Family-based treatment (FBT) is the leading evidence-based treatment for adolescents
with eating disorders,
1
and has particularly strong research support for the treatment of anorexia nervosa
(AN).
National Institute for Health and Care Excellence
Eating Disorders: Recognition and Treatment. Version 2.0. Full Guideline.
Eating Disorders: Recognition and Treatment. Version 2.0. Full Guideline.
Clinical Guideline: Methods, Evidence and Recommendations. Published May 2017;
https://www.nice.org.uk/guidance/ng69/evidence/full-guideline-pdf-161214767896
Date accessed: November 5, 2021
2
FBT is an outpatient treatment consisting of 3 phases.
2
In phase 1, because patients with AN are often ambivalent about treatment and recovery,
parents are given the responsibility for weight restoration. This involves making
all eating-related decisions for their child, including deciding what will be eaten
and when, how much will be eaten, monitoring all meals and snacks, and curtailing
physical activity. Once the patient has gained weight, eating disordered behaviors
have lessened, and the adolescent’s thoughts and behaviors are no longer being driven
by the eating disorder, responsibility for eating is gradually handed back to the
adolescent—to whatever extent is age-appropriate—in phase 2. In phase 3, the treatment
team ensures that the adolescent is back on track with healthy development. FBT has
also been found to be effective for bulimia nervosa.
3
Although the phases of treatment are the same for bulimia nervosa, the focus of treatment
is on developing a regular pattern of eating and eliminating binge eating and purging.Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of the Academy of Nutrition and DieteticsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Eating Disorders: Recognition and Treatment. Version 2.0. Full Guideline.Clinical Guideline: Methods, Evidence and Recommendations. Published May 2017;https://www.nice.org.uk/guidance/ng69/evidence/full-guideline-pdf-161214767896Date accessed: November 5, 2021
- Treatment Manual for Anorexia Nervosa: A Family-Based Approach.2nd ed. Guilford Press, 2013
- Randomized clinical trial of family-based treatment and cognitive-behavioral therapy for adolescent bulimia nervosa.J Am Acad Child Psychiatry. 2015; 54: 886-894
- The five tenets of family-based treatment for adolescent eating disorders.J Eat Disord. 2022; 10: 60
- Psychological consequences of food restriction.J Am Diet Assoc. 1996; 96: 589-592
- Naturalistic outcome of family-based inpatient treatment for adolescents with anorexia nervosa.Eur Eat Disord Rev. 2018; 26: 141-145
- Family in Residence Program: A family empowerment model for higher levels of care.in: Murray S.B. Anderson L.K. Cohn L. Innovations in Family Therapy for Eating Disorders. Routledge, 2017: 161-175
- Adapting family-based therapy to a day hospital programme for adolescents with eating disorders: Preliminary outcomes and trajectories of change.J Fam Ther. 2013; 35: 102-120
- A family-based eating disorder day treatment program for youth: Examining the clinical and statistical significance of short-term treatment outcomes.Eat Disord. 2014; 22: 1-18
- Incorporating family-based therapy principles into a partial hospitalization programme for adolescents with anorexia nervosa: Challenges and considerations.J Fam Ther. 2015; 37: 41-60
- Predictors of weight restoration in a day-treatment program that supports family-based treatment for adolescents with anorexia nervosa.Eat Disord. 2019; 27: 400-417
- Clinical outcomes of a novel, family-centered partial hospitalization program for young patients with eating disorders.Eat Weight Disord. 2012; 17: e170-e177
- Short-term intensive family therapy for adolescent eating disorders: 30-month outcome.Eur Eat Disord Rev. 2015; 23: 210-218
- Academy for Eating Disorders position paper: The role of the family in eating disorders.Int J Eat Disorder. 2010; 43: 1-5
- Updates in the treatment of eating disorders in 2018: A year in review in.Eating Disorders: The Journal of Treatment & Prevention. Eat Disord. 2019; 27: 6-17
- Adolescent anorexia: Guiding principles and skills for the dietetic support of family-based treatment.J Acad Nutr Diet. 2019; 119: 17-25
- An exploratory examination of patient and parental self-efficacy as predictors of weight gain in adolescents with anorexia nervosa.Int J Eat Disord. 2015; 48: 883-888
- Family-based treatment of eating disorders in adolescents: Current insights.Adolesc Health Med Ther. 2017; 8: 69-79
- ‘I know I can help you’: Parental self-efficacy predicts adolescent outcomes in family-based therapy for eating disorders.Eur Eat Disord Rev. 2013; 21: 108-114
