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Background/Objectives: The goal of childhood obesity treatment is to benefit the physical and mental health of children who suffer from it and to prevent complications, improving their quality of life and ensuring adequate development. Family-based interventions are demonstrating positive results, especially in prepubertal children. The aim of our study was to evaluate the effectiveness of a family grocery basket intervention for the treatment of childhood obesity in a Spanish primary care office. Methods: A randomized controlled trial comparing a family grocery basket intervention through the analysis of unhealthy products included in the grocery receipts that families bring to the primary care office, in comparison with the usual interventions. Results: Ninety-one children participated in the study (intervention group: n = 60, control group: n = 31). After one year of follow-up, a relevant weight loss with a decrease of ≥0.5 SDS in the z-IMC was obtained in 60.6% of the total sample. In the intervention group, there was a significant decrease in the number of unhealthy products in the family grocery basket and a lower percentage of hypertension and severe obesity than in the control group. In families in which there was a significant decrease in the consumption of unhealthy products, a higher percentage of weight loss was observed. Conclusions: Intervention in the family grocery basket through receipts is an original, simple and effective tool for family-based treatment in childhood obesity. [ABSTRACT FROM AUTHOR]

Family-based treatments provided around the world for children with mental health, physical health, and developmental disorders often convey secondary mental health benefits to caregivers and siblings who participate in those treatments. Yet, there are no systematic evaluations of these secondary benefits, suggesting that current estimates of the effectiveness of family treatments do not accurately represent the full scope of benefits to participants. In the present study, we use a three-level meta-analysis to summarize the secondary benefits for caregivers (n = 19,895) and siblings (n = 784) who participated in the treatment of a child family member. Results from 128 studies across many countries reveal multiple strengths in the research literature, including frequent use of standardized treatments, random assignment of participants to treatment conditions, and comparison of family-based treatments to usual services. This meta-analysis examines 412 effect sizes and shows that family-based treatments produce small but statistically significant secondary benefits (d = 0.25) compared to individually focused treatments and conditions. In addition, the magnitude of these secondary benefits is relatively consistent across a range of possible moderators, including characteristics of the participants, clinical interventions, study methods, and measures. The only significant moderator of family-based treatments is caregiver gender, such that male caregivers report fewer secondary benefits than do female caregivers. Our findings suggest that there is a pressing need for researchers to routinely measure secondary benefits in studies evaluating family-based treatments of childhood disorders. Furthermore, researchers of these treatments should report family structure, key demographic information (e.g., lesbian, gay, bisexual, transgender, queer or questioning families), and cultural values (e.g., familismo) in their studies. Moreover, administrators, policymakers, and treatment providers would do well to consider the secondary benefits and cost savings of interventions that are delivered to families of children with a wide range of disorders. Public Significance Statement: This meta-analysis demonstrates that family members benefit from their own participation in treatments for children with mental health, physical health, and developmental disorders. These benefits include improved individual adjustment, family dynamics, and extrafamilial relationships for both caregivers and siblings. Moreover, in large part, the benefits of family participation are consistent across the age, gender, and minority status of family members as well as across clinical interventions and study methods. The findings of this study emphasize the importance of incorporating families in the design and implementation of treatments for childhood disorders and suggest that such treatments may be especially cost-effective owing to their broad clinical effects beyond the individual child. Individually focused treatments for childhood disorders do not include family members as agents of change and, thus, do not provide the same opportunities for caregivers to enhance their parenting skills, improve relations with their children, or strengthen their marriages as well as other sources of social support. Policymakers and administrators should keep the results of the present study in mind as they select and fund interventions to meet the needs of children and families in their communities. [ABSTRACT FROM AUTHOR]

ABSTRACT Introduction Methods Results Discussion Studies have shown that early weight gain in family‐based treatment (FBT) predicts treatment response in adolescents with anorexia nervosa (AN); however, research examining factors associated with early weight gain in FBT is limited. This study tested the feasibility and acceptability of ecological momentary assessment (EMA) in early FBT, particularly to capture momentary data on family climate during mealtimes.Using multiple methods, quantitative (EMA) and qualitative (interviews) data were collected in the first 4 weeks of FBT. Participants (11 families; 9 adolescents, 19 parents/caregivers) completed EMA assessments daily on the emotional climate during meals, parental strategies and confidence/agreement in renourishment. Qualitative interviews obtained technological and procedural data using EMA. Completion rates and markers of change were explored using repeated measures ANOVA. Interviews were analyzed using reflexive thematic analysis.The EMA completion rate for all family members was 78%: 84% for adolescents, 83% for mothers, 64% for fathers. Results demonstrated changes in caregivers' use of renourishment strategies and in the emotional climate (decreased anger) at mealtimes. No changes were observed in caregiver confidence/agreement in renourishment. Qualitative analyses revealed factors interfering with and facilitating the use of EMA.EMA is an acceptable and feasible tool for use with adolescents and their families in early FBT, particularly to capture momentary data on family climate during mealtimes. Future research is needed with larger sample sizes to examine the mechanisms of change in early FBT, and the utility of EMA as a clinical tool in FBT. [ABSTRACT FROM AUTHOR]

Abstract Background Access to evidence-based treatments such as family-based therapy (FBT) is difficult for adolescents diagnosed with Anorexia Nervosa (AN) living in rural or regional areas due to a limited trained workforce, high staff turnover and inconsistent treatment fidelity. Telehealth offers a potential access solution by facilitating care irrespective of family or service location. The disruption to the health system caused by COVID-19 amplified an existing need and increased the use of telehealth to deliver FBT before its efficacy and safety was fully evaluated. This study aimed to evaluate the feasibility, acceptability and preliminary efficacy of telehealth-FBT delivered by community-based clinicians within rural services directly into the home to reduce the eating disorder symptoms of adolescents diagnosed with AN. Methods A pre- and post-implementation multi-site case series delivered up to 20 sessions of telehealth-FBT to 28 adolescents (89.29% female, M = 14.68 ± 1.58 years) living in rural or regional Australia. The RE-AIM framework guided the evaluation, with Reach (treatment uptake and completion); Efficacy (change in weight, global eating disorder symptoms, and remission from baseline to end of treatment and six-month follow-up); Adoption (patient characteristics and drop out); Implementation (intervention fidelity) and Maintenance (outcomes and intervention during the follow-up period) used to assess the feasibility and preliminary efficacy of telehealth-FBT. Results There was a high level of interest in telehealth-FBT, with two-thirds of eligible families consenting to participate. Both treatment engagement and completion rates were over 60%, and treatment was delivered with acceptable fidelity. Twenty adolescents (71.43%) met the diagnostic criteria for AN (baseline 86.03%mBMI ± 7.14), and eight (28.57%) for Atypical AN (baseline 101.34%mBMI ± 8.28), with an overall mean duration of illness of 8.53 months (SD = 5.39, range 2–24 months). There was a significant increase in %mBMI at the end of treatment compared to the baseline (p = 0.007, 95%CI: 1.04–6.65), with over 68% of adolescents weight restored and 36.8% of these achieving both weight and psychological remission criteria. Weight remained significantly improved at six-month follow-up (p = 0.005, 95%CI: 1.57–8.65). Also, there was a decrease in adolescents’ global eating disorder symptoms, as rated by their parents, at the end of treatment compared to the baseline of 0.735 (p = 0.028, 95%CI: 0.079–1.385). Conclusions Telehealth-FBT was feasibly implemented into rural services and delivered by community clinicians with reach, adoption, preliminary efficacy, and fidelity scores comparable to those reported by specialist studies. Trial registration The study was conducted according to the HREC-approved protocol (HREC 2020/ETH00186) and registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR # 12620001107910).

