Comparing randomized controlled trials of outpatient family-based or inpatient multimodal treatment followed by outpatient care in youth with anorexia nervosa: Differences in populations, metrics, and outcomes

Verena Haas; Janine Nadler; Ross D Crosby; Sloane Madden; Michael Kohn; Daniel Le Grange; Ana Sofia Oliveira Gonçalves; Johannes Hebebrand; Christoph U Correll

doi:10.1002/erv.2907

Comparing randomized controlled trials of outpatient family-based or inpatient multimodal treatment followed by outpatient care in youth with anorexia nervosa: Differences in populations, metrics, and outcomes

Eur Eat Disord Rev. 2022 Nov;30(6):693-705. doi: 10.1002/erv.2907. Epub 2022 Apr 26.

Authors

Affiliations

¹ Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
² Sanford Center for Biobehavioral Research, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota, USA.
³ University of Sydney, Sydney, Australia.
⁴ Department of Adolescent and Young Adult Medicine, Centre for Research into Adolescent'S Health, Westmead Hospital, University of Sydney, Sydney, Australia.
⁵ Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, California, USA.
⁶ Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, IL, USA (Emeritus).
⁷ Institute of Public Health, Charité - Universitätsmedizin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
⁸ Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
⁹ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, USA.
¹⁰ Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, New York, USA.

PMID: 35474627
DOI: 10.1002/erv.2907

Abstract

Objective: Various approaches exist to treat youth with anorexia nervosa (AN). Family-based treatment (FBT) has never been compared to long inpatient, multimodal treatment (IMT) in a randomized controlled trial (RCT). The aim of this study was to compare data on body weight trajectories, change in eating disorder psychopathology, hospital days and treatment costs in RCTs delivering FBT or IMT.

Method: Review of RCTs published between 2010 and 2020 in youth with AN, delivering FBT or IMT.

Results: Four RCTs delivering FBT (United States, n = 2; Australia, n = 2), one RCT delivering Family Therapy for AN (United Kingdom) and two RCTs delivering IMT (France, n = 1; Germany, n = 1) were identified from previous meta-analyses. The comparison of studies was limited by (1) significant differences in patient baseline characteristics including pretreated versus non-pretreated patients, (2) use of different psychometric and weight measures and (3) different initial velocity of weight recovery. Minimal baseline and outcome reporting standards for body weight metrics and nature/dose of interventions allowing international comparison are needed and suggestions to developing these standards are presented.

Discussion: An RCT should investigate, whether FBT is a viable alternative to IMT, leading to comparable weight and psychopathology improvement with less inpatient time and costs.

Keywords: adolescent; eating disorders; hospitalisation; review; setting; weight gain.

Publication types

Review
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Ambulatory Care
Anorexia Nervosa* / therapy
Combined Modality Therapy
Family Therapy
Humans
Inpatients
Outpatients
Randomized Controlled Trials as Topic
Treatment Outcome