Desired weight and treatment outcome among adolescents in a novel family-based partial hospitalization program

Predictors of treatment outcome in higher levels of care among a large sample of adolescents with heterogeneous eating disorders

BACKGROUND

Despite widespread use of higher levels of care in treating eating disorders in adolescents, research supporting the use of these treatments remains limited by small sample sizes and a predominant focus on anorexia nervosa. Further, existing data regarding predictors of outcome have yielded mixed findings. In the current study, we evaluated treatment outcomes and predictors of outcome among a large sample of adolescents with eating disorders presenting to inpatient, residential, partial hospitalization programs, and intensive outpatient programs across the United States.

METHODS

Adolescents (N = 1,971) completed self-report measures of eating disorder symptoms, depression, and anxiety at treatment admission, stepdown, and discharge. Using linear mixed effect models, we evaluated changes in symptoms over treatment separately among youth admitted to inpatient/residential treatment and those admitted to partial hospitalization/intensive outpatient programs, and used established metrics to gauge frequency of reliable (i.e., statistically reliable) and clinically significant change.

RESULTS

Results suggested decreases in eating disorder symptoms, depression, and anxiety from intake to discharge. Around 50% of the sample reported reliable decreases in eating disorder symptoms at stepdown and discharge, with 30% of the sample reporting reliable reductions in depression and anxiety. Psychiatric comorbidity, primary diagnosis, age, and eating disorder symptoms at admission consistently predicted treatment-related change, although patterns in findings varied across symptoms.

CONCLUSIONS

Data from our sample are consistent with past work suggesting that adolescents enrolled in higher levels of care report clinical benefit; however, these effects are heterogenous, and a significant portion of individuals may not report reliable change in symptoms. Ultimately, ongoing work is required to better understand how and for whom higher levels of care may achieve their benefit and to identify the optimal approach for improving outcomes for adolescents with eating disorders.

Detrimental Effects of Online Pro-Eating Disorder Communities on Weight Loss and Desired Weight: Longitudinal Observational Study

BACKGROUND

Online pro-eating disorder (pro-ED) communities are considered harmful because of their detrimental effects on their users' body dissatisfaction, dieting, and help seeking. To date, it is unknown to which extent participation in pro-ED communities affects users' body weight and desired weight loss.

OBJECTIVE

This study aims to investigate the changes in the current and desired body weight of users of a pro-ED community (r/proed) on the social media website Reddit over time.

METHODS

Data on 1170 users and the unsolicited weight information they shared with the pro-ED community were collected over a period of 15 months. Linear growth models were used to model changes in the users' current and desired BMI over time.

RESULTS

Both current and desired BMI decreased over time, with a predicted rate of 0.087 and 0.015 BMI points per week, respectively. Weight loss was moderated by the users' activity level in the community, with more active users losing more weight. Users with a higher baseline BMI experienced greater weight loss, but even users with a very low baseline weight (BMI <17 kg/m²) lost weight during their participation. In addition, users decreased their desired weight over time, with many pursuing extremely low, unrealistic weight goals. Changes in the desired weight were moderated by the baseline current BMI and baseline desired BMI. Users with higher desired weight and lower body weight at baseline decreased their desired weight more over time.

CONCLUSIONS

This is the first study to demonstrate the detrimental effects of pro-ED communities in a longitudinal study based on a large data set of user-generated online data. The results extend the literature detailing the harmful effects of online pro-ED communities by showing users' weight loss, decreases in desired weight, and that higher activity levels lead to greater weight loss. Users could be driven to pursue very low, unrealistic weight loss goals by images of very thin bodies presented in these communities.

Individualisierte Therapieplanung mithilfe des Gewichtsmappings bei Anorexia nervosa

Die Anorexia nervosa ist eine seltene, schwerwiegende Erkrankung, deren Therapie bislang oft nur mäßig wirksam ist. Stagnierende Verläufe oder ein erhebliches Auf und Ab in der Gewichtsentwicklung zwischen stationären Behandlungen und dem häuslichen Transfer sind verbreitet und können stationäre Aufnahmen bzw. Wiederaufnahmen notwendig machen. Im Folgenden werden daher Techniken des Gewichtsmappings vorgestellt, die eine individualisierte Therapieplanung ermöglichen. Hierzu zählt zum einen die retrospektive Analyse des Lifecharts, in der die Gewichtsentwicklung über die Lebenspanne aufgezeigt wird und die damit Schweregrad der Essstörung, Krankheitsdauer und -verlauf sowie transdiagnostisch relevante Prozesse veranschaulichen kann. Zum anderen gehört dazu die prospektive Technik des Gewichtsmappings, die in einem standardisierten Vorgehen die individuell relevanten Gewichtsmarker erfasst und visualisiert. Diese diagnostischen Informationen können eine personalisierte Therapieplanung unterstützen, die sowohl den Zeitverlauf als auch den Schwierigkeitsgrad des Bewältigungsprozesses antizipiert. Mithilfe der Techniken des Gewichtsmanagements kann die Expositionsbehandlung zielgerichtet therapeutisch angeleitet und begleitet werden. Dabei werden die Arbeit mit Intervallmodulen und ihre Rolle für eine bewältigungsorientierte Expositionsbehandlung diskutiert.

Adolescent Eating Disorder Day Programme Treatment Models and Outcomes: A Systematic Scoping Review

Background: Adolescent eating disorder day programmes (DP), or partial hospitalization programs, are becoming increasingly widespread worldwide. They typically function as an alternative to inpatient care and/or a step up or down in treatment intensity. There has been an increase in the number of publications within the last 5 years investigating DP outcomes. While there are now numerous programmes operating internationally, there is large variability in the content, structure and theoretical underpinnings of each programme. This makes it difficult to compare programme outcomes, and the impact the therapeutic model may have. Aims: To review existing literature on adolescent eating disorder DP treatment models and outcomes. Methods: A systematic scoping review was conducted. Four databases (PsychInfo, EMBASE, Medline, CENTRAL) were searched for relevant peer-reviewed journal articles and book chapters investigating adolescent eating disorder DPs that function as alternatives to inpatient treatment. No restrictions on study methodology were imposed. Studies were first mapped by location, study characteristics and day programme treatment characteristics, then narratively synthesized. Results: Forty nine studies were included in this review. All used a quantitative methodology. One study also included qualitative methods. The majority of studies included describe DPs in the USA (69%). Seventy-six percent of the studies described DPs that operate 5-days per week and most (57%) either only admit or only report on outcomes for restrictive eating disorders. Two-thirds (69%) reported on DPs that had a family focused treatment model, the remainder had a more integrated treatment model informed mostly by individual psychotherapeutic models. Generally, DP treatment is associated with weight gain and improvements in eating disorder and comorbid psychopathology. The studies that include follow-up data (27%) reveal improvements are usually maintained from 3 months to 2 years post-treatment. Early weight gain, early psychological change and early therapeutic alliance are associated with improved end of treatment outcomes. Findings regarding other potential predictors of outcome are mixed. Conclusions: Current evidence suggests day programmes are an effective alternative to inpatient treatment that lead to sustained improvements. DPs tend to either be young-person-only with a family-focused treatment model or all age with a more integrative model. Controlled, empirical investigations into the impact of the therapeutic model on outcomes are needed, as are investigations into treatment mechanisms and the individual and parent experience of day programme treatment.