Eating Disorders II

What are some concerns with the treatments of eating disorders? (Lilienfeld et al., 2013)

Very few are evidence-based

Are clinicians the problem when looking at eating disorder treatment ineffectiveness? (Lilienfeld et al., 2013)

Most were untrained

How can we prevent eating disorders?

A lowering of eating and other concerns in the present

and a lower level of future development of eating disorders

Is the prevention of eating disorders risk-free? (Carter et al., 1997; Baronowski & Heatherington, 2001)

Could worsen the pathology

What prevention approaches work?

Media literacy

Cognitive dissonance

CBT

Weight management

How can we prevent obesity?

Involving schools, families and policies to encourage lifestyle changes

What is the most effective treatment for obesity?

Within the NICE guideline (2017)

What treatments are effective for adult obesity?

CBT-ED

Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)

Specialist Supportive Clinical Management (SSCM)

What treatments are effective for child/adolescent obesity?

AN-focused family therapy

CBT-ED

What is an effective treatment for binge eating disorder?

CBT-ED (group or individual)

What is an effective treatment for adults with bulimia nervosa?

CBT-ED (individual)

What is an effective treatment for OSFED?

Therapies similar to the full disorder

What is an effective treatment for ARFID?

N/A- too new

Can briefer therapies be as effective for non-underweight eating disorders? (Waller et al., 2018)

Yes, despite being delivered by nonspecialists

Does the therapeutic alliance work in the way that clinicians assume? (Graves et al., 2017)

No, early symptom reduction enhances therapeutic alliance and treatment outcome in EDs

Is early change critical? (Vall & Wade, 2015)

Yes, the most robust predictor of outcome at both the end of treatment (EoT) and follow-up was the meditational mechanism of greater symptom change early during treatment.

Is there any evidence that severity or duration reduce effectiveness? (Raykos et al., 2018)

Yes, greater levels of illness severity and duration were not associated with poorer treatment outcomes

What are common elements in which treatments work?

Exposure to foods

What is the need for case/risk management?

Medical monitoring & management and Intensive treatments

What medications can be used for treatment of EDs?

SSRI for Bulimia Nervosa & Novel Antipsychotics for Anorexia Nervosa

What other physical interventions can be used for EDs?

Neuromodulation & Leucotomy

How effective are the best therapies for adult psychological disorders? (Hansen et al., 2002)

50% recovery

25% improvement

20% unchanged

5% deteriorate

What effect does addressing eating and nutrition have?

Reduces anxiety, depression, impulsivity, and compulsivity

Reduces alcohol levels

Enhances cognitive flexibility, social skills

Normalises and stabilises weight

Enhances quality of life

Why are we so poor at treating obesity?

Difficult to change due to the biology x environment interaction

How can we support people with obesity?

Do not blame the patient

Political changes (sugar tax)

Coaching and therapy