Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 132: (i) Family Matters (n = 2); (ii) Weight Stigma, Part 2 (n = 3); (ii) Binge Eating, Part 2 (n = 2); and (iv) Dec 2024 - March 2025 Treatment Interlude, Part 8 (n = 4)
Colleagues (N now = 1346 in 50 countries),
Please (a) continue to send me any and all announcements (e.g., conferences, awards, webinars, prevention resources, your recent publications); and (b) pass along the following to anyone who would like to join this free email list.
EDUCATIONAL/PERSONAL DEVELOPMENT OPPORTUNITY
PROFESSIONAL DEVELOPMENT OPPORTUNITY
Reasons Eating Disorders Center presents a Free Webinar
Beyond the Screen: Harnessing The Power of Connection in Virtual Therapy
Presenters: Lisa Arroyas, RD, CES-D, Sarah Naouchi, MSN, RDN, L. Terrell Williamson, APCC, Rachel Cannon, MA, MFT, and Raylene Hungate, RD/N
Date & Time: Thursday, April 24, 2025, 12 pm - 1 pm PT | 3 pm - 4 pm ET | 7 pm - 8 pm UTC
Received 8 April 2025 via an email from Reasons Eating Disorders Center. Our own Dr. Nikki Rollo, LMFT, CEDS-S, is Executive Director
ML NOTE 1: Dr. Rollo, her colleagues, and I would appreciate it if you would pass this along to any and all who might be interested.
Description: Beyond the Screen: Harnessing The Power of Connection in Virtual Therapy
Presenters: Lisa Arroyas, RD, CES-D, Sarah Naouchi, MSN, RDN, L. Terrell Williamson, APCC, Rachel Cannon, MA, MFT, and Raylene Hungate, RD/N
Date & Time: Thursday, April 24, 2025, 12 pm - 1 pm PT | 3 pm - 4 pm ET | 7 pm - 8 pm UTC
Cost: None; it is free
Registration link: https://tinyurl.com/5f2dnuwk
Description: Effective virtual therapy goes beyond participation—it’s about authentic connection. This interactive workshop explores four key dimensions of connection in virtual care: self, others, the treatment team, and the broader community. Through practical strategies, live demonstrations, and real-world applications, providers will gain tools to enhance engagement, combat Zoom fatigue, and strengthen therapeutic alliance. Learn how Reasons Eating Disorder Center integrates these best practices into our Virtual PHP and IOP programs to create meaningful, structured remote care.
ACCESS TO TREATMENT/RECOVERY ADVOCACY-IN-ACTION ESSAY
Improving Access to and Experiences of Eating Disorder Care
by Alykhan Asaria
Received via the 16 March 2025 Life Stories Diary Newsletter (https://lifestoriesdiary.com) published/curated by our own Recovery Advocate Par Excellence, Author, Bolder Model, Force to Be Reckoned With, and my close friend Dr. June Alexander (Australia).
ML NOTE 2: Below are the first 5 paragraphs of this essay. The entire essay is available for reading and sharing at https://lifestoriesdiary.com/2025/03/17/improving-access-to-eating-disorder-care/.
*ML NOTE 3: The article that June alludes to below, as presented 28 January 2025 in Newsletter NO. 103 (#10), is
Asaria, A. (2025). Improving eating disorder care for underserved groups: A lived experience and quality improvement perspective. Journal of Eating Disorders, 13, 11. https://doi.org/10.1186/s40337-024-01145-2 [Full text available for download at: https://tinyurl.com/3tduxbbv]
Improving Access to and Experiences of Eating Disorder Care, by Alykhan Asaria
*In this first post that June Alexander has adapted from Alykhan Asaria’s article on improving eating disorder care, underserved groups and humanistic eating disorder care are discussed.
This article on improving access to eating disorder (ED) care is informed by my lived experiences, independent research, and involvement in the underappreciated field of quality improvement (QI).