- Are parental self-efficacy and family flexibility mediators of treatment for anorexia nervosa?.Int J Eat Disord. 2018; 51: 275-280
- Clinical guidelines for dietitians treating young people with anorexia nervosa: family focused approach. The Association of UK Dietitians.https://www.researchgate.net/publication/335740796Date accessed: September 15, 2021
- Family members’ reflections upon a Family-based inpatient treatment program for adolescent anorexia nervosa: A thematic analysis.J Eat Disord. 2021; 9: 7
- Food choice and diet variety in weight-restored patients with anorexia nervosa.J Am Diet Assoc. 2011; 111: 732-736
- Cognitive-behavioral therapy for bulimia nervosa: Time course and mechanisms of change.J Consult Clin Psychol. 2002; 70: 267-274
- Emotion-focused family therapy for eating disorders in children and adolescents.Clin Psychol Psychother. 2015; 22: 75-82
- Emotion-focused family therapy for eating disorders across the lifespan: A pilot study of a 2-day transdiagnostic intervention for parents.Clin Psychol Psychother. 2016; 23: 14-23
- Are single-parent families different from two-parent families in the treatment of adolescent bulimia nervosa using family-based treatment?.Int J Eat Disord. 2009; 42: 153-157
- A comparison of short- and long-term family therapy for adolescent anorexia nervosa.J Am Acad Child Adolesc Psychiatry. 2005; 44: 632-639
- Intuitive Eating: A Revolutionary Program That Works.3rd. St. Martin’s Press, 2012
- Development and psychometric evaluation of a measure of intuitive eating.J Couns Psychol. 2006; 53: 226-240
- Intuitive Eating: A Revolutionary Program That Works.2nd. St. Martin’s Press, 2003
- Audit of digestive complaints and psychopathological traits in patients with eating disorders: A prospective study.Digest Liver Dis. 2013; 45: 639-644
- Psychological features are important predictors of functional gastrointestinal disorders in patients with eating disorders.Scand J Gastroenterol. 2005; 40: 929-935
- Gastrointestinal comorbidities which complicate the treatment of anorexia nervosa.Eat Disord. 2017; 25: 122-133
- The intersect of gastrointestinal symptoms and malnutrition associated with anorexia nervosa and avoidant/restrictive food intake disorder: Functional or pathophysiologic? – A systematic review.Int J Eat Disord. 2021; 54: 1019-1054
- Nutritional rehabilitation in anorexia nervosa: Review of the literature and implications for treatment.BMC Psychiatry. 2013; 13: 290
- Pre-meal anxiety and food intake in anorexia nervosa.Appetite. 2010; 55: 214-218
- New insights into symptoms and neurocircuit function of anorexia nervosa.Nat Rev Neurosci. 2009; 10: 573-584
- Hunger does not motivate reward in women remitted from anorexia nervosa.Biol Psychiatry. 2015; 77: 642-652
- Cognitive distortions amongst women experiencing bulimic episodes.Int J Eat Disorder. 1991; 10: 547-555
- The diet composition and nutritional knowledge of patients with anorexia nervosa.J Hum Nutr. 1981; 35: 265-273
- Implementation of transdiagnostic treatment for emotional disorders in residential eating disorder programs: A preliminary pre-post evaluation.Psychother Res. 2019; 29: 1045-1061
Biography
J. Patterson is a virtual nutrition manager, Eating Recovery Center, Denver, CO.
Biography
J. L. Myers is a Clinical Dietitian II, Eating Recovery Center, Denver CO.
Biography
E. Gallagher is a Clinical Dietitian II, Eating Recovery Center, Denver CO.
Biography
G. R. Hartman is a senior clinical dietitian, Eating Recovery Center, Denver CO.
Biography
J. Bush Lewis is a nutrition director, Eating Recovery Center, Plano TX.
Biography
C. Royster is a nutrition manager, Eating Recovery Center, Hunt Valley, MD.
Biography
E. Easton is national director of psychotherapy, Eating Recovery Center and Pathlight Mood and Anxiety Centers, Denver, CO.
Biography
A. O’Melia is chief medical officer and chief clinical officer, Eating Recovery Center and Pathlight Mood & Anxiety Centers, Denver, CO, and an adjunct associate professor, University of Utah, Salt Lake City, UT.
Biography
R. D. Rienecke is director of research, Eating Recovery Center and Pathlight Mood & Anxiety Centers, Chicago IL, and an adjunct associate professor at Northwestern University, Chicago, IL.
Article info
Publication history
Published online: June 20, 2022
Accepted:
June 14,
2022
Received:
April 18,
2022
Footnotes
STATEMENT OF POTENTIAL CONFLICT OF INTEREST Renee D. Rienecke receives consulting fees from the Training Institute for Child and Adolescent Eating Disorders, LLC and royalties from Routledge. No potential conflict of interest was reported by the remaining authors.
AUTHOR CONTRIBUTIONS All authors contributed to the writing of the manuscript and edited the final version.
Identification
Copyright
© 2022 by the Academy of Nutrition and Dietetics.
