Michael Levine's Eating Disorders Prevention/Sociocultural Factors Newsletter
NO. 281: (i) Screening/Early ID (n =2); (ii) Wt Stigma, Part 1 (n = 2); (iii) Athletes, Sports, and Dance, Part 2 (n = 2); Nature of EDs, Part 8 (n = 3); and (v) April-May Tx Interlude, Part 9 (n = 3)
Colleagues (N now = 1459 in 49 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.
Anorexia Nervosa and Associated Disorders (ANAD) presents
in honor of Pride Month, a live Community Event
Centering the Margins: Why Bridging the Gap in LGBTQIA+ Eating Disorder Care Requires All of US
with Eric Dorsa and Jason Wood
Thursday, June 18, 2026, 2:00 p.m. Eastern | 11:00 a.m. Pacific | 6:00 p.m. UTC
Received yesterday 4 June 2026, via an email from the Anorexia Nervosa and Associated Disorders (ANAD) nonprofit organization.
Centering the Margins: Why Bridging the Gap in LGBTQIA+ Eating Disorder Care Requires All of US
with Eric Dorsa and Jason Wood
Thursday, June 18, 2026, 2:00 p.m. Eastern | 11:00 a.m. Pacific | 6:00 p.m. UTC
FREE, Register at: https://tinyurl.com/4ebszjpf
Traditional recovery spaces can often leave LGBTQIA+ individuals feeling overlooked or disconnected. This Pride Month, we are hosting a collaborative conversation with Eric Dorsa (they/them) to bridge the gap between those with lived experience and the professionals who support them.
Together, we will explore the power of chosen family and inclusive care, dispelling the myth that community is only built among those with identical backgrounds.
We’ll also highlight the vital role clinicians play in fostering environments where clients can heal without hiding their authentic selves.
ADVOCACY-IN-ACTION SUCCESS
The Eating Disorders Coalition (EDC) announces
Funding Victories for the
Labor, Health and Human Services, Education, and Related Agencies (LHHS) Fiscal Year 2027 (FY27) Appropriations Bill that
Advances Critical Investments in Eating Disorder Prevention, Early Detection, and Treatment
Received 12 June 2026 via an email from the Eating Disorders Coalition for Research, Policy & Action (EDC). The bold-for-emphasis is in the original.
ML NOTE 1: There are 3 members of this Substack Group among the leaders of the EDC: Officers - Secretary, Millie Plotkin, MLS, FAED; Treasurer, Johanna Kandel (Alliance for Eating Disorders); and Director - S. Bryn Austin, ScD, FAED (https://www.hsph.harvard.edu/striped/)
EDC Secures Key House LHHS Funding Victories
WASHINGTON, D.C. (June 12, 2026) — The Eating Disorders Coalition for Research, Policy & Action (EDC) applauds the U.S. House of Representatives Appropriations Committee for advancing critical investments in eating disorder prevention, early detection, and treatment in the Labor, Health and Human Services, Education, and Related Agencies (LHHS) Fiscal Year 2027 (FY27) appropriations bill.
EDC extends sincere thanks to the bipartisan Members of Congress who championed these priorities: Representatives Robert Aderholt (R-AL-04), Paul Tonko (D-NY-20), Andrew Garbarino (R-NY-02), Brian Fitzpatrick (R-PA-01), Judy Chu (D-CA-28), Juan Ciscomani (R-AZ-06), Ashley Hinson (R-IA-01), Stephanie Bice (R-OK-05), Mark Pocan (D-WI-02), Marcy Kaptur (OH-09), Madeline Dean (D-PA-04), Chellie Pingree (D-ME-01), David Valadao (R-CA-22), and Bonnie Watson Coleman (D-NJ-12).
Funding secured in the House FY27 LHHS bill:
- $4 million for the National Center of Excellence for Eating Disorders (ED-CoE) — $1 million above EDC’s request. This funding will support expanded engagement with primary care providers, including pediatricians, to provide specialized training on eating disorder screening and treatment.
- $1 million for the HHS Office on Women’s Health research grants — aligned with EDC’s request. This funding will continue prioritizing projects that support early detection and treatment protocols for women and girls with, or at risk of developing, an eating disorder.
“These funding increases reflect growing bipartisan recognition that eating disorders are serious, life-threatening illnesses—and that earlier identification and evidence-based treatment save lives,” said Christine Peat, PhD, President, EDC Board of Directors.
