Research Summary: Efficacy of Family-Based Treatment for Adolescents
By Russell Marx, MD, NEDA Education Director & Board Member
So often, it is difficult to bridge the gap between the research community and families that are affected by eating disorders, as many families aren’t getting the information they need to make informed decisions about treatment options. With that in mind, NEDA is beginning a series of blog entries on eating disorders research. It is our hope that these updates will bring new information to families from the academic research community.
I will try and focus on “what’s new and what’s true” with a minimum of professional jargon.
In the January 2013 issue of the International Journal of Eating Disorders (IJED), Jennifer Couturier and her colleagues wrote on the “Efficacy of Family-Based Treatment for Adolescents.” In a healthcare context, “efficacy” is the capacity of an intervention to produce a beneficial effect. In this study, the authors discuss “remission” as the preferred outcome (that is, a decrease in symptoms). They define this in several ways: absence of diagnosable criteria, achievement of a certain percent of ideal body weight, and abstinence from binge eating and purging.
In this literature review, six randomized controlled trials (the gold standard for clinical research) were found that compared Family-Based Treatment (FBT) with individual treatments in adolescents with Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Eating Disorders Not Otherwise Specified (EDNOS).
These studies with small sample sizes were combined in a “meta-analysis”. In this context, meta-analysis refers to a statistical way of combining evidence of several smaller studies, so that the resulting greater statistical “power” has a better chance to detect an effect than in the individual studies. Lucky for us, Jennifer Couturier did a post-doctoral research fellowship at Stanford and actually understands statistics. As Abigail Zucker writes in her New York Times review of the new book Naked Statistics, “If you want to eat sausage and survive, you should know what goes on the factory. That dictum – one of the few certainties in an uncertain world – most definitely applies to the statistical sausage factory where medical data is ground into advice.”
The results indicated that “although there does not appear to be a significant difference between FBT and individual therapy when measured at the end of treatment, when measured at 6-12 month follow-up, FBT is superior.” A possible explanation for these results are that the parents have learned helpful techniques, and they could be acting in place of a therapist to support healthier behaviors and continued adequate weight gain in their adolescent child.
The authors go on to conclude that “Family therapy focusing on symptom interruption of eating disordered behaviors should be recommended as the first line of treatment for adolescents with eating disorders. Given the growing evidence base for FBT for adolescents with eating disorders, it would be prudent to study implementation strategies and effectiveness of this treatment in the community.”
The medical community can be resistant to change. Harvard economist Michael Porter writes in his seminal book Redefining Health Care2: “It takes, on average, seventeen years for the results of clinical trials to become standard clinical practice.”
Parents can help by utilizing the simple mantra: “Educate, Advocate, Donate.” One good opportunity for education will be the upcoming University of California, San Diego Eating Disorders Conference (February 22-23). This is one of the first professional conferences open to families, and it will focus on advances in FBT, as well as other topics. Speakers include such notables as Walt Kaye MD and Kerri Boutelle PhD from UC San Diego, Daniel Le Grange, PhD from the University of Chicago, and Janet Treasure, PhD, FRCP, from Kings College, London.
1 LeGrange, D. & Lock, J., (Eds.). (2011). Eating disorders in children and adolescents: A clinical handbook. New York, NY: Guilford Press.
2 Porter, M & Olmstead Teisberg, E. (2006). Redefining health care: Creating value-based competition on results. Boston, MA: Harvard Business School Publishing.