Living With Food: The Science Supporting Eating Disorder Treatment

By, Dr. Mark Warren

In the field of eating disorders, multiple studies have shown that Family Based Treatment (FBT) is the most effective method available to achieve successful weight restoration and maintenance after treatment is completed. Unfortunately, specific treatments for adults have not been shown to have the same long term benefits as FBT. Clearly there are many variables involved in this data, however there are elements to FBT that may point us to a better understanding of what happens for adults.

FBT has 3 distinct phases: refeeding, transition of control from family back to the patient, and addressing normal adolescent issues. All of this happens while the adolescent is in the (hopefully) safe confines of their family. For adults, intensive treatment often stops after refeeding and cessation of behaviors, which would be considered only phase 1 of FBT. It often happens that an adult client is stepped down to a lower level of care from a hospital, residential facility, or partial hospitalization program once refeeding is complete. Step down may be indicated, as a lower level of care may provide more freedom and a chance for a more fulfilling life. The step-down may also be precipitated by insurance concerns or issues related to food, work, or family, as opposed to the completion of treatment. Unfortunately, a potential result of early step-down is that a slow transition to feeding oneself may not occur. Adult patients may find themselves having achieved a healthy weight and have strong motivation and commitment for recovery, but have decreased support around eating and have difficulty with their ability to generalize the skills they have learned in treatment.

FBT clinical experience suggests the treatment for an eating disorder may take years. After refeeding is done, significant external accountability, consultation, management, and therapy are necessary to maintain a healthy weight, motivation, and physical safety. Without a good treatment team and a supportive community maintaining recovery is very difficult. Our hope for any individual with an eating disorder is not only that they achieve goal weight, but that they achieve the ability to feed themselves and that they are able to fight against eating disorder thoughts and urges. There will be many bumps in the road, and many obstacles that may emerge. However, if a long term plan, which will likely extend many years, is developed, that will help patients eat well, have a supportive community, feel better about themselves, their bodies, and their ability to live they life they are striving for, that health and recovery can be achieved.

Should you have any questions or comments regarding this post please email blog@eatingdisoderscleveland.org

Contributions by Sarah Emerman

By, Drs Mark Warren and Lucene Wisniewski

As readers of this blog know, at CCED we have fully committed to Family Based Treatment (FBT). That being said, like many others in the field we have found that doing FBT can be extremely stressful for the family. Both child and parents are likely to experience the re-feeding process as being taxing on their relationship, their lives, and their ability to focus on other enjoyable actives.

Based on our experience and the feedback we have received from families, we have a sense that by providing increased support for parents and adolescents, FBT can be made more tolerable and thus more accessible to a greater number of families.

There are several ways in which we supplement standard Maudsley FBT. For the adolescents, our programs focus on eating meals prepared and provided by parents, and learning Cognitive Behavioral and Dialectical Behavioral Therapy skills to improve the ability to manage the re- feeding process. We also provide groups to help the adolescents develop relationships with other clients to diminish isolation and stigma during this stressful time. For parents, we provide up to 6 hrs per week of parental support either with staff or other parents whose children are also involved in FBT.

The ability for daily on-site face-to-face contact with other parents appears to be of much value and in many cases parents have stayed in contact after treatment and continued to provide support to one and other. It is our experience that by providing parental support, meal time assistance, teaching skills to adolescents, and creating a greater community of other families that the entire FBT process can be made easier for family members to tolerate the re-feeding process and feel supported.

If you are a parent who is currently doing FBT with your child and would like additional support we encourage you to reach out to other parents and clinicians who understand the process you’re experiencing. We suggest looking to Maudsley Parents and FEAST to make these connections.

Should you have any questions or comments regarding this post please email blog@eatingdisorderscleveland.org

Contributions by Sarah Emerman