EDC looks forward to reviewing the U.S. Senate LHHS Appropriations Committee’s bill in the coming weeks and working with both chambers to ensure these priorities are included in the final FY27 appropriations package.
The Eating Disorders Coalition for Research, Policy & Action is a federal advocacy organization based in Washington, D.C. The EDC advances the recognition of eating disorders as a public health priority throughout the United States.
Media Contact: Emily Rosenberg, erosenberg@eatingdisorderscoalition.org
Research Publication Categories in This Newsletter
(i) Screening/Early Identification (n =2); (ii) Weight Stigma, Part 1 (n = 2); (iii) Athletes, Sports, and Dance, Part 2 (n = 2); (iv) Nature/Correlates of EDs, Part 8 (n = 3); and (v) April-May Treatment Interlude, Part 9 (n = 3)
CONGRATULATIONS to our own
Dr. Hiba Jebeile (Australia) and colleagues for publication of the Screening/Early Identification review article in #1.
Drs. Carolyn Becker (USA; see also #6), Vivienne Hazzard (USA), and Tiffany Stewart (USA; see also #6) and colleagues for publication of the Athletes research article in #5.
Drs. Kelsey Hagan (USA), Tiffany Brown (USA), Jennifer Harriger (USA) and Christina Sanzari (USA) and Drs. Rachael Flatt (USA), Kelsie Forbush (USA), Carolyn Becker (USA), Tiffany Stewart (USA), and Sasha Gorrell (USA) and colleagues for publication of the Athletes research article in #6.
Suzanne Mares (The Netherlands) and colleagues for publication of the Nature of Eating Disorders research article in #8.
Drs. Daniel Le Grange (USA) and Brittany Matheson (USA) and colleagues, including distinguished scientist-practitioner-mentor Dr. James Lock (USA), for publication of the Treatment research article in #12.
SCREENING/EARLY IDENTIFICATION
1. House, E. T., McMaster, C. M., Lister, N. B., Jardine, I. R., Lorien, S. J., Seidler, A. L., & Jebeile, H. (2026). Identifying eating disorders in adolescents and adults living with higher weight: An updated systematic review of questionnaire diagnostic accuracy. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.70132
Full text available for download at: https://tinyurl.com/3bzkhsuf
ABSTRACT. Objective: To update the evidence regarding the diagnostic accuracy of eating disorder (ED) questionnaires in adolescents and adults with higher weight. Method: Five databases were systematically searched from 2020 to November 2025 (CRD420251186115). Included studies reported on the diagnostic accuracy of self-report questionnaires against a clinical interview to identify EDs and disordered eating behaviors (DEBs) in adolescents and adults with higher weight. Narrative synthesis was conducted, and findings from new studies were synthesized alongside previously identified studies.
Results: Thirty-two studies (5 new) were included, reporting on the diagnostic accuracy of 13 questionnaires in adults and 5 in adolescents. The diagnostic accuracy of questionnaires was examined to identify any ED (5 questionnaires in adults, 0 adolescents), binge-eating disorder (8 adult, 2 adolescent), DEBs (e.g., binge eating, purging) (4 adult, 1 adolescent), loss-of-control eating (1 adult, 2 adolescent), bulimia nervosa, atypical anorexia nervosa, purging disorder, and night eating syndrome (each n = 1 adult, 0 adolescent). The Eating Disorder Examination Questionnaire (7 studies; sensitivity 0.16–0.88; specificity 0.54–1.0), Binge Eating Scale (6 studies; sensitivity 0.37–0.98; specificity 0.48–0.96), and Questionnaire on Eating and Weight Patterns (6 studies; sensitivity 0.07–1.0; specificity 0.0–1.0) were most used.
Discussion: Progress in evaluation of the diagnostic accuracy of ED questionnaires in people with higher weight has been limited. There remains a lack of evidence regarding the diagnostic accuracy of questionnaires in adolescents and a lack of sufficiently sensitive questionnaires to identify EDs other than binge-eating disorder. Assessing the diagnostic accuracy of questionnaires in people with higher weight remains a research priority.