ABSTRACT Family-based treatment (FBT) has been shown to be an effective treatment for adolescent anorexia nervosa and the method is nowadays generally recommended, but probably not widely enough in practice in Finland. Around a decade ago, one severe anorexia patient was successfully treated by a paediatrician (JR), in an initially unplanned treatment, at a healthcare centre as an outpatient, by coaching the family to return the patient to their previous normal eating habits. The severe malnutrition (weight loss of 20 kgs and body mass index 14.3 kg/m2) and the eating disorder symptoms alleviated in approximately six months by actively supporting and coaching the parents, in weekly appointments, to take whole responsibility for the meals. During the last ten years, the paediatrician (JR) has applied the coaching family-based method (c-FBM) to all adolescent patients with a restrictive eating disorder seeking help, first at the Primary Healthcare Centre of Oulu, and lately at Primary Healthcare Centres of Länsi-Pohja District and at a private clinic in Oulu. The c-FBM is otherwise quite similar to the generally used FBT method, with the most significant difference being the primary care paediatrician taking the main responsibility for the treatment. In this article we introduce the c-FBM through four lately treated patient cases who have all benefited from the treatment within one year.

ABSTRACT Eating disorders (EDs), including anorexia nervosa (AN), bulimia nervosa (BN) and others, are serious mental illnesses that often begin in adolescence and early adulthood. EDs are associated with serious medical and psychological consequences and are considered difficult to treat. Family therapy has been a mainstay of treatment for children and adolescents with AN and other EDs for over 30 years. Among the family-focused treatment modalities, a manualized approach called familybased treatment (FBT) has gained the most evidence of efficacy. This model emphasizes parental support in the process of normalization of eating behaviours. Research findings indicate that FBT can lead to significant clinical improvement in three-fourths of young AN patients, with approximately 40% of adolescents achieving full remission following FBT. The aim of this review is to describe the main principles of FBT, to review current research on its effectiveness and outcome predictors, and to briefly describe two potentially effective variants of FBT - multi-family therapy (MFT) and parent-focused treatment (PFT). The authors also share their experience of implementing FBT at the Eating Disorder Unit of Helsinki University Hospital and discuss some aspects of its implementation in Finland.

Avoidant restrictive food intake disorder (ARFID), a recently described eating disorder categorized under DSM-5, has varied clinical presentations. The primary eating disorders have well-established practice parameters for management. However, there is no evidence-based first line of management for ARFID. There is a significant gap in this evolving construct and clinical practice. We present a case series from a tertiary care center in India, focusing on clinical management. Four adolescents with 3 girls and 1 boy between 12 and 17 years of age were included in the study. Diagnosis and management were delayed in all. Mean body mass index was 15.36 (5.26) kg/m2 at the time of diagnosis. Key drivers were dread of choking, sensory characteristics, and avoidance of unpleasant upper and lower gastrointestinal symptoms. This series supports a culturally cognizant hypothesis, an evidence based, viable management model for ARFID in low- and middle-income countries (LMIC). A combination of family-based treatment (FBT) and cognitive behavior therapy is an effective treatment model for India and other LMICs.

ABSTRACT Objective Methods Results Discussion Family‐based treatment (FBT) is the leading evidence‐based treatment for adolescent eating disorders, but research exploring access and engagement in FBT is sparse. This paper focuses on findings from a broader study, specifically addressing the social determinants of health (SDH) impeding access and engagement in FBT for diverse families (i.e., families belonging to identity groups subject to systemic barriers and prejudices).Forty‐one FBT clinicians were recruited globally using purposive and snowball sampling. Clinicians participated in individual interviews or focus groups, discussing their experiences engaging diverse families in FBT. Qualitative data were transcribed verbatim and analyzed using reflexive thematic analysis.The findings underscore the pervasive impact of SDH on equitable access to FBT, specifically, the critical need for tailored approaches by clinicians to enhance access and engagement in FBT for diverse families experiencing practical, resource, and systemic barriers. Recommendations include broader dissemination of FBT knowledge, telehealth options to mitigate geographical barriers, community resource collaborations, and sensitivity to cultural and systemic factors impacting treatment engagement.Results of this study may inform future FBT planning (tailoring treatment approaches to address barriers), clinician training, clinical decision‐making tools, and opportunities for supporting under‐resourced families within the model, leading to more equitable FBT treatment access and engagement for diverse families. [ABSTRACT FROM AUTHOR]

Background: Access to evidence-based treatments such as family-based therapy (FBT) is difficult for adolescents diagnosed with Anorexia Nervosa (AN) living in rural or regional areas due to a limited trained workforce, high staff turnover and inconsistent treatment fidelity. Telehealth offers a potential access solution by facilitating care irrespective of family or service location. The disruption to the health system caused by COVID-19 amplified an existing need and increased the use of telehealth to deliver FBT before its efficacy and safety was fully evaluated. This study aimed to evaluate the feasibility, acceptability and preliminary efficacy of telehealth-FBT delivered by community-based clinicians within rural services directly into the home to reduce the eating disorder symptoms of adolescents diagnosed with AN. Methods: A pre- and post-implementation multi-site case series delivered up to 20 sessions of telehealth-FBT to 28 adolescents (89.29% female, M = 14.68 ± 1.58 years) living in rural or regional Australia. The RE-AIM framework guided the evaluation, with Reach (treatment uptake and completion); Efficacy (change in weight, global eating disorder symptoms, and remission from baseline to end of treatment and six-month follow-up); Adoption (patient characteristics and drop out); Implementation (intervention fidelity) and Maintenance (outcomes and intervention during the follow-up period) used to assess the feasibility and preliminary efficacy of telehealth-FBT. Results: There was a high level of interest in telehealth-FBT, with two-thirds of eligible families consenting to participate. Both treatment engagement and completion rates were over 60%, and treatment was delivered with acceptable fidelity. Twenty adolescents (71.43%) met the diagnostic criteria for AN (baseline 86.03%mBMI ± 7.14), and eight (28.57%) for Atypical AN (baseline 101.34%mBMI ± 8.28), with an overall mean duration of illness of 8.53 months (SD = 5.39, range 2–24 months). There was a significant increase in %mBMI at the end of treatment compared to the baseline (p = 0.007, 95%CI: 1.04–6.65), with over 68% of adolescents weight restored and 36.8% of these achieving both weight and psychological remission criteria. Weight remained significantly improved at six-month follow-up (p = 0.005, 95%CI: 1.57–8.65). Also, there was a decrease in adolescents' global eating disorder symptoms, as rated by their parents, at the end of treatment compared to the baseline of 0.735 (p = 0.028, 95%CI: 0.079–1.385). Conclusions: Telehealth-FBT was feasibly implemented into rural services and delivered by community clinicians with reach, adoption, preliminary efficacy, and fidelity scores comparable to those reported by specialist studies. Trial registration: The study was conducted according to the HREC-approved protocol (HREC 2020/ETH00186) and registered with the Australian and New Zealand Clinical Trials Registry (ANZCTR # 12620001107910). Plain English summary: Families living in rural and regional locations face additional challenges accessing healthcare, and in particular quality evidence-based treatment for conditions needing specialist knowledge or treatment. For young people in these areas with anorexia nervosa, accessing Family Based Treatment (FBT) is difficult compared to their urban counterparts. This study evaluated the feasibility and preliminary efficacy of telehealth-FBT delivered by local community-based clinicians to 28 families living in rural Australia. Results showed that telehealth-FBT was well-received, with high engagement and completion rates. Most adolescents experienced significant weight gain and improvement in eating disorder symptoms by the end of treatment, with continued benefits observed at a six-month follow-up. The study found that telehealth-FBT could be effectively implemented in rural health services, achieving outcomes similar to those from specialised academic clinical settings. [ABSTRACT FROM AUTHOR]

