Eating Disorder Day Programs: Is There a Best Format?

Abstract

The use of a Day Program (DP) format (i.e., intensive daily treatment with no overnight admission) has been shown to be an effective treatment for eating disorders (EDs). The disadvantages, however, include higher cost than outpatient treatment (including costs of meals and staff), greater disruption to patients' lives, and the use of a highly structured and strict schedule that may interrupt the development of patients' autonomy in taking responsibility for their recovery. This study investigated whether reducing costs of a DP and the disruption to patients' lives, and increasing opportunity to develop autonomy, impacted clinical outcomes. Three sequential DP formats were compared in the current study: Format 1 was the most expensive (provision of supported dinners three times/week and extended staff hours); Format 2 included only one dinner/week and provision of a take-home meal. Both formats gave greater support to patients who were not progressing well (i.e., extended admission and extensive support from staff when experiencing feelings of suicidality or self-harm). Format 3 did not provide this greater support but established pre-determined admission lengths and required the patient to step out of the program temporarily when feeling suicidal. Fifty-six patients were included in the analyses: 45% were underweight (body mass index (BMI) < 18.5), 96.4% were female, 63% were given a primary diagnosis of anorexia nervosa (or atypical anorexia nervosa), and mean age was 25.57 years. Clinical outcomes were assessed using self-reported measures of disordered eating, psychosocial impairment, and negative mood, but BMI was recorded by staff. Over admission, 4- and 8-week post-admission, and discharge there were no significant differences between any of the clinical outcomes across the three formats. We can tentatively conclude that decreasing costs and increasing the opportunities for autonomy did not negatively impact patient outcomes, but future research should seek to replicate these results in other and larger populations that allow conclusions to be drawn for different eating disorder diagnostic groups.

Keywords: anorexia nervosa; autonomy; bulimia nervosa; day program; day treatment; eating disorder; other specified feeding and eating disorder; stepped care.

Figure 1

CONSORT diagram of participant flow. * Exception of n = 1 participant who had their second admission in 2018 included in the analyses in lieu of their first admission in 2017.

Figure 2

Change over the program for each of the three time periods, August 2018 to August 2019, September 2019 to September 2020, October 2020 to July 2021 in: (a) Global levels of disordered eating. (b) Impairment due to the eating disorder. (c) Depression, anxiety and stress. (d) BMI in underweight people (n = 24).

Figure 2

Change over the program for each of the three time periods, August 2018 to August 2019, September 2019 to September 2020, October 2020 to July 2021 in: (a) Global levels of disordered eating. (b) Impairment due to the eating disorder. (c) Depression, anxiety and stress. (d) BMI in underweight people (n = 24).