2. Chen, S., Zhu, R., Kang, Q., Gu, L., Peng, S., Chen, H., Yang, K., Song, H., Deng, M., & Chen, J. (2026). The Chinese Eating Disorder Brief Screening Scale (CEDBS): Development and psychometric validation in general and clinical populations. International Journal of Eating Disorders. Advance online publication. https://doi.org/10.1002/eat.70130
Email address for correspondence: chenjue2088@163.com
ABSTRACT. Objective: Despite growing recognition of eating disorders (EDs) as a public health concern in China, validated instruments suitable for efficient large-scale screening remain limited. This study aimed to develop and validate the Chinese Eating Disorder Brief Screening Scale (CEDBS).
Method: Scale development and validation were structured across two studies. Study 1 involved item generation and refinement through expert evaluation, cognitive interviews, and a pilot study (N = 146). Study 2 examined psychometric properties in large non-clinical (N = 3573) and clinical (N = 325) samples. Analyses included exploratory and confirmatory factor analysis for construct validity, McDonald’s ω and intraclass correlation coefficients (ICC) for reliability, Pearson correlations for convergent and discriminant validity, and receiver operating characteristic (ROC) analysis for screening accuracy.
Results: The final 10-item CEDBS demonstrated a unidimensional structure, high internal consistency (ω = 0.95), and acceptable test–retest reliability (ICC = 0.81). CEDBS scores correlated strongly with established ED-specific measures (eating disorder inventory subscales: rs = 0.51–0.87; eating disorder examination-questionnaire global score: r = 0.74; eating attitudes test-26: r = 0.81) and showed a moderate correlation with the anxiety scale (r = 0.35), supporting discriminant validity. ROC analysis yielded an area under the curve of 0.88, with an optimal cutoff of 16.5 (sensitivity = 0.75, specificity = 0.84).
Discussion: The CEDBS demonstrates preliminary psychometric support as a brief screening tool for identifying probable ED cases in Chinese populations. An integer cutoff score of 17 may be considered for practical use.
WEIGHT STIGMA, Part 1 of Many
ML NOTE 2: The articles described below in #3 AND #4 came to my attention via the Obesity and Energetics Offerings (OEO) online newsletters of 24 April 2026 and 22 May 2026, respectively. For more information about free participation in the OEO online newsletter series as an ongoing and valuable exercise in education, research methods, and critical thinking, see Obesity and Energetics Offerings.
3. Lopez-Arana, S., Aguilar Encina, M. F., Aravena Giovanetti, V., Basfi-Fer, K., Tiscornia, C., Estremadoyro, C., & Pereyra-González, I. (2026). Mapping weight stigma in food-based dietary guidelines across thirteen countries in Latin America and the Caribbean: A qualitative analysis. The Lancet Regional Health: Americas, 57, 101438. https://doi.org/10.1016/j.lana.2026.101438
Full text available for download at: https://tinyurl.com/acjbxkt8
SUMMARY. Background: Weight stigma is a growing public health concern with documented harms to physical, mental and social well-being. Food-Based Dietary Guidelines (FBDGs), central to nutrition education and policy, may unintentionally reinforce stigmatising narratives. In the Latin America and the Caribbean (LAC), where the obesity is shaped by complex determinants, this study aims to uncover the presence and patterns of weight stigma in national FBDGs and inform the development of more inclusive, person-centred nutrition policies.
Methods: A content analysis was performed. We used the Weight Stigma Heat Map (WSHM) to assess thirteen national FBDGs and four technical documents from LAC countries. Ten thematic areas focused on language, imagery, behavioural framing, and representations of health were analysed. Inter-evaluator agreement was evaluated using Bangdiwala’s test.
Findings: Most FBDGs contained explicit or implicit weight-stigmatising content. Common patterns included portraying weight loss as a universal health goal, using alarmist language around obesity, and framing body weight as fully modifiable through individual behaviour, often without acknowledging individual variability or clinical context. Thinness was often linked to physical activity, while higher weight was associated with sedentarism and poor choices. Structural determinants were rarely acknowledged. Only Saint Vincent and the Grenadines adopted a more inclusive, environmentally focused approach. Inter-evaluator agreement was high (Bangdiwala’s B = 0.93), supporting the reliability of the coding process.
Interpretation: National FBDGs across LAC frequently reflect moralising and reductionist narratives that may perpetuate weight stigma. Revising these documents through a person-centred lens, grounded in human rights, social justice, and a multifactorial understanding of obesity is essential to promote equitable public health nutrition.