Background: Temperament Based Therapy with Support (TBT‐S) is an emerging intervention based on empirically supported neurobiological models. Due to its novelty, only a handful of studies to date have examined TBT‐S, and none of these previous studies have provided a qualitative evaluation of how TBT‐S is perceived by the target population. Therefore, the aim of the current study was to provide an increased understanding of how TBT‐S is experienced by patients with an eating disorder and their supports. Method: Forty‐six patients with an eating disorder and 63 supports consented to be included in the study. The participants provided written responses to six open‐ended questions during the post‐treatment assessment, detailing their treatment experiences and offering additional feedback. Thematic analysis (TA) was used to analyze their written responses, aiming for a combination of latent and semantic themes. Results: The results reveal a substantial overlap between patients' and supports' experiences with TBT‐S. In both groups, identified themes suggest increased knowledge and hopefulness as key benefits of the intervention. While both patients and support persons considered TBT‐S to be worthwhile, patients also reported finding the intervention quite challenging. Additionally, both groups emphasized the neurobiological rationale as an essential component of TBT‐S. Conclusions: The qualitative evaluations from this study offer new insights into how TBT‐S is experienced by the target population. The findings provide an opportunity to incorporate participant suggestions for improving the treatment, and serve as an important building block for future studies aimed at assessing the effectiveness of TBT‐S as an augmentation to treatment‐as‐usual. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Method Results Discussion While Family‐based treatment for anorexia nervosa (FBT‐AN) is effective for weight restoration and improvement in eating‐related cognitions, its effect on exercise attitudes and behaviors is little studied. Compulsive exercise is common in AN and often challenging to change.This secondary analysis examined changes in attitudes toward compulsive exercise (Compulsive Exercise Test‐CET) and behaviors (Eating Disorder Examination‐EDE) using data from a randomized clinical trial testing an adjunctive treatment for adolescents with AN who failed to gain 2.4 kg by Session 4—a predictor of poor outcome. The main hypothesis is that attitudes toward compulsive exercise and decreases in compulsive exercise behavior would improve over the course of treatment.Participants reported decreases in compulsive exercise attitudes by Session 4 and compulsive exercise episodes by end of treatment (EOT). There were no differences between early FBT responders (weight gain of 2.4 kg by session 4) and early non‐responders.These results suggest that FBT facilitates adolescents with AN to change attitudes toward compulsive exercise early in treatment (by Session 4) as well as reduction in compulsive exercise behaviors by EOT. Future studies should assess whether changes in attitudes toward compulsive exercise early in treatment is a mechanism of FBT treatment effect. [ABSTRACT FROM AUTHOR]

Eating disorders (EDs) are a group of serious, potentially life-threatening illnesses that typically have their onset during adolescence and can be associated with severe medical and psychosocial complications. The impact of EDs on caregivers and other family members can also be significant. Health care providers (HCPs) play an important role in the screening and management of adolescents and young adults with EDs. This position statement assists community-based HCPs with recognizing, diagnosing, and treating EDs in the paediatric population. Screening modalities, indications for hospitalization, medical complications, and monitoring of young people with EDs are summarized. Current evidence supports the use of family-based treatment (FBT) as the first-line psychological therapeutic modality for adolescents with restrictive EDs. While the provision of FBT may be beyond the scope of practice for some community physicians, this statement reviews its core tenets. When an ED is diagnosed, early application of these principles in the community setting by HCPs may slow disease progression and provide guidance to families. [ABSTRACT FROM AUTHOR]

To increase the number of family‐based interventions and deal directly with the family dynamic that creates maladaptive manners of coping and connection, structural family therapy (SFT) for autism spectrum disorder (ASD) was developed. The model slowly supports families in being more flexible in their relationships and dynamics while imparting interpersonal skills which enhance communication particularly between the children with ASD and their parents by reforming and supporting an appropriate family structure and family dynamic. [ABSTRACT FROM AUTHOR]

Abstract Eating disorders can significantly impact the psychosocial functioning and physical health of adolescents. Early and effective treatment is crucial to prevent long-lasting and potentially devastating adverse effects. The National Institute for Health and Care Excellence has recommended cognitive behaviour therapy (CBT) for eating disorders in adolescents when family therapy is unacceptable, contraindicated, or ineffective. This recommendation was primarily based on the review of promising results from the enhanced version of CBT (CBT-E) adapted for adolescents with eating disorders aged between 12 and 19 years. A non-randomized effectiveness trial has also shown that CBT-E achieved a similar outcome to family-based treatment (FBT) at 6- and 12-months. CBT-E has several advantages. It is acceptable to young people, and its collaborative nature suits ambivalent young patients who may be particularly concerned about control issues. The transdiagnostic scope of the treatment is an advantage as it can treat the full range of disorders that occur in adolescent patients. It is an individual one-on-one treatment that does not necessitate the full involvement of the family. This approach is particularly beneficial for families that can only provide limited support. Future challenges include clarifying the relative efficacy of CBT-E and family therapy for the treatment of adolescent patients with eating disorders in a randomized control trial and increasing its effectiveness, identifying the reasons for the lack of response, and modifying the treatment accordingly.

Background: Family-based treatment (FBT) is the leading intervention for adolescents with anorexia nervosa (AN); however, it is under researched in socioeconomically disadvantaged and racially diverse youth. Methods: Semi-structured interviews were completed with ten FBT clinicians who practice in publicly-funded settings. Interview questions were focused on implementation challenges, overall acceptability and appropriateness of FBT, and naturally-occurring treatment adaptations. Results: Content analysis revealed common themes relating to the implementation of FBT in publicly-funded, community-based settings: acceptability and appropriateness, complexity and learnability, perceived core components of FBT, cultural adaptations, socioeconomic factors, logistical considerations, organizational and systemic barriers, training acceptability, participant's self-efficacy, and telehealth accommodations. Conclusion: The discussed themes offer insights into the implementation of FBT for settings with limited resources, aligning with prior research on clinical adaptations for multicultural patients. Recognizing these themes can guide clinical adjustments and refine the adapted treatment model in real-world settings for patients facing systemic barriers. [ABSTRACT FROM AUTHOR]

The multiple benefits of family-based treatment (FBT) used in substance use disorder (SUD) treatment include increased treatment engagement, better treatment outcomes, and cost-effectiveness compared to other behavioral health treatment modalities. However, the prevalence and types of FBTs offered among SUD treatment facilities are largely unknown. The present study used data collected during 2009–2010 from 325 treatment centers in the United States to (1) explore the prevalence in the utilization of FBT in SUD treatment, and (2) identify differences between treatment facilities that do and do not offer FBT. Results indicated that the adoption of FBT was negatively associated with the percentage of clients who were unemployed or involved in the criminal justice system at time of intake, and positively related to the number of hours of individual therapy and treatment center emphasis on utilizing the 12 Steps. Additionally, the majority of treatment centers that followed the American Society of Addiction Medicine (ASAM) clinical guidelines offered FBT. Lastly, the percentage of families involvement was negatively associated with centers' proportion of revenues from Medicaid (i.e., health insurance for those with limited income) and positively associated with treatment center revenues from private insurance. The impact of having FBT in SUD treatment centers is discussed. [ABSTRACT FROM AUTHOR]

Eating disorders can significantly impact the psychosocial functioning and physical health of adolescents. Early and effective treatment is crucial to prevent long-lasting and potentially devastating adverse effects. The National Institute for Health and Care Excellence has recommended cognitive behaviour therapy (CBT) for eating disorders in adolescents when family therapy is unacceptable, contraindicated, or ineffective. This recommendation was primarily based on the review of promising results from the enhanced version of CBT (CBT-E) adapted for adolescents with eating disorders aged between 12 and 19 years. A non-randomized effectiveness trial has also shown that CBT-E achieved a similar outcome to family-based treatment (FBT) at 6- and 12-months. CBT-E has several advantages. It is acceptable to young people, and its collaborative nature suits ambivalent young patients who may be particularly concerned about control issues. The transdiagnostic scope of the treatment is an advantage as it can treat the full range of disorders that occur in adolescent patients. It is an individual one-on-one treatment that does not necessitate the full involvement of the family. This approach is particularly beneficial for families that can only provide limited support. Future challenges include clarifying the relative efficacy of CBT-E and family therapy for the treatment of adolescent patients with eating disorders in a randomized control trial and increasing its effectiveness, identifying the reasons for the lack of response, and modifying the treatment accordingly. [ABSTRACT FROM AUTHOR]

