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

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 interventi...

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Autores principales: Lebow, Jocelyn, Mattke, Angela, Narr, Cassandra, Partain, Paige, Breland, Renee, Gewirtz O’Brien, Janna R., Geske, Jennifer, Billings, Marcie, Clark, Matthew M., Jacobson, Robert M., Phelan, Sean, Harbeck-Weber, Cynthia, Le Grange, Daniel, Sim, Leslie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067301/
https://www.ncbi.nlm.nih.gov/pubmed/33892810
http://dx.doi.org/10.1186/s40337-021-00413-9
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author Lebow, Jocelyn
Mattke, Angela
Narr, Cassandra
Partain, Paige
Breland, Renee
Gewirtz O’Brien, Janna R.
Geske, Jennifer
Billings, Marcie
Clark, Matthew M.
Jacobson, Robert M.
Phelan, Sean
Harbeck-Weber, Cynthia
Le Grange, Daniel
Sim, Leslie
author_facet Lebow, Jocelyn
Mattke, Angela
Narr, Cassandra
Partain, Paige
Breland, Renee
Gewirtz O’Brien, Janna R.
Geske, Jennifer
Billings, Marcie
Clark, Matthew M.
Jacobson, Robert M.
Phelan, Sean
Harbeck-Weber, Cynthia
Le Grange, Daniel
Sim, Leslie
author_sort Lebow, Jocelyn
collection PubMed
description 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.
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spelling pubmed-80673012021-04-26 Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study Lebow, Jocelyn Mattke, Angela Narr, Cassandra Partain, Paige Breland, Renee Gewirtz O’Brien, Janna R. Geske, Jennifer Billings, Marcie Clark, Matthew M. Jacobson, Robert M. Phelan, Sean Harbeck-Weber, Cynthia Le Grange, Daniel Sim, Leslie J Eat Disord Research Article 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. BioMed Central 2021-04-23 /pmc/articles/PMC8067301/ /pubmed/33892810 http://dx.doi.org/10.1186/s40337-021-00413-9 Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Lebow, Jocelyn
Mattke, Angela
Narr, Cassandra
Partain, Paige
Breland, Renee
Gewirtz O’Brien, Janna R.
Geske, Jennifer
Billings, Marcie
Clark, Matthew M.
Jacobson, Robert M.
Phelan, Sean
Harbeck-Weber, Cynthia
Le Grange, Daniel
Sim, Leslie
Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study
title Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study
title_full Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study
title_fullStr Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study
title_full_unstemmed Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study
title_short Can adolescents with eating disorders be treated in primary care? A retrospective clinical cohort study
title_sort can adolescents with eating disorders be treated in primary care? a retrospective clinical cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067301/
https://www.ncbi.nlm.nih.gov/pubmed/33892810
http://dx.doi.org/10.1186/s40337-021-00413-9
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