4. Saquimux Contreras, M. A., Ramos Salas, X., Ferreira Bento, S., de Pádua, K. S., & Martins Duarte Osis, M. J. (2026). The weight of society: A qualitative study on how social norms shape body size and weight ideals. The Lancet Regional Health: Americas. Advance online publication. https://doi.org/10.1016/j.lana.2026.101491
Full text available for download at: https://tinyurl.com/4c9mpc64
SUMMARY. Background: Weight bias and stigma have transformed body weight from a purely biological attribute into a complex social phenomenon. Social and health scientists continue to critically examine how weight stigmatising discourses and biased perceptions shape attitudes, beliefs and everyday experiences. Studies show that socially mediated subjectivities profoundly affect women’s health-related behaviours and decision-making. This study seeks to explore, from the standpoint of patients attending a gynaecological clinic, how weight bias and stigma influence women’s perceptions of their own weight and body size and the healthcare decisions they make.
Methods: This qualitative study was conducted in a Family Planning Outpatient Clinic in the southeastern region of Brazil. Interviews (n = 6) and focus groups (n = 2, six participants per group) with patients were conducted from February to November 2024. All participants identified as women, and the interviews and focus groups were analysed using a reflexive thematic analysis approach.
Findings: The rationality of weight bias and stigma influences how women perceive their weight and body shape. This turns biological functions, such as eating and exercising, into social actions that respond to imposed norms that shape common sense about what is considered a healthy and desirable weight.
Interpretation: Medical research and clinical practice often reduce health risk factors to poor personal choices or biological predispositions, while neglecting systemic drivers such as weight bias, stigma and fatphobic representations, medicalised discourses of weight, and neoliberal ideals equating thinness with moral virtue. The rationality behind the embodied realities of women navigating weight-based discrimination reveals how weight bias and stigma shape women’s everyday life, social actions and healthcare decisions.
ATHLETES, ATHLETICS, SPORT, AND DANCE, Part 2 of 3
5. Rowan, M., Becker, C. B., Hazzard, V. M., Wesley, N. Y., Varzeas, K. A., Ackerman, K., & Stewart, T. M. (2026). Modifiable risk factors of female athlete psychological resilience and mental health: A longitudinal investigation. Sport, Exercise, and Performance Psychology. Advance online publication. https://doi.org/10.1037/spy0000412
Full text available for download at: https://tinyurl.com/5kmy8xx3
ABSTRACT. This study aimed to identify potential modifiable risk factors that predict psychological resilience in female athletes and evaluate how well resilience predicts outcomes over time in this group. Three hundred ninety-three female athletes completed demographics and self-report measures at baseline and at least one (3-, 6-, and/or 12-month) follow-up assessment. The Connor–Davidson Resilience Scale 10 and Brief Resilience Scale measured resilience. Hypothesized upstream risk factors included sleep, emotion dysregulation, experiential avoidance, social support, and intolerance of uncertainty. Hypothesized downstream outcomes of low resilience included posttraumatic stress disorder, depression, anxiety, substance abuse, and high perceived stress.
Greater emotion regulation difficulties, experiential avoidance, intolerance of uncertainty, social support, and sleep difficulties each significantly longitudinally predicted decreases in resilience over 12 months. Resilience significantly predicted decreases in prevalence of high perceived stress, depression, anxiety, and posttraumatic stress disorder over 12 months. Resilience may be a useful focus of intervention. Difficulties with emotion regulation, experiential avoidance, intolerance of uncertainty, social support, and sleep difficulties are identified as modifiable risk factors and may be targeted in future interventions to enhance resilience in female athletes.
6. Chapa, D. A. N., Hagan, K. E., Brown, T. A., Harriger, J. A., Sanzari, C. M., Hanss, K., Flatt, R. E., Forbush, K. T., Becker, C. B., Farrell, J. I., Stewart, T. M., & Gorrell, S. (2026). Athletes’ relationships to training: Validation of an assessment tool across female and male athletes. Eating Behaviors, 62. Advance online publication. https://doi.org/10.1016/j.eatbeh.2026.102100
Email address for correspondence: iversonchapada@upmc.edu
ABSTRACT. Objective: Reasons for exercise training are often adaptive (e.g., athletic achievement), but for some athletes, their relationship with training can include a maladaptive desire for weight loss, which can increase risk for eating-disorder pathology. Prior validation of the Athletes’ Relationships to Training scale (ART) supported its validity among female athletes. The current study extended this work to compare psychometric properties of the ART among female and male athletes; we expected the measure to perform similarly across sexes.