Objective: Family‐based treatment (FBT) is an efficacious treatment for adolescent anorexia nervosa (AN). A parent‐only guided self‐help version of FBT (GSH‐FBT) demonstrated preliminary efficacy in pilot investigations. To address challenges in access to care, we adapted GSH‐FBT into a parent‐only multi‐family group format (MF‐GSH‐FBT) delivered via videoconferencing. Method: This report details the feasibility and acceptability of a parent‐only group‐based multi‐family GSH‐FBT (MF‐GSH‐FBT) for adolescent AN delivered virtually. The MF‐GSH‐FBT intervention consisted of 12 weekly 60‐min sessions facilitated by a clinician in addition to online FBT video content and recommended readings. Adolescents and parents completed assessments at baseline and post‐treatment. Parents reported their child's weight each week. Results: A total of 13 adolescents (15.57 + 1.63 years; 92% female; 23% Hispanic) with AN and their parents enrolled and initiated treatment. Four consecutive cohorts of groups of 3–4 families were completed from April 2022 to April 2023. Across cohorts, parents attended 85% of sessions. Most parents rated the treatment sessions as helpful (79%; agree/strongly agree) and felt supported by the other group members (84%). All parents (100%) reported MF‐GSH‐FBT helped their child, and most (90%) reported their child had improved by end‐of‐treatment. On average, adolescents gained 3.53 kg (SD: 3.76) from pre‐ to post‐treatment, with percent estimated mean body weight increasing 5% on average. Parental self‐efficacy also increased from baseline to end‐of‐treatment. Discussion: MF‐GSH‐FBT for AN appears feasible and acceptable to parents participating in this pilot study. Challenges with recruitment and adolescent data collection remain questions for future investigation. Public significance: This study describes initial pilot testing of a virtual guided self‐help family‐based treatment for adolescents with anorexia nervosa delivered in a multi‐family group format. This treatment aims to enhance access to family‐based treatment for anorexia nervosa whilst providing additional support to parents. [ABSTRACT FROM AUTHOR]

ABSTRACT Objective Methods Results Discussion Trial Registration To systematically review and evaluate the efficacy of eating disorder focused family therapy (FT‐ED) in comparison to all other forms of psychotherapy for children and adolescents with anorexia nervosa. A secondary aim is to assess the relative efficacy of different variations of FT‐ED (e.g., shorter vs. longer dose, parent‐focused).A search with relevant terms was systematically conducted on four databases. Twenty‐three publications across 18 randomized controlled trials met inclusion criteria. Outcomes of interest included variables related to weight, eating psychopathology, and remission status. Study quality was assessed, and data were extracted by two independent researchers.Adolescents receiving FT‐ED gained significantly more weight by the end of treatment in comparison to those receiving individual psychotherapy. FT‐ED that was delivered just to parents or to parents and child separately offered preferable weight outcomes and rates of recovery at the end of treatment in comparison to conjoint FT‐ED. No other outcomes tested in the meta‐analysis were statistically significant at the end of treatment or follow‐up.Currently available data suggest the use of FT‐ED in its conjoint or separated/parent focused format is the best outpatient treatment option for adolescents with anorexia nervosa when immediate weight gain is paramount. The variability of outcome measurement, including the tools used and timepoints chosen, limit comparison among no more than a handful of studies. The field would benefit from the standardization of measurement and reporting guidelines for future clinical trials.PROSPERO number: CRD42023396263. [ABSTRACT FROM AUTHOR]

BackgroundTo investigate the KAP toward family-based treatment among parents of children with leukemia.MethodsThis cross-sectional study was conducted between December, 2022 and July, 2023 in the Pediatric hematologic oncology department of West China Second University Hospital, Sichuan University. The study population consisted of parents of children diagnosed with leukemia. Their demographic characteristics and KAP toward family-based treatment for leukemia were collected by self-administered questionnaires.ResultsA total of 482 parents participated, including 379 (78.63%) females, with an average age of 35.83 ± 6.40 years. The mean scores for KAP were 7.28 ± 1.13 (possible range: 0–10), 37.82 ± 4.38 (possible range: 9–45), and 40.09 ± 4.17 (possible range: 9–45), respectively. Multivariate logistic regression analysis indicated that the knowledge score (OR = 1.48, 95% CI: [1.08–2.05], P = 0.016), attitude score (OR = 1.31, 95% CI: [1.18–1.46], P < 0.001), education of junior college and above (OR = 11.28, 95% CI: [1.94–65.65], P = 0.007), and monthly income of 5,000–10,000 Yuan (OR = 10.88, 95% CI: [1.15–102.98], P = 0.037) were independently associated with a proactive practice. Structural equation modeling (SEM) results highlighted the significant direct impact of knowledge on attitude (β = 0.72, P = 0.002), attitude on practice (β = 0.57, P < 0.001), and knowledge on practice (β = 0.81, P < 0.001).ConclusionParents of children with leukemia demonstrated inadequate knowledge, but positive attitudes and proactive practices toward family-based treatment for leukemia. Future interventions should not only prioritize augmenting parental knowledge through educational initiatives but also focus on fostering positive attitudes and providing support for both knowledge and practical parenting skills to facilitate proactive involvement.

Family-based treatment (FBT) is recommended for anorexia nervosa (AN) in young people (YP). However, a substantial proportion of YP undergoing FBT do not recover. Several modifications to standard FBT have been tested to improve recovery rates. This review provides an updated overview of empirically tested modifications to FBT for AN in YP and estimates whether such modifications increase the percentage recovering. Computerized searches performed in five databases resulted in the inclusion of 43 papers (representing 40 original studies), highlighting that a variety of modifications to standard FBT have been tested and appear promising. However, only 11 studies compared the results of a modification to standard FBT. In conclusion, some modifications, such as parent-focused treatment, the addition of home treatment, or interventions for families at risk of non-response, appear to have the potential to improve the recovery rate, either at the group or subgroup level. Other modifications, such as FBT-based guided self-help, virtually delivered FBT, or FBT delivered during in- or day-patient stays, enable the dissemination of FBT principles to other contexts and to patient groups with limited access. Small additions to FBT, such as a workshop or parent-to-parent consultation, do not seem to improve the recovery rate.

In their systematic review on parent illness representations in their children with anorexia nervosa (AN), Marchetti and Sawrikar (International Journal of Eating Disorders, 2023) integrate past research on the parental experience of the illness, investigating whether the Common Sense Model of Self‐Regulation (CSM) is a useful framework for understanding parental responses to AN. Given that family‐based treatment (FBT) is a first‐line treatment for adolescents with eating disorders and is based upon integrating parents into the treatment process, it is especially relevant to explore how parent illness representations may impact FBT. In this commentary, we describe how FBT is designed to support parents and address many of the common unhelpful beliefs and emotions associated with parenting an adolescent with AN. We include specific examples of how parents can be supported within FBT as manualized. We also examine parental representations that may not be addressed by FBT, and how these may impact treatment outcomes in FBT, possibly via the impact of expressed emotion. Future research is needed to determine if modifications to FBT are required to address parental representations of the illness. We end by expanding upon Marchetti and Sawrikar's suggestions on how treatment could be extended to better support parents as necessary. [ABSTRACT FROM AUTHOR]

Marchetti and Sawrikar's (2024) systematic review of parent illness representations of their child's anorexia nervosa provides a valuable synthesis of 32 qualitative studies. The key themes that emerge paint a concerning picture of parents' perceptions of AN as: difficult to identify and understand; of chronic duration; uncontrollable; severe; and associated with serious consequences. A sense of hopelessness and low‐parental self‐efficacy was identified. This Commentary explores the key findings of this review in four areas: AN treatment and recovery (control/cure); emotional representations of the illness; parent understanding of the illness (coherence) and its causes; and consequences of the AN. These illness perceptions are discussed along with relevant quantitative investigations of parent experiences, with a view to suggesting how the toll on parents might be reduced and how reducing burdens on parents might also lead to improved timely treatment outcomes. It is proposed that two broad features are needed: improved help‐seeking experiences in the health care system; and, more parent‐focussed support. [ABSTRACT FROM AUTHOR]

