bone mineral density and increased risk of fractures. The triad is not an inevitable consequence of participation in sports or physical activity at any level, however, exercise may contribute to the disruption of caloric balance."
Research: Maintaining Factors
Research: Resistance to Treatment
- Treatment of Anorexia Nervosa against the Patient’s Will: Ethical Considerations
by Tomas J. Silber, MD Reproduced by permission of the American Academy of Pediatrics: Silber TJ. Treatment of anorexia nervosa against the patient's will: ethical considerations. Adolesc Med State Art Rev. 2011;22(2):283-8, x. "The central issue surrounding involuntary treatment is not whether the patient lacks the capacity to consent or refuse treatment but rather the context and relationships involved in quality care. At the end it is always values that underlie and strengthen the good work. These include fundamental respect for the person, even as liberty is restricted; beneficence; and truth telling."
- Perceived Coercion and Change in Perceived Need for Admission in Patients Hospitalized for Eating Disorders Conclusions: "Nearly half of patients with eating disorders who denied a need for treatment on admission converted to acknowledging that they needed to be admitted within 2 weeks of hospitalization."
Research: Evidence-Based Treatment