Methods: We conducted confirmatory factor analyses (CFA) in the full sample and measurement invariance tests separated by self-reported sex in young-adult athletes from three universities (N = 424, 44.3% male, M[SD]age = 18.9[1.3] years). Pearson correlations tested associations among ART scores with other psychological symptoms to evaluate construct validity, and t-tests evaluated mean group differences in ART scores between males and females.
Results: The ART’s four-factor structure replicated in the full sample, and in males and females separately with good fit. Results from multi-group CFA analyses supported measurement invariance between males and females. There was support for construct validity, such that overall correlations among the ART, maladaptive exercise measures, and eating-disorder pathology were higher relative to correlations with anxiety and depression. Compared to females, males scored significantly higher on the ART total and all subscale scores, with the exception of Body Dissatisfaction.
Discussion: Results provided preliminary evidence that the ART can be used to assess maladaptive training behaviors among both male and female young-adult athletes, thereby informing interventions designed to improve exercise motivation.
NATURE, CORRELATES, AND COURSE OF EDs, Part 8 of now 9
7. Chernov, N. V., Kibitov, A. A., Kulygina, M. A., Moiseeva, T. V., Grishanina, A. M., Fedorova, E. V., Ryauzova, E.S., & Karpenko, O. A. (2025). Moderating effect of metacognition on the relationship between perfectionism, body image disturbance, and body mass index in anorexia nervosa: A cross-sectional study. Consortium PSYCHIATRICUM, 6(4), 24-34. https://doi.org/10.17816/CP15736
Full text available, in English and Russian, for download at: https://tinyurl.com/mrnmkrjs
ABSTRACT. Background: Despite theoretical concepts about the key role of perfectionism in the formation of the symptoms of anorexia nervosa (AN), the aspects of the mutual influence between body mass index (BMI), perfectionism, and body image in patients with AN remain insufficiently studied or contradictory. Studying integrative cognitive processes, such as metacognition, may reveal new mechanisms of perfectionism’s influence on the clinical manifestations of AN. Aim: The assessment of the moderating effect of metacognition on perfectionism associated with BMI and body image in patients with AN.
Methods: A cross-sectional study was conducted involving patients with AN who were undergoing inpatient treatment. Perception of one’s own body was assessed using the Body Image Questionnaire. Perfectionism was assessed using the Multidimensional Perfectionism Scale. The level of metacognition of patients was assessed using the Metacognition Assessment Scale-Abbreviated, which evaluates Self-reflectivity, Understanding the other’s mind, Decentration, and Mastery (the ability to develop adaptive strategies for coping and behaviour regulation). BMI was also recorded.
Results: A total of 130 patients were examined. At a Mastery score of ≥4 higher perfectionism scores were associated with an increase in BMI, and at a Mastery level of ≤1 a higher level of perfectionism was associated with decreasing of BMI. Even with minimal Self-reflectivity scores (≥2), the negative effect of perfectionism on body image was evident. Body image disturbance was positively correlated with perfectionism. No correlations were found between BMI and perfectionism and between BMI and body image disturbance.
Conclusion: The effect of perfectionism on body image disturbance and BMI in patients with AN depends on the magnitude of Self-reflectivity and Mastery. The obtained data indicate the necessity of incorporating psychotherapy aimed at the development of metacognition in patients with AN.
8. Wezenberg, E., Peters, S. K., van Elburg, A. A., & S. Mares, S. H. W. (2026). Alexithymia in anorexia nervosa, more state than trait? A multi-dimensional assessment of emotion processing in patients with anorexia nervosa, recovered patients and healthy controls. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.70125
Full text available for download at: https://tinyurl.com/2s3nb6hn
ABSTRACT. Objective: Alexithymia is implicated in both development and maintenance of Anorexia Nervosa (AN). It is unclear what defines alexithymia in AN. In this study, emotion processing related to alexithymia was examined. Method: 40 patients with AN, 43 recovered (RC) patients and 35 matched healthy controls (HC) filled out questionnaires on eating disorder pathology (EDE-Q), depression (CES-D), alexithymia (TAS-20), and emotion regulation (DERS). BMI was obtained. Behavioural (naming emotions, valence and intensity ratings) and physiological responses (heart rate and skin conductance) to emotional stimuli were assessed. Data were analysed for group differences, and controlled for effects of depression.