Objective: The therapeutic alliance is broadly linked with positive outcomes. However, nearly all research in this area involves in‐person therapy, whereas teletherapy has grown increasing common since the COVID‐19 pandemic. There is now a pressing need to establish whether the nature and importance of the therapeutic alliance is impacted by teletherapy. This study examined therapeutic alliance in families of youth with anorexia nervosa who were participating in a randomized controlled trial that transitioned from in‐person to telehealth visits during the COVID‐19 pandemic. Method: We analysed data from 53 adolescents and their parents (20 began in‐person, 33 began with telehealth). Both parents, youth and therapist completed the Working Alliance Inventory–Short Revised after 4 weeks of treatment. Results: We found no significant differences across telehealth and in‐person treatment for paternal or therapist reported data. However, both adolescents and mothers reported higher bond and goal‐related alliance for in‐person sessions compared to telehealth. Conclusions: Findings regarding alliance across telehealth and in‐person sessions were mixed, with some preference among mothers and youth for in‐person treatment. Future studies should determine whether possible adaptations can improve working alliance during family‐based treatment for anorexia nervosa via telehealth. [ABSTRACT FROM AUTHOR]

BackgroundFamily-based treatment (FBT) is the leading intervention for adolescents with anorexia nervosa (AN); however, it is under researched in socioeconomically disadvantaged and racially diverse youth.MethodsSemi-structured interviews were completed with ten FBT clinicians who practice in publicly-funded settings. Interview questions were focused on implementation challenges, overall acceptability and appropriateness of FBT, and naturally-occurring treatment adaptations.ResultsContent analysis revealed common themes relating to the implementation of FBT in publicly-funded, community-based settings: acceptability and appropriateness, complexity and learnability, perceived core components of FBT, cultural adaptations, socioeconomic factors, logistical considerations, organizational and systemic barriers, training acceptability, participant’s self-efficacy, and telehealth accommodations.ConclusionThe discussed themes offer insights into the implementation of FBT for settings with limited resources, aligning with prior research on clinical adaptations for multicultural patients. Recognizing these themes can guide clinical adjustments and refine the adapted treatment model in real-world settings for patients facing systemic barriers.

Abstract Purpose Family-based treatment (FBT) has contributed significantly to the treatment of anorexia nervosa (AN) in young people (YP). However, parents are concerned that FBT and the active role of parents in the task of refeeding may have a negative impact on family relations. The aim of the review is to assess whether families engaged in FBT for AN are more or less impacted in their family wellbeing and caregiver burden, compared to families with a YP diagnosed with AN, who are not undergoing treatment with FBT. Method Computerized searches across six databases complemented by a manual search resulted in 30 papers being included in the scoping review. Results The review identified 19 longitudinal studies on change in family wellbeing in families in FBT-like treatments, and 11 longitudinal studies on change in family wellbeing in treatment where parents are not in charge of refeeding. Only three randomized controlled studies directly compare FBT to treatment without parent-led refeeding. Conclusion The available research suggests no difference between intervention types regarding impact on family wellbeing. Approximately half of the studies find improvements in family wellbeing in both treatment with and without parent-led refeeding, while the same proportion find neither improvement nor deterioration. As parents play a pivotal role in FBT, there is a need for good quality studies to elucidate the impact of FBT on family wellbeing. Level of evidence Level V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees.

Abstract Background Outpatient family-based treatment (FBT) is effective in treating restrictive eating disorders among adolescents. However, little is known about whether FBT reduces higher level of care (HLOC) utilization or if utilization of HLOC is associated with patient characteristics. This study examined associations between utilization of eating disorder related care (HLOC and outpatient treatment) and reported adherence to FBT and patient characteristics in a large integrated health system. Methods This retrospective cohort study examined 4101 adolescents who received care for restrictive eating disorders at Kaiser Permanente Northern California. A survey was sent to each medical center to identify treatment teams as high FBT adherence (hFBT) and low FBT adherence (lFBT). Outpatient medical and psychiatry encounters and HLOC, including medical hospitalizations and higher-level psychiatric care as well as patient characteristics were extracted from the EHR and examined over 12 months post-index. Results 2111 and 1990 adolescents were treated in the hFBT and lFBT, respectively. After adjusting for age, sex, race/ethnicity, initial percent median BMI, and comorbid mental health diagnoses, there were no differences in HLOC or outpatient utilization between hFBT and lFBT. Females had higher odds of any utilization compared with males. Compared to White adolescents, Latinos/Hispanics had lower odds of HLOC utilization. Asian, Black, and Latino/Hispanic adolescents had lower odds of psychiatric outpatient care than Whites. Conclusions Reported FBT adherence was not associated with HLOC utilization in this sample. However, significant disparities across patient characteristics were found in the utilization of psychiatric care for eating disorders. More efforts are needed to understand treatment pathways that are accessible and effective for all populations with eating disorders.

Abstract Objective Eating disorders are characterized by disturbances in nutritional intake and abnormal mealtime behaviors. Laboratory eating paradigms offer a unique opportunity to accurately measure dietary intake and eating behaviors, however, these studies have predominantly occurred in adults. This paper describes the development and preliminary psychometric examination of the Buffet Challenge, a laboratory-based meal task for youths with an eating disorder. Method We recruited and assessed 56 participants as part of a randomized controlled trial of Family-Based Treatment for adolescents with anorexia nervosa. Adolescents completed the Buffet Challenge at baseline, midway through treatment (~ week 16 of a 6 months course), and end of treatment. Participants and their parents also reported eating disorder symptomatology and treatment related variables of interest were recorded. Results All adolescents were willing to complete the Buffet Challenge at all time points, although one refused to give up their cellphone, and there were no significant adverse events recorded. Preliminary results are presented. Conclusions Our initial pilot of this task in adolescents with anorexia nervosa demonstrates its acceptability, although investigation of our hypotheses was hindered by significant missing data due to COVID-related research shutdowns. Future studies should replicate procedures in a larger sample to ensure analyses are adequately powered.

Abstract Existing descriptions of the treatment of avoidant/restrictive food intake disorder (ARFID) at higher levels of care (HLOC) for eating disorders are limited, despite HLOC settings frequently serving patients with ARFID. The purpose of this commentary is to expand on the preliminary literature that describes pediatric ARFID treatment at HLOC by describing two specific components of our approach to treating pediatric ARFID that may not yet have traction in the current literature. Specifically, we highlight the utility of (1) treatment accommodations that appropriately account for patients’ neurodevelopmental needs (e.g., executive functioning, sensory processing) and (2) the adjunctive use of Dialectical Behavior Therapy (DBT) elements within family-based pediatric ARFID treatment. We also describe necessary future directions for research in these domains to clarify if incorporating these considerations and approaches into pediatric ARFID treatment at HLOC does indeed improve treatment outcomes.

Purpose: Family-based treatment (FBT) has contributed significantly to the treatment of anorexia nervosa (AN) in young people (YP). However, parents are concerned that FBT and the active role of parents in the task of refeeding may have a negative impact on family relations. The aim of the review is to assess whether families engaged in FBT for AN are more or less impacted in their family wellbeing and caregiver burden, compared to families with a YP diagnosed with AN, who are not undergoing treatment with FBT. Method: Computerized searches across six databases complemented by a manual search resulted in 30 papers being included in the scoping review. Results: The review identified 19 longitudinal studies on change in family wellbeing in families in FBT-like treatments, and 11 longitudinal studies on change in family wellbeing in treatment where parents are not in charge of refeeding. Only three randomized controlled studies directly compare FBT to treatment without parent-led refeeding. Conclusion: The available research suggests no difference between intervention types regarding impact on family wellbeing. Approximately half of the studies find improvements in family wellbeing in both treatment with and without parent-led refeeding, while the same proportion find neither improvement nor deterioration. As parents play a pivotal role in FBT, there is a need for good quality studies to elucidate the impact of FBT on family wellbeing. Level of evidenceLevel V: Opinions of authorities, based on descriptive studies, narrative reviews, clinical experience, or reports of expert committees. [ABSTRACT FROM AUTHOR]