I live in the United Kingdom (UK), so my experiences and QI are of the UK’s National Health Service (NHS). However, this article applies broadly to healthcare providers worldwide, as similar ED care improvements are needed internationally. Furthermore, the latest international research informs this commentary.
I identify and discuss 12 groups of individuals whom I believe are more likely to be underserved in ED care. These 12 ‘underserved groups’ (USGs) comprise:
1. People with longstanding EDs and/or older-age ED sufferers.
2. Younger children/preadolescents.
3. People with under-recognised/underappreciated EDs.
4. People with higher weights.
5. People with comorbidities.
6. People with neurodevelopmental conditions (neurodiverse people).
7. Digitally excluded people.
8. Socioeconomically and/or socio-geographically disadvantaged people.
9. Ethnic/racial minorities.
10. Sexual and gender-diverse people.
11. Males.
12.Caregivers/loved ones.
ED sufferers/caregivers are also an underserved group in general mental health care, so broader factors for improving ED care will be explored in a future article. These factors include stigma, research biases, inadequate clinical monitoring and diagnosing, poor-quality treatments, disorganised service transitions, systemic problems/inefficiencies, and underfunding/under-resourcing. Along with these and other broader issues, specific recommendations for underserved groups must be considered.
I advocate a humanistic care approach based on the inexpensive and “CHEAP” principles of:
Compassion
Hope
Empathy
Appreciation (of identity), and
Patience
Research Publication Categories in This Newsletter
(i) Family Matters (n = 2); (ii) Weight Stigma, Part 2 (n = 3); (ii) Binge Eating, Part 2 (n = 2); and (iv) Dec 2024 - March 2025 Treatment Interlude, Part 8 (n = 4)
CONGRATULATIONS to our own
Dr. Vivienne Hazzard (USA) and colleagues for publication of the Family Matters research article in #1.
Christina Sanzari (USA) and Dr. Janet Lydecker (USA) for publication of the Family Matters research article in #2.
Natala Garcia Moreno (USA), Dr. Catherine Walker (USA), Nathalie Gullo (USA), and colleague for publication of the Weight Stigma research article in #3.
Dr. Kelly Romano (USA) and Carol Peterson (USA) and colleagues—including distinguished scientist-practitioner-mentors Drs. Stephen Wonderlich (USA) and the late Ross Crosby (USA)—for publication of the Binge Eating research article in #6.
Drs. Jennifer Wildes (USA) and Andrea Kass Graham (USA) and colleagues for publication of the Binge Eating research article in #7.
Drs. Amelia Austin (Canada), Katherine Loeb (USA), and Daniel Le Grange (USA) and colleagues, including distinguished scientist-practitioner-mentor Dr. Gina Dimitropoulos (Canada), for publication of the Treatment research article in #9.
FAMILY MATTERS
1. Berge, J. M., Hazzard, V. M., Aqeel, M., Miller, L., & Brandenburg, D. (2025). The influence of family weight talk on health and well-being from childhood to adulthood. Family Relations. Advance online publication. https://doi.org/10.1111/fare.13173
Email address for correspondence: jerica.berge@cuanschutz.edu
ABSTRACT. Objective: The aim of this study was to examine whether exposure to family weight talk as a child was associated with a variety of health and well-being outcomes including weight, eating behaviors, unhealthy weight-control behaviors, self-esteem, body satisfaction, and psychosocial outcomes in adulthood. Background: Prior research shows associations between parent weight talk and higher weight status and depressive symptoms in children and adolescents. Less is known about associations between family weight talk and health and well-being outcomes in children and whether these associations track into adulthood.
Method: Parents (N = 1,131) from families representing six racial or ethnic groups (African American, Hispanic, Hmong, Native American, Somali/Ethiopian, White) were recruited through primary care clinics in Minnesota in 2016–2019. Parents reported retrospectively on exposure to family weight talk as a child and current health and well-being via an online survey. Associations of interest were examined in regression models adjusted for sociodemographic characteristics
Results: Retrospective reports of exposure to family weight talk as a child were significantly associated with higher weight status, engagement in unhealthy weight-control behaviors and binge eating, lower diet quality, lower self-esteem and body satisfaction, and higher depressive and anxious symptoms in adulthood.