Results: Although high levels of negative affect, alexithymia and emotion regulation problems were found in self-report questionnaires, the AN group was able to identify and name simple explicit emotions, and showed only subtle signs of reduced physiological responsiveness when viewing the emotion pictures. The RC group only showed differences to the healthy control group in self-assessed alexithymia.
Conclusions: The present results give more evidence of alexithymia as a state than a trait feature in AN. Longitudinal studies are advised to gain more insight into how eating disorder behaviours versus alexithymia and emotion regulation change during the recovery process of AN.
9. Pelzer, M., Werthmann, J., Svaldi, J., Fleischhaker, C., Haack-Dees, B., Renner, F., & Tuschen-Caffier, B. (2026). Mirror exposure in adolescents with anorexia nervosa: a feasibility study on body image disturbance and attentional bias. Eating and Weight Disorders, 31, 54. https://doi.org/10.1007/s40519-026-01880-2
Full text available for download at: https://tinyurl.com/ytt6zmr7
ABSTRACT. Purpose: Body image disturbances (BID) are central to anorexia nervosa (AN), influencing its development, maintenance and relapse. While mirror exposure (ME) has been shown to reduce BID in adults, research in adolescents is limited. This pilot randomized controlled trial examined the feasibility and effects of ME, added to treatment as usual (TAU), in adolescent inpatients with AN. In addition, we explored changes in body-related attentional bias as a potential mechanism of change.
Methods: Adolescent female inpatients with AN were randomized to receive either 12 ME sessions over 4 weeks (ME group, n = 11) or TAU (n = 13) in a pre-post design. Primary outcomes were global measures of BID and eating disorder (ED) pathology. Attentional bias was assessed using two eye-tracking paradigms. Results: Relative to TAU, ME did not improve BID or ED pathology. Both groups showed reductions in BID over time. Exploratory post-hoc analyses indicated reductions in body control and avoidance behaviors in the ME but not the TAU group. An attentional bias toward self-defined unattractive body parts was present but did not change over time in either group.
Discussion: In this pilot trial, ME did not provide additional benefits over TAU in improving global BID or ED pathology in adolescent inpatients with AN. Improvements in BID may reflect general therapeutic effects of inpatient treatment. Exploratory analyses indicated potential effects on specific body-related behaviors but require cautious interpretation due to limited power. Future research should examine for whom and at what stage body image–focused interventions may be beneficial. Level of evidence: Level I, randomized controlled trial. Trial registration: The study is registered on the German Clinical Trial Register (DRKS; registration number: DRKS0019104).
APRIL - MAY TREATMENT INTERLUDE, Part 9 of now 11
10. Wilson, D., Grimmer, H., Renata A. Mendes, R. A., Irwin, J., Atherton, J., Litster, R., White, J., & Loxton, N. J. (20260. Examining comorbid psychopathology symptoms as predictors of family based treatment for adolescents with anorexia nervosa and atypical anorexia nervosa in a real-world setting. European Eating Disorders Review. Advance online publication. https://doi.org/10.1002/erv.70124
Full text available for download at: https://tinyurl.com/5w3ud9w4
ABSTRACT. Background: For adolescents with Anorexia Nervosa (AN) or Atypical Anorexia Nervosa (AAN), Family Based Treatment (FBT) is an effective treatment. However, outcomes remain suboptimal, making investigations into predictors of outcome important. Most prior research into FBT has focussed on parental and family factors as predictors. Objective: The current study aimed to identify predictors of FBT for adolescents with AN and AAN in a real-world setting, specifically focussed on comorbid patient psychopathology as a predictor of outcome.
Method: A prospective cohort of 135 young people engaging in manualised FBT (female = 92.6%, age = 14.33 years, SD = 1.54, range 11–17) at a public outpatient child and youth eating disorder (ED) service were evaluated. Measures of ED and comorbid psychopathology and BMI outcomes were evaluated pre- and post-treatment.
Results: Results showed that age was a predictor of drop-out and weight gain, with older age associated with higher chance of drop-out and less weight gain. No comorbid psychopathology measure predicted drop-out or treatment outcomes. Discussion: Findings highlight the potential role of age in treatment non-completion and weight regain in FBT, suggesting the potential need for developmental considerations to FBT among this group.
11. Pedersen, S. H., Bentz, M., Bay, S., & Midtgaard, J. (2026). "You kind of became free again": Danish adolescents' experiences of family-based treatment for anorexia nervosa - A qualitative study. Psychotherapy Research. Advance online publication. https://doi.org/10.1080/10503307.2026.2662964
Full text available for download at: https://tinyurl.com/4dfxtpww
ABSTRACT. Objective: To explore danish adolescents' experiences of Family-Based Treatment (FBT) for anorexia nervosa (AN). Method: Individual semi-structured interviews were conducted with 15 adolescents (13 females, mean age 15.8 years) at the end of treatment and analysed via inductive reflexive thematic analysis.
Result: Three overarching themes were generated through analysis: Losing Control - Gaining Freedom captured adolescents' initial distress at relinquishing responsibility for renourishment to parents, later experienced as liberating, as parental oversight countered AN and restored agency. The Difficult Trust reflected how AN itself complicated trust, with adolescents feeling that others did not always believe or trust them.
From Conflict to Closeness described evolving parent-child relationships, showing that early conflicts gave way to strengthened bonds, particularly with the parent who assumed primary responsibility, as collaborative engagement fostered improved communication and mutual understanding. Overall, early distress coexisted with long-term gains in autonomy and familial closeness.
Conclusion: By the end of treatment, adolescents came to recognize the rationale and value of parental responsibility for renourishment in FBT, reporting that it facilitated recovery while strengthening relationships. The findings emphasize the importance of trust, safe therapeutic spaces, and active involvement from both parents, and highlight a need for targeted adaptations for transitional-age youth.
12. Lock, J, Le Grange, D., Matheson, B., Kim, B., Bohon, C., & Jo, B. (2026). Training clinicians in private practice in family-based treatment for anorexia nervosa: randomized controlled trial comparing two online approaches. Journal of Medical Internet Research, 28, e89999. https://doi.org/10.2196/89999
Full text available for download at: https://tinyurl.com/su7hn8rb
ABSTRACT. Background: There is a critical need to disseminate efficacious psychosocial treatments for mental disorders because there is a significant gap between evidence-based treatment (EBT) approaches and usual clinical practice. To address this gap, cost-effective, efficient, and scalable methods of training mental health clinicians in EBT are needed. One example of the need to improve dissemination and implementation of psychosocial treatments is for adolescents with anorexia nervosa (AN), a serious mental disorder with an incidence rate of about 1% that can become life-threatening.
Based on outcomes from a series of randomized controlled trials (RCTs), an EBT for adolescents with AN is family-based treatment (FBT); however, few therapists are trained in the approach. Some studies suggest that online training is feasible for training clinicians treating eating disorders, including pilot data related to FBT specifically, but RCTs examining different training formats for FBT to improve fidelity and patient outcomes are needed.
Objective: This study compared 2 different formats for delivering online training in FBT to therapists treating adolescents with AN and planned to assess the feasibility of the 2 training formats, as well as to examine whether either approach was superior in improving fidelity to FBT or patient outcomes.
Methods: Participants were 123 mental health therapists licensed in the United States in private practice with no previous FBT training. Therapists were randomized to either (1) a webinar training lecture series or (2) an interactive e-training on-demand program (ET-FBT) with an additional focus on key FBT interventions. Both groups were offered up to 12 one-hour group-based clinical case consultation (CCC) sessions posttraining. We examined the feasibility and acceptability of the online training programs and posttraining outcomes in fidelity to key components of FBT, self-efficacy, and working alliance. We explored rates of patient early response (weight gain of 2.4 kg at session 4) in adolescent patients with AN treated after FBT training during CCC.
Results: Both online trainings had a high completion rate of 95% (117/123), with CCC completion at 38% (47/123). Both programs showed significant improvements within randomized groups in therapists’ fidelity, self-efficacy, and working alliance. Working alliance improved significantly more in the ET-FBT group, but there were no other significant differences between training groups. Early response rates doubled posttraining and CCC (16%-34%), regardless of randomized training format, a rate that is similar to that achieved by therapists in RCTs examining FBT treatment outcomes.
Conclusions: It is feasible to deliver online training in FBT to clinicians in private practice in 2 different formats, and both trainings led to significant improvements in fidelity, self-efficacy, working alliance, and patient outcomes. Future studies should address challenges in patient recruitment for posttraining CCC and refine CCC implementation to maximize training effects and efficiency. Trial Registration: ClinicalTrials.gov NCT04428580; https://clinicaltrials.gov/study/NCT04428580. International Registered Report Identifier (IRRID): RR2-doi: 10.1016/j.cct.2022.106889