Background: Outpatient family-based treatment (FBT) is effective in treating restrictive eating disorders among adolescents. However, little is known about whether FBT reduces higher level of care (HLOC) utilization or if utilization of HLOC is associated with patient characteristics. This study examined associations between utilization of eating disorder related care (HLOC and outpatient treatment) and reported adherence to FBT and patient characteristics in a large integrated health system. Methods: This retrospective cohort study examined 4101 adolescents who received care for restrictive eating disorders at Kaiser Permanente Northern California. A survey was sent to each medical center to identify treatment teams as high FBT adherence (hFBT) and low FBT adherence (lFBT). Outpatient medical and psychiatry encounters and HLOC, including medical hospitalizations and higher-level psychiatric care as well as patient characteristics were extracted from the EHR and examined over 12 months post-index. Results: 2111 and 1990 adolescents were treated in the hFBT and lFBT, respectively. After adjusting for age, sex, race/ethnicity, initial percent median BMI, and comorbid mental health diagnoses, there were no differences in HLOC or outpatient utilization between hFBT and lFBT. Females had higher odds of any utilization compared with males. Compared to White adolescents, Latinos/Hispanics had lower odds of HLOC utilization. Asian, Black, and Latino/Hispanic adolescents had lower odds of psychiatric outpatient care than Whites. Conclusions: Reported FBT adherence was not associated with HLOC utilization in this sample. However, significant disparities across patient characteristics were found in the utilization of psychiatric care for eating disorders. More efforts are needed to understand treatment pathways that are accessible and effective for all populations with eating disorders. Plain English summary: Adolescents with restrictive eating treated by Family-Based Treatment (FBT) teams had better early weight gain but no differences in the use of intensive outpatient, residential, partial hospital programs or inpatient psychiatry care when compared to those treated by teams with a low adherence to the FBT approach. Factors such as sex, race, ethnicity, mood disorders, and suicidality were associated with the use of psychiatric services. These findings are consistent with previously documented systematic disparities in accessing psychiatric services across patient demographics and should be used to inform the development of proposed care models that are more inclusive and accessible to all patients. [ABSTRACT FROM AUTHOR]

Existing descriptions of the treatment of avoidant/restrictive food intake disorder (ARFID) at higher levels of care (HLOC) for eating disorders are limited, despite HLOC settings frequently serving patients with ARFID. The purpose of this commentary is to expand on the preliminary literature that describes pediatric ARFID treatment at HLOC by describing two specific components of our approach to treating pediatric ARFID that may not yet have traction in the current literature. Specifically, we highlight the utility of (1) treatment accommodations that appropriately account for patients' neurodevelopmental needs (e.g., executive functioning, sensory processing) and (2) the adjunctive use of Dialectical Behavior Therapy (DBT) elements within family-based pediatric ARFID treatment. We also describe necessary future directions for research in these domains to clarify if incorporating these considerations and approaches into pediatric ARFID treatment at HLOC does indeed improve treatment outcomes. [ABSTRACT FROM AUTHOR]

Objective: Eating disorders are characterized by disturbances in nutritional intake and abnormal mealtime behaviors. Laboratory eating paradigms offer a unique opportunity to accurately measure dietary intake and eating behaviors, however, these studies have predominantly occurred in adults. This paper describes the development and preliminary psychometric examination of the Buffet Challenge, a laboratory-based meal task for youths with an eating disorder. Method: We recruited and assessed 56 participants as part of a randomized controlled trial of Family-Based Treatment for adolescents with anorexia nervosa. Adolescents completed the Buffet Challenge at baseline, midway through treatment (~ week 16 of a 6 months course), and end of treatment. Participants and their parents also reported eating disorder symptomatology and treatment related variables of interest were recorded. Results: All adolescents were willing to complete the Buffet Challenge at all time points, although one refused to give up their cellphone, and there were no significant adverse events recorded. Preliminary results are presented. Conclusions: Our initial pilot of this task in adolescents with anorexia nervosa demonstrates its acceptability, although investigation of our hypotheses was hindered by significant missing data due to COVID-related research shutdowns. Future studies should replicate procedures in a larger sample to ensure analyses are adequately powered. [ABSTRACT FROM AUTHOR]

Abstract Background Temperament Based Therapy with Support (TBT-S) aims to target the mechanisms underlying the aetiology and maintenance of eating disorders, and was developed as an adjunct to treatment as usual. There is limited research investigating acceptability, feasibility and possible benefits of TBT-S. Therefore, the primary aim of the current study was to assess treatment feasibility and acceptability at a tertiary specialized eating disorders service in Norway, with a secondary aim to explore possible benefits in clinical outcome. Methods Forty-one patients (mean age 25.3, range 18–43) and 58 supports were assessed pre- and post TBT-S. The majority of the patients were diagnosed with either anorexia nervosa or atypical anorexia nervosa. Participants completed an 18-item Patient and Support Satisfaction Questionnaire, in addition to a questionnaire assessing the usefulness of the different intervention components and strategies utilised in TBT-S, as well as a 4-item treatment satisfaction questionnaire. Measures of treatment efficacy were completed at both time-points, whereas treatment acceptability was only assessed post-treatment. Results Findings reveal that TBT-S is a feasible treatment with high client satisfaction. Preliminary outcome data were also encouraging, and in line with previous studies. There were no voluntary drop-outs. All participants, both patients and supports, reported that TBT-S helped them deal more effectively with their challenges. After completing treatment, there was a significant decrease in patients’ self-reported eating disorder psychopathology, psychosocial impairment and state anxiety, while trait anxiety remained unchanged. Patients also reported significantly improved social relationships, whereas supports reported a significant increase in (own) psychological health. There were no differences in family functioning. Conclusions TBT-S is a promising new treatment for eating disorders with high acceptability scores and low treatment attrition. Future studies should aim to explore methods which can most appropriately measure the effect of TBT-S and the usefulness of the different components of this treatment. Randomised controlled trials are needed to assess treatment efficacy of TBT-S.

Abstract Background Family therapy for adolescent anorexia nervosa (AN) has stronger evidence of efficacy in comparison with individual therapy, and family-based treatment (FBT) is the most evaluated in numerous randomized clinical trials. However, few studies have focused on how FBT performs outside of research settings. The current study is the first to assess clinical outcomes of FBT for adolescent AN in Finland, in a specialized outpatient clinic. Aim The naturalistic outcome of outpatient FBT for adolescent AN was investigated. Methods Fifty-two female patients and their families who received FBT at a tertiary eating disorders unit participated in the study. Data on their pre-treatment parameters, treatment details, and condition at the end of treatment (EOT) was collected from their medical records. Results At EOT, a majority (61.5%) had achieved a full weight restoration [percentage of expected body weight (%EBW) ≥ 95%]. Participants with an %EBW ≥ 95 at EOT had a significantly higher pre-treatment %EBW than those with an EBW

Abstract Background Family-based treatment (FBT) is currently the most effective evidence-based treatment approach for adolescents with anorexia nervosa (AN). Home treatment (HT) as an add-on to FBT (FBT-HT) has been shown to be acceptable, feasible and effective. The described three-arm randomized clinical trial (RCT) is intended to investigate whether FBT-HT demonstrates higher efficacy compared to standard outpatient FBT with supplemental mindfulness-based stress reduction training (FBT-MBSR). Methods This RCT compares FBT-HT to standard outpatient FBT and FBT-MBSR as a credible home-based control group in terms of efficacy and delivery. Adolescents with AN or atypical AN disorder (n = 90) and their parent(s)/caregiver(s) are to be randomly assigned to either FBT, FBT-HT or FBT-MBSR groups. Eating disorder diagnosis and symptomatology are to be assessed by eating disorder professionals using standardized questionnaires and diagnostic instruments (Eating Disorder Examination, Eating Disorder Inventory, Body Mass Index). In addition, parents and caregivers independently provide information on eating behavior, intrafamily communication, stress experience and weight. The therapeutic process of the three treatments is to be measured and assessed among both participants and care providers. The feasibility, acceptability and appropriateness can thus also be evaluated. Discussion We hypothesize that FBT-HT will be an acceptable, appropriate and feasible intervention and, importantly, will outperform both established FBT and FBT-MBSR in improving adolescent weight and negative eating habits. Secondary outcome measures include the reduction in the stress experienced by caregivers, as well as the regulation of perceived expressed emotions within the family, while the intrafamily relationships are hypothesized to mediate/moderate the effectiveness of FBT. The proposed study has the potential to enhance the scientific and clinical understanding of the efficacy of FBT for AN, including whether the addition of HT to FBT versus another home-based adjunct intervention improves treatment outcomes. Furthermore, the study aligns with public health priorities to optimize the outcomes of evidence-based treatments and integrate the community setting. Trial registration This study is registered at ClinicalTrials.gov (NCT05418075).