Conclusions: Retrospective reports of exposure to family weight talk as a child tracked into adulthood and was associated with a variety of negative health and well-being outcomes. Implications: Results suggest that researchers, clinicians, and family life educators may want to both assess and intervene on family weight talk to mitigate the long-term influence on health and well-being outcomes.
2. Sanzari, C. M., & Lydecker, J. A. (2025). Parental overvaluation of child weight/shape is associated with disordered eating in children beyond associations with parental internalized weight bias. Journal of the American Academy of Nutrition and Dietetics. Advance online publication. https://doi.org/10.1016/j.jand.2025.02.015
Email address for correspondence: janet.lydecker@yale.ed
ABSTRACT. Background: Parental overvaluation (ie, parental identity based on their child’s weight) and parental weight bias internalization (ie, parents’ internalization of societal bias toward people living in larger bodies) are both associated with their children’s disordered eating. Less is known about the extent to which these constructs overlap and how their combination may relate to pediatric disordered eating Objective: This study examined the relationship between parental overvaluation, parental internalized weight bias, and children’s disordered eating to test whether parental overvaluation was associated with disordered eating in children beyond the effects of parental internalized weight bias.
Design: Cross-sectional data were collected from parents in the United States recruited online through Mechanical Turk from March 2021 through January 2022. Participants/setting: Participants included 196 parents (mean age = 38.2 years). Participants were excluded if they were younger than 21 years, lived with their child less than one-half the time, or failed to meet attention and validity checks embedded throughout assessments.
Main outcome measures: Disordered eating in children behaviors (eg, overeating, binge eating, purging, and secretive eating) were evaluated. Statistical analyses performed: Correlations compared parental overvaluation and internalized weight bias. Hierarchical logistical regressions tested the association of internalized weight bias with disordered eating in children behaviors and then whether parental overvaluation significantly contributed to the variance in disordered eating in children eating behaviors beyond the effect of internalized weight bias.
Results: Across all disordered eating in children behaviors, parental internalized weight bias was significant in the first step of the logistic regression when it was the sole variable (all, p < .005). When both variables were included in models, parental overvaluation, but not weight bias, was significantly associated with all disordered eating in children behaviors (all, p < .001). Conclusions: The extent to which a parent evaluates their worth as a parent based on their child’s weight/shape is more strongly associated with disordered eating behaviors in children than with internalized weight bias. More research is needed to determine whether parent-focused treatment for pediatric eating disorders could benefit from strategies aimed at shifting the valued aspects of parental identity away from child weight/shape.
WEIGHT STIGMA, Part 2 of 5
3. Garcia Moreno, N., Walker, D. C., Gullo, N., & O'Dea, C. J. (2025). Weight stigma's effects on misdiagnosis of eating disorders among laypeople and healthcare professionals. International Journal of Eating Disorders, 58(4), 690-702. https://doi.org/10.1002/eat.24374
Email address for correspondence: walkerc@union.edu
ABSTRACT. Objective: There is limited research on weight bias in diagnosing eating disorders (EDs), particularly among healthcare professionals (HCPs). This is especially true for atypical anorexia nervosa, a diagnosis recently described in the DSM that includes people with anorexia nervosa symptoms who are not clinically underweight. Method: Using a within-subjects design, we assessed diagnosis, diagnostic confidence, and ED-related medical knowledge among a sample of lay people and medical professionals. Participants read three clinical vignettes (counterbalanced to avoid order effects) of a woman with anorexia nervosa or atypical anorexia nervosa (described as obese) and were assessed on weight stigma and prior ED medical knowledge
Results: Both lay people and HCPs were less likely to diagnose atypical anorexia nervosa and were less confident in that diagnosis than in the anorexia nervosa vignette condition. Lay participants' diagnostic bias, but not HCPs', was impacted by weight stigma; HCPs' confidence was impacted by weight stigma. In both cases, participants high in weight stigma were more accurate (lay sample) or more confident (HCPs) in diagnoses. Last, greater ED medical knowledge improved accuracy of diagnosis of vignette cases for the HCP sample that included snowball sample recruitment and CloudResearch participants and lay people, but not for the HCP sample recruited via snowball sampling only.
