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. 2021 Apr 23;9(1):55.
doi: 10.1186/s40337-021-00413-9.

Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study

Jocelyn Lebow  1   2 , Angela Mattke  3 , Cassandra Narr  3 , Paige Partain  3 , Renee Breland  3 , Janna R Gewirtz O'Brien  4 , Jennifer Geske  5 , Marcie Billings  4 , Matthew M Clark  6 , Robert M Jacobson  7   3   5 , Sean Phelan  5 , Cynthia Harbeck-Weber  6 , Daniel Le Grange  8   9 , Leslie Sim  6
Affiliations

Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study

Jocelyn Lebow et al. J Eat Disord. .

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.

Keywords: Adolescent; Anorexia nervosa; Feeding and eating disorders; Pediatrics; Primary health care.

Plain language summary

Family-Based Treatment (FBT) is considered the first-choice intervention for adolescent anorexia nervosa. However, finding a qualified provider in this modality is difficult. Treatment programs for other pediatric mental health conditions have successfully overcome barriers to accessing quality treatment 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. This study examined weight gain in 15 adolescents with restrictive eating disorders receiving FBT-PC and 15 adolescents receiving standard FBT. At the end of treatment, both groups showed large improvements in BMI percentile and large decreases in weight suppression. Each group had the same number of drop-outs and referrals to more intensive eating disorder treatment. Findings suggest that primary care providers have potential to improve weight and clinical status in adolescents with restrictive eating disorders. Based on these preliminary results, more rigorous testing of the FBT-PC model is indicated.

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Conflict of interest statement

Dr. Le Grange receives royalties from Guilford Press and Routledge. He also is Co-Director of the Training Institute for Child and Adolescent Eating Disorders, LLC. The other authors have indicated they have no financial relationships relevant to this article or potential conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Increases in weight and BMI percentile over time for both cohorts
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