Abstract Background Anorexia nervosa (AN) is a serious mental illness associated with high rates of morbidity and mortality. Family-based treatment (FBT) is a well-established treatment for adolescent AN, yet it is underutilized in community settings and is unavailable to many families, particularly those from lower income and racial and ethnic minority backgrounds. Furthermore, some families do not respond optimally to FBT, possibly because of challenges translating skills acquired in office-based treatment settings to naturalistic settings. Home-based treatment could reduce barriers to access and enhance generalization of newly learned treatment skills. Home-based models demonstrate initial feasibility, acceptability, and efficacy for adolescent AN, however, FBT principles have yet to be applied as a stand-alone intervention in a home-based level of care. This paper describes the rationale for and process of adapting FBT principles/interventions to improve fit within a home-based model delivered in the context of community mental health, and discusses potential strengths and opportunities associated with this approach. Results Adaptations were made through consultation with collaborating community agencies and were guided by the complex interventions framework. The primary modifications included: (1) altered dose; (2) multiple family meals; (3) additional support for meal preparation and supervision; (4) clinician attendance at medical appointments; (5) cultural adaptation; and (6) introduction of distress tolerance and emotion regulation skills. Conclusions Implementing FBT in the home may present one promising and novel approach to enhance engagement and treatment outcomes for adolescents with restrictive eating disorders, particularly those who are underserved, but evaluation of efficacy/effectiveness is needed.

Purpose: Intuitive eating (IE) is an adaptive eating construct for which little research exists in eating disorder (ED) samples. IE is negatively correlated with disordered eating behaviors in healthy adolescents and adults, and similar associations have been found in adults with EDs. This study aims to examine IE in a treatment seeking sample of adolescents and their caregivers to understand the role of IE in weight gain during FBT. Methods: Descriptive statistics and bivariate correlations were calculated in a sample of 47 pairs of adolescent patients and their caregivers who initiated outpatient FBT at a large academic medical center. Analyses examined associations between caregiver and adolescent IE on the Intuitive Eating Scale (IES), change in percent expected body weight (%EBW) by session 4 and end of treatment (EOT), clinical impairment, and ED pathology. Results: Significant correlations were found between aspects of adolescent IE, ED symptoms, and clinical impairment. Caregiver IES scores (Reliance on Hunger and Satiety Cues, Body-Food Choice Congruence, IES Total) were negatively related to adolescent ED symptoms (EDE-Q Weight Concerns, EDE-Q Shape Concerns, EDE-Q Global) at baseline. Caregiver IE (Eating for Physical Rather than Emotional Reasons) was positively associated with adolescent weight gain at FBT session 4 and EOT, even when statistically adjusting for gender and initial level of care. Conclusion: Study results were consistent with past research indicating adolescent IE is negatively associated with ED behaviors, cognitions, and impairment. This study is the first to provide evidence that caregiver IE is positively associated with adolescent weight gain in FBT and is the first to provide evidence that caregiver IE is negatively related to adolescent ED symptoms. Future research should examine adolescent and caregiver IE throughout FBT to understand the role of IE in treatment response. Level of evidence: Level III: Evidence obtained from cohort or case-control analytic studies. [ABSTRACT FROM AUTHOR]

Purpose: Caregivers play a pivotal role in the success of family-based treatment (FBT) for anorexia nervosa (AN). Caregiver burden is frequently demonstrated in eating disorders (EDs) and may impact FBT outcomes. This study examined factors associated with caregiver burden before starting FBT and whether pre-treatment caregiver burden was associated with weight gain during FBT. Methods: Participants included 114 adolescents with AN or atypical AN (mean age = 15.6 years, SD = 1.4) and a primary caregiver (87.6% mothers) who received FBT in the United States. Before starting treatment, participants completed self-report measures of caregiver burden (via the Eating Disorder Symptom Impact Scale), caregiver anxiety, caregiver depression, and ED symptoms. Clinical characteristics and percentage of target goal weight (%TGW) at FBT session 1 and 3 and 6 months after starting treatment were obtained via retrospective chart review. Hierarchical regressions examined predictors of caregiver burden before FBT initiation. Associations between pre-treatment caregiver burden and %TGW gain at 3 and 6 months after starting FBT were assessed with hierarchical regressions. Results: Caregiver anxiety (p < 0.001), family history of EDs (p = 0.028), adolescent mental health treatment history (p = 0.024), and ED symptoms (p = 0.042) predicted caregiver burden before starting FBT. Pre-treatment caregiver burden was not associated with %TGW gain at 3 or 6 months. Males demonstrated less %TGW gain than females at 3 months (p = 0.010) and 6 months (p = 0.012). Conclusion: Proactively evaluating caregiver burden before starting FBT is suggested. Providing recommendations and/or referrals for identified caregiver vulnerabilities could indirectly impact FBT progress. Males in FBT could require longer courses of treatment and extra vigilance to this demographic is suggested. Level of evidence: Level III, case–control analytic study. [ABSTRACT FROM AUTHOR]

Background: Temperament Based Therapy with Support (TBT-S) aims to target the mechanisms underlying the aetiology and maintenance of eating disorders, and was developed as an adjunct to treatment as usual. There is limited research investigating acceptability, feasibility and possible benefits of TBT-S. Therefore, the primary aim of the current study was to assess treatment feasibility and acceptability at a tertiary specialized eating disorders service in Norway, with a secondary aim to explore possible benefits in clinical outcome. Methods: Forty-one patients (mean age 25.3, range 18–43) and 58 supports were assessed pre- and post TBT-S. The majority of the patients were diagnosed with either anorexia nervosa or atypical anorexia nervosa. Participants completed an 18-item Patient and Support Satisfaction Questionnaire, in addition to a questionnaire assessing the usefulness of the different intervention components and strategies utilised in TBT-S, as well as a 4-item treatment satisfaction questionnaire. Measures of treatment efficacy were completed at both time-points, whereas treatment acceptability was only assessed post-treatment. Results: Findings reveal that TBT-S is a feasible treatment with high client satisfaction. Preliminary outcome data were also encouraging, and in line with previous studies. There were no voluntary drop-outs. All participants, both patients and supports, reported that TBT-S helped them deal more effectively with their challenges. After completing treatment, there was a significant decrease in patients' self-reported eating disorder psychopathology, psychosocial impairment and state anxiety, while trait anxiety remained unchanged. Patients also reported significantly improved social relationships, whereas supports reported a significant increase in (own) psychological health. There were no differences in family functioning. Conclusions: TBT-S is a promising new treatment for eating disorders with high acceptability scores and low treatment attrition. Future studies should aim to explore methods which can most appropriately measure the effect of TBT-S and the usefulness of the different components of this treatment. Randomised controlled trials are needed to assess treatment efficacy of TBT-S. [ABSTRACT FROM AUTHOR]