Discussion: These findings highlight the urgency for more public awareness and training for HCPs emphasizing that people of all sizes can present with restrictive eating disorders.
ML NOTE 4: The articles described below in #4 and #5 came to my attention via the Obesity and Energetics Offerings online newsletters of 5 April 2025 and 15 March 2025, respectively. For more information about free participation in this ongoing and valuable exercise in education, research methods, and critical thinking, see Obesity and Energetics Offerings.
4. Khoo, W. S., Chen, Y.-C., Chou, Y.-Y., Pan, Y.-W, Weng, Y.-H., & Tsai, M.-C. (2025). Cross-sectional and longitudinal associations among weight stigma, psychological distress, and eating behaviors in youth with obesity: A clinical sample. Medicina, 61, 466. https://doi.org/10.3390/medicia61030466
Full text available for download at: https://tinyurl.com/3xj5czbt
ABSTRACT. Background and Objectives: Obesity in youth is a growing public health concern, placing them at higher risk for adverse physical and psychological outcomes. Understanding the predictors that affect weight management, particularly the role of internalized weight stigma, psychosocial factors, and eating behaviors, is essential for developing an effective intervention at longitudinal follow-up. Materials and
Methods: We enrolled 102 youths with obesity aged 10 to 18 years old from clinical settings. Baseline demographic data, psychosocial measures, including the Weight Self-Stigma Questionnaire (WSSQ) and Hospital Anxiety and Depression Scale (HADS), and eating behavior scales, such as the Three-Factor Eating Questionnaire (TFEQ-R21) and eating disorder as Sick, Control, One, Fat, Food questionnaire (SCOFF), were collected in the first visit. We conducted a study with both cross-sectional and longitudinal components. Correlational bivariate analysis was conducted to explore relationships between key variables. The factors affecting BMI changes were investigated using generalized estimating equations (GEEs) as part of a longitudinal analysis.
Results: The mean age of participants was 13.22 years and 63.7% were male. Bivariate correlation analysis revealed positive relationships between initial BMI Z-scores and WSSQ scores (r = 0.196, p < 0.05). In bivariate analysis, a negative correlation was found between the difference in BMI Z-scores and visit number (r = −0.428, p < 0.01). GEE analysis demonstrated that initial BMI Z-scores (coefficient = 1.342, p < 0.001) and anxiety (coefficient = 0.050, p < 0.001) were significant positive predictors of BMI Z-scores, while depression was negatively associated (coefficient = −0.081, p < 0.001). Excluding the TFEQ subscales, SCOFF improved the model’s QIC and highlighted WSSQ as a significant, albeit weak, predictor (p = 0.615 in the full model versus p < 0.05 in the reduced model).
Conclusions: Psychosocial factors, particularly anxiety and weight stigma, are associated with elevated BMI Z-scores in youth affected by obesity in this study. The baseline age, BMI Z-score, internalized weight stigma, and psychological stress influenced the body weight trajectory over time. Frequent clinical follow-ups contribute to improved BMI outcomes. Future research may examine the efficacy of weight management by reducing weight stigma and psychological distress along with the outpatient care of obesity.
