Simple Ways to Start FBT for Eating Disorders in the Hospital
Presenters: Christiane Lenzen, MD, and Tamara Maginot, PhD
Eating disorders are illnesses that affect children, adolescents, and adults and are associated with significant morbidity and mortality. Family-based treatment (FBT) has emerged as an effective intervention, and likely the treatment of choice, for adolescents with anorexia nervosa who are medically stable.
This session focused on exploring the pivotal role of FBT in the inpatient setting. FBT is a therapy designed to restore adolescents to health with the support of their parents. It’s characterized by four principles, as explained by the presenters.
- It’s agnostic, meaning as physicians we should not care about why or how the illness started. The etiology is not important.
- FBT is parent-empowered. This means that the patient’s family should be a main resource. We can take responsibility for the treatment plan initially, but eventually, the parents should be given the responsibility of weight restoration.
- FBT requires the separation of the illness from the patient. One example is not to use the term “manipulative” when describing such patients. These patients are ill and need treatment.
- Clinicians serve as consultants, meaning we must balance our role of having an active stance with empowering the parent to eventually take over the role.
FBT consists of a three-phase treatment plan: weight restoration, return of control, and review of adolescent development issues with relapse prevention. With weight restoration, food decisions such as what food, how much food, and when food is eaten are taken out of the patient’s hands and given to the parents. Once there is steady weight gain, we move to the “return of control” phase, in which gradual responsibility over food is given back to the adolescent. The last phase involves identifying any developmental challenges and how the adolescent will navigate them.
The session provided a stepwise approach to initiating FBT. First beginning with a structured refeeding menu, it then moves on to meal-room participation. The next step after that would be family meals, and finally modified method education and meal planning. The initial focus should be meal completion and taking a supplement if needed. Keep in mind that it might be best to target eating disorder behaviors later in the treatment.
Despite its success, there are some patients for whom FBT is contraindicated: patients who will no longer live with their parents, patients with parents who have severe psychopathology, and patients with a history of abuse.
Parental education on the illness is also an important component. Teaching parents about the consequences of malnutrition on the body will promote a better understanding of the disease. The presenters shared a nice handout that described those effects on each body system in simplistic language.
Key Takeaways
- FBT is an effective intervention for patients with eating disorders and is defined as the restoration of adolescent health with the support of their parents.
- FBT consists of a three-phase treatment plan: weight restoration, return of control, and review of adolescent development issues with relapse prevention.
- Although the literature supports the use of FBT due to its effectiveness, more research is needed to identify some patients for whom it may be contraindicated—such as patients who will no longer live with their parents, patients with parents who have severe psychopathology, and patients with a history of abuse.
Dr. Musaitif is a pediatric hospitalist and assistant professor of clinical pediatrics at the University of Illinois College of Medicine, Peoria, Ill.