Background: Family therapy for adolescent anorexia nervosa (AN) has stronger evidence of efficacy in comparison with individual therapy, and family-based treatment (FBT) is the most evaluated in numerous randomized clinical trials. However, few studies have focused on how FBT performs outside of research settings. The current study is the first to assess clinical outcomes of FBT for adolescent AN in Finland, in a specialized outpatient clinic. Aim: The naturalistic outcome of outpatient FBT for adolescent AN was investigated. Methods: Fifty-two female patients and their families who received FBT at a tertiary eating disorders unit participated in the study. Data on their pre-treatment parameters, treatment details, and condition at the end of treatment (EOT) was collected from their medical records. Results: At EOT, a majority (61.5%) had achieved a full weight restoration [percentage of expected body weight (%EBW) ≥ 95%]. Participants with an %EBW ≥ 95 at EOT had a significantly higher pre-treatment %EBW than those with an EBW < 95% at EOT. Participants with an EBW ≥ 95% at EOT showed significantly higher total weight gain during the treatment period, a higher rate of regular menstrual periods at EOT, significantly lower rates of dietary restrictions, and less cognitive or behavioral symptoms of the eating disorder overall, compared to participants who did not achieve a normal body weight. In 22 cases (42.3%), there was no need for further treatment at the end of FBT. Participants who needed further treatment after FBT, compared to those who did not, showed significantly higher rates of psychiatric comorbidity, history of mental health treatment, and need for psychopharmacological treatment. Conclusions: In this naturalistic study, and in line with previous studies, FBT for AN appeared to be an effective and sometimes sufficient intervention, especially for patients with milder weight deficit and less severe psychiatric comorbidities. The results show that FBT can be successfully implemented in Finland and suggest that training more ED clinicians in FBT would be beneficial. Trial registration: The study was retrospectively registered on February 8th, 2023, in ClinicalTrials.gov Protocol Registration and Results System, identifier: NCT05734573. Plain English summary: Family-based treatment (FBT), a form of family therapy for eating disorders (ED) in young patients, has proven to be effective in numerous large-scale studies. This study aims to evaluate outcomes of the treatment for anorexia nervosa (AN) in a 'real-world' setting in a specialized outpatient clinic in Helsinki, Finland. Fifty-two young female patients seen for treatment between June 2013 and December 2017 were included in the study. Demographic and treatment characteristics, weight, and ED symptoms before and after treatment are reported. At the end of treatment, most patients had a good outcome, including normalization of their body weight and reduced ED symptoms. The majority of patients who needed further treatment after FBT suffered from an additional psychiatric disorder together with AN. [ABSTRACT FROM AUTHOR]

Background: Family-based treatment (FBT) is currently the most effective evidence-based treatment approach for adolescents with anorexia nervosa (AN). Home treatment (HT) as an add-on to FBT (FBT-HT) has been shown to be acceptable, feasible and effective. The described three-arm randomized clinical trial (RCT) is intended to investigate whether FBT-HT demonstrates higher efficacy compared to standard outpatient FBT with supplemental mindfulness-based stress reduction training (FBT-MBSR). Methods: This RCT compares FBT-HT to standard outpatient FBT and FBT-MBSR as a credible home-based control group in terms of efficacy and delivery. Adolescents with AN or atypical AN disorder (n = 90) and their parent(s)/caregiver(s) are to be randomly assigned to either FBT, FBT-HT or FBT-MBSR groups. Eating disorder diagnosis and symptomatology are to be assessed by eating disorder professionals using standardized questionnaires and diagnostic instruments (Eating Disorder Examination, Eating Disorder Inventory, Body Mass Index). In addition, parents and caregivers independently provide information on eating behavior, intrafamily communication, stress experience and weight. The therapeutic process of the three treatments is to be measured and assessed among both participants and care providers. The feasibility, acceptability and appropriateness can thus also be evaluated. Discussion: We hypothesize that FBT-HT will be an acceptable, appropriate and feasible intervention and, importantly, will outperform both established FBT and FBT-MBSR in improving adolescent weight and negative eating habits. Secondary outcome measures include the reduction in the stress experienced by caregivers, as well as the regulation of perceived expressed emotions within the family, while the intrafamily relationships are hypothesized to mediate/moderate the effectiveness of FBT. The proposed study has the potential to enhance the scientific and clinical understanding of the efficacy of FBT for AN, including whether the addition of HT to FBT versus another home-based adjunct intervention improves treatment outcomes. Furthermore, the study aligns with public health priorities to optimize the outcomes of evidence-based treatments and integrate the community setting. Trial registration This study is registered at ClinicalTrials.gov (NCT05418075). [ABSTRACT FROM AUTHOR]

Background: Anorexia nervosa (AN) is a serious mental illness associated with high rates of morbidity and mortality. Family-based treatment (FBT) is a well-established treatment for adolescent AN, yet it is underutilized in community settings and is unavailable to many families, particularly those from lower income and racial and ethnic minority backgrounds. Furthermore, some families do not respond optimally to FBT, possibly because of challenges translating skills acquired in office-based treatment settings to naturalistic settings. Home-based treatment could reduce barriers to access and enhance generalization of newly learned treatment skills. Home-based models demonstrate initial feasibility, acceptability, and efficacy for adolescent AN, however, FBT principles have yet to be applied as a stand-alone intervention in a home-based level of care. This paper describes the rationale for and process of adapting FBT principles/interventions to improve fit within a home-based model delivered in the context of community mental health, and discusses potential strengths and opportunities associated with this approach. Results: Adaptations were made through consultation with collaborating community agencies and were guided by the complex interventions framework. The primary modifications included: (1) altered dose; (2) multiple family meals; (3) additional support for meal preparation and supervision; (4) clinician attendance at medical appointments; (5) cultural adaptation; and (6) introduction of distress tolerance and emotion regulation skills. Conclusions: Implementing FBT in the home may present one promising and novel approach to enhance engagement and treatment outcomes for adolescents with restrictive eating disorders, particularly those who are underserved, but evaluation of efficacy/effectiveness is needed. [ABSTRACT FROM AUTHOR]

Objective: Eating disorders are serious psychiatric conditions predominantly affecting children, adolescents, and young adults. While family‐based treatment (FBT) is the gold standard outpatient treatment approach for adolescents with restrictive eating disorders, there is not a universally recognized best practice within higher levels of care. There is a particular dearth of literature detailing recommended psychological and behavioral interventions in the inpatient medical setting. Method: The present article provides an account of how FBT principles have been incorporated in Children's Hospital of Orange County at Mission's inpatient medical stabilization program for children and adolescents with restrictive eating disorders. Practical examples illustrate how key FBT tenets are successfully translated into the inpatient multidisciplinary setting. Results: The use of FBT can encourage a unified approach among medical and psychosocial providers and serves to destigmatize patients with eating disorders and associated behaviors. The successes and challenges of FBT implementation are discussed. Discussion: Though anecdotal evidence and preliminary findings support positive outcomes from the implementation of FBT within a pediatric medical stabilization program for patients, families, and staff, research is needed to understand best practices within higher levels of care. Additional research efforts will also help elucidate whether adapted FBT can become a standard of care for patients with restrictive eating disorders in inpatient settings. Public Significance: This article describes how a children's hospital has adopted family‐based treatment (FBT) for youth who are hospitalized due to an eating disorder. FBT is the most efficacious treatment for youth with eating disorders. This article describes specific examples of how FBT can be implemented within a medical setting. This article will support a greater understanding of FBT principles and guide providers to translate FBT into higher level of care settings. [ABSTRACT FROM AUTHOR]

Background: Although over one-third of adolescents presenting with restrictive eating disorders have a history of being overweight, there is no evidence-based treatment for atypical anorexia nervosa (AAN). Family-Based Treatment (FBT) is a feasible treatment and is routinely applied to treat atypical anorexia nervosa in adolescents; however, identifying a treatment target weight within FBT for these patients is a challenge. Objective: This study aimed to 1) increase understanding regarding recommendations for weight gain versus weight stabilization in FBT for adolescents with AAN and 2) examine treatment outcomes in FBT for adolescents with AAN. Method: Using a retrospective design, we reviewed the files of 41 patients with AAN who were referred for FBT at a pediatric eating disorder program located within a tertiary care health centre. Results: We found variability in recommendations for weight gain, with 56% of the sample recommended to gain weight and 44% recommended to stabilize weight. Baseline BMI for age appeared to be a key factor in establishing recommendations for weight gain. AAN patients in our sample gained a significant amount of weight across treatment, with those recommended to gain weight showing more weight gain during treatment. Forty-nine percent of the sample completed FBT; those patients displayed a mean of 10kg of weight gain during treatment. Conclusions: Findings suggest that many patients gained weight during the course of FBT for AAN. Further study on weight changes during FBT for adolescents with AAN and increased diagnostic consistency for AAN will be important for this field. [ABSTRACT FROM AUTHOR]

Plain English summary Family-based treatment is one of the