5. Wetzel, K. E., Himmelstein, M. S., & Ciesla, J. A. (2025). Bracing for impact: An intensive longitudinal investigation of weight stigma, vigilant coping, and maladaptive eating. Social Science & Medicine, 371. Advance online publication. https://doi.org/10.1016/j.socscimed.2025.117904
Email address for correspondence: karenewetzel@gmail.com
ABSTRACT. Objective: Interpersonal weight stigma (being teased, treated unfairly, or discriminated against for body weight) increases one's stress and negatively impacts their well-being. Weight stigma consistently increases maladaptive eating behaviors, such as eating to cope, binge eating, and restrictive dieting. Previously published cross-sectional models suggest that vigilant coping (being on the lookout for future discrimination) is one way in which weight stigma may impact maladaptive eating behaviors, especially as internalized weight stigma (self-stigma) increases. This study aimed to analyze these relationships longitudinally using ecological momentary assessments.
Methods: Female, higher weight college students (MBMI = 32.7, SDBMI = 6.09) from a large public midwestern university (N = 130) completed 3 surveys per day for 7 days, reporting their vigilant coping, eating to cope, restrictive dieting, and binge eating. Data was collected from January 2023–February 2024. We examined the relationship between baseline experienced and internalized weight stigma and day-to-day vigilant coping. Additionally, we examined vigilant coping earlier in the day as a predictor of eating later in the day.
Results: Experienced and internalized weight stigma did not interact to predict day-to-day vigilant coping, but they both independently predicted vigilant coping. Vigilant coping earlier in the day predicted restrictive dieting later in the day but did not predict emotional or binge eating. There were no significant conditional indirect effects. Conclusions This study establishes vigilant coping as a longitudinal predictor of restrictive dieting, but further research is required to understand other health behaviors and outcomes related to vigilant coping.
BINGE EATING, Part 2 of 3
6. Romano, K. A., Peterson, C. B., Forester, G, Wonderlich, J. A., Wonderlich, S. A., Engel, S. E., & Crosby, R. D. (2025). Momentary mediational associations among affect, emotion dysregulation, and different types of loss of control eating among adults with binge eating disorder. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24415
Full text available for download at: https://tinyurl.com/yc5yz6yz
ABSTRACT. Objective: Few studies have directly assessed the mechanistic role of transdiagnostic self-regulatory factors that are theorized to promote core disinhibited disordered eating behaviors that characterize binge eating disorder (BED) in the natural environment, such as emotion dysregulation. The present study used ecological momentary assessment (EMA) to address this research gap by examining whether: (1) emotion dysregulation mediated associations between negative and positive affect and loss of control (LOC) eating at the within-person level; (2) these associations varied across distinct LOC eating dimensions.
Method: Adults with BED (N = 107; Mage = 39.87, SD = 13.35) responded to six surveys per day for a 7-day EMA period. Multilevel structural equation models examined whether momentary emotion dysregulation mediated momentary associations between negative and positive affect, and different LOC eating outcomes ("general" [subjective experience of] LOC while eating; difficulties resisting eating; difficulties stopping eating after starting; feeling driven/compelled to eat; not paying attention to one's eating; feeling disconnected while eating [e.g., numb, zoned out]).
Results: Experiencing a sequential worsening of negative affect and, in turn, emotion dysregulation over a day mapped onto higher levels of certain LOC eating outcomes ("general" LOC eating, difficulties resisting eating, driven/compelled to eat, disconnected while eating) but not others (difficulties stopping eating, not paying attention to one's eating). All momentary mediational pathways involving positive affect as a predictor were not significant.
Discussion: These findings support emotion dysregulation as a mechanistic process that can precipitate certain types of LOC eating in daily life and may be leveraged to improve BED theory, research, and real-time interventions.
7. Green, A. E., Schneider, K. L., Chang, A., Feinstein, B. A., Rooper, I. R., Wildes, J. E., & Graham, A. K. (2025). Exploring drivers of binge eating in individuals with food insecurity and recurrent binge eating: A qualitative analysis. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.24434
Full text available for download at: https://tinyurl.com/y2cy3uza
ABSTRACT. Objective: This study explored the drivers of binge eating in people with food insecurity and recurrent binge eating. Method: Participants were 28 adults, ages 26–69 (M = 46.22, SD = 11.94; 64.3% female), who endorsed current food insecurity and recurrent binge eating (≥ 12 episodes in the past 3 months). Individual semi-structured interviews were conducted to assess the relationship between food access and binge eating. Data were analyzed using thematic analysis.
Results: Participants reported binge-eating drivers unique to individuals with food insecurity (fluctuating food access) and drivers commonly observed in those who binge eat, such as binge-promoting narratives and drivers related to mental health (e.g., stress) and physical health (e.g., sleep deprivation). The themes “fluctuating food access” and “negative impacts of mental and physical health” also interacted to promote binge eating, such that financial uncertainty promoted stress, which led to binge eating.
Discussion: This qualitative assessment of individuals' lived experience with food insecurity and binge eating suggests the relevance of considering food insecurity-specific factors, mental and physical health, and binge-promoting narratives when addressing binge eating in this subpopulation. Future research should explore whether improving access to nutritious foods and enhancing coping strategies address binge eating in individuals with food insecurity.
DECEMBER 2024 — MARCH 2025 TREATMENT INTERLUDE, Part 8 of 9
8. Duffy, F., Peebles, I., Clark, E., Loomes, R., Thomson, L., Maloney, E., & Nimbley, E. (2025). Clinicians' experiences of eating disorder focused family therapy with autistic young people. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.3173
Full text available for download at: https://tinyurl.com/32kpsbcb
ABSTRACT. Objective: Eating disorder focused family therapy (FT-ED) is the leading outpatient intervention for adolescents with Anorexia Nervosa. Autistic people report poorer eating disorder treatment experiences and may be at increased risk of inpatient admissions. There is a need to consider adaptions to eating disorder treatment for this population. The aim of this study is to explore the experiences of clinicians in the delivery of FT-ED for Autistic young people with Anorexia Nervosa and any adaptations currently being implemented. Method: FT-ED trained clinicians who had experience of delivering this modality with young Autistic people and their families, were invited to take part in interviews. Transcripts were analysed using Reflexive Thematic Analysis.
Results: Eleven clinicians completed interviews and analysis generated four themes and eight subthemes: (1) Systemic context, (2) Raising potential autism, (3) Autism eating disorders crossover, (4) Manual versus adaptations. Conclusions: This paper is the first exploration of clinician's experience delivering FT-ED to Autistic young people and their families and highlighted unique considerations with this population. It is an initial step to consider adaptations to the FT-ED model, with the aim of making eating disorder treatments more effective, accessible and acceptable for Autistic young people and their families.
9. Singh, M., Austin, A., Lindenbach, D., Vander Steen, H., Habina, C., Marcoux-Louie, G., Loeb, K. L., Engel S, Le Grange D., & Dimitropoulos, G. (2025). Ecological momentary assessment for adolescents with anorexia nervosa and their parents/caregivers in family-based treatment. International Journal of Eating Disorders, 58(3), 608-623. https://doi.org/10.1002/eat.24368
Full text available for download at: https://tinyurl.com/2kch7p7d
ABSTRACT. Introduction: Studies have shown that early weight gain in family-based treatment (FBT) predicts treatment response in adolescents with anorexia nervosa (AN); however, research examining factors associated with early weight gain in FBT is limited. This study tested the feasibility and acceptability of ecological momentary assessment (EMA) in early FBT, particularly to capture momentary data on family climate during mealtimes.
Methods: Using multiple methods, quantitative (EMA) and qualitative (interviews) data were collected in the first 4 weeks of FBT. Participants (11 families; 9 adolescents, 19 parents/caregivers) completed EMA assessments daily on the emotional climate during meals, parental strategies and confidence/agreement in renourishment. Qualitative interviews obtained technological and procedural data using EMA. Completion rates and markers of change were explored using repeated measures ANOVA. Interviews were analyzed using reflexive thematic analysis.
Results: The EMA completion rate for all family members was 78%: 84% for adolescents, 83% for mothers, 64% for fathers. Results demonstrated changes in caregivers' use of renourishment strategies and in the emotional climate (decreased anger) at mealtimes. No changes were observed in caregiver confidence/agreement in renourishment. Qualitative analyses revealed factors interfering with and facilitating the use of EMA.
Discussion: EMA is an acceptable and feasible tool for use with adolescents and their families in early FBT, particularly to capture momentary data on family climate during mealtimes. Future research is needed with larger sample sizes to examine the mechanisms of change in early FBT, and the utility of EMA as a clinical tool in FBT.
10. Mayr, L. M., Besse-Flütsch, N., Smigielski, L., Walitza, S., & Pauli, D. (2025). Cost-effectiveness analysis of family-based treatment with additional home treatment for adolescent anorexia nervosa. European Eating Disorders Review, 33(3), 608-615. https://doi.org/10.1002/erv.3170
Email address for correspondence: dagmar.pauli@pukzh.ch
ABSTRACT. Objective: Family-based treatment (FBT) is promising for treating adolescents with anorexia nervosa, but long-term remission rates are modest. Home treatment (HT) as a supplement to FBT aims to enhance sustainability and effectiveness by supporting recovery within the family. This study compares the cost-effectiveness of FBT alone versus FBT with additional HT for adolescents with anorexia nervosa.
Method: This cost-effectiveness analysis is based on a non-randomized pilot study, which examined the effectiveness of HT for adolescents with anorexia nervosa, disregarding the financial aspects. HT involved therapeutic interventions delivered in the patient's home environment, while FBT involved structured therapy sessions at the psychiatric clinic. Data from 61 patients were analysed, with 40 receiving FBT + HT and 21 receiving FBT only. Costs included FBT sessions, HT sessions, and inpatient treatment. Effectiveness was measured by weight restoration at thresholds of expected body weight (EBW) > 85% and EBW > 95%.
Results: FBT + HT promoted greater weight restoration within three months compared to FBT alone (70% vs. 52% at EBW > 85%; 38% vs. 29% at EBW > 95%). FBT + HT was more cost-effective, with lower average costs per patient meeting weight restoration criteria (8243 vs. 20,446 Swiss francs at EBW > 85%; 15,387 vs. 37,485 Swiss francs at EBW > 95%). Inpatient treatment accounted for most of the cost, with FBT + HT reducing hospitalisation needs.
Conclusions: FBT with additional HT is a more cost-effective treatment for adolescents with anorexia nervosa. Although the cost-effectiveness index was relatively high, effective treatment could reduce the long-term burdens of this disorder. Larger long-term studies are needed to validate these findings and assess sustained cost-effectiveness.
11. Wilson, D. R., Withington, T., Dalle Grave, R., & Dalton, M. (2025). CBT-E following discontinued FBT for adolescents with eating disorders: time for a more individual approach? The Cognitive Behaviour Therapist, 18, e1. https://doi.org/10.1017/S1754470X24000400
Full text available for download at: https://tinyurl.com/2xawh3m7
ABSTRACT. Family-based treatment (FBT) has proven efficacy among adolescents with eating disorders (ED). However, it is not effective or suitable for all young people and their families, which makes alternative treatments important. This is the first pilot study to compare the relative effectiveness of manualised enhanced cognitive behaviour therapy (CBT-E) among a transdiagnostic eating disorder sample of adolescents for whom CBT-E was their first ED treatment (n = 42), and a group who had previously started FBT which had been discontinued without full recovery (n = 27). Participants (n = 69) aged 13–17 with an eating disorder completed manualised CBT-E. Outcome measures included body mass index (BMI) centile, ED psychopathology and clinical impairment.
Across the cohort, results showed improvements across ED psychopathology, clinical impairment and BMI centile. The effect of the intervention on ED psychopathology and clinical impairment did not vary between groups, nor did attrition rates. There was a difference between the groups on BMI centile, with those who had previously been treated with FBT showing no change in BMI centile, whereas those with no previous FBT increased BMI at post-treatment. Implications from this research suggest that CBT-E is a viable promising alternative and could be offered among those for whom FBT has not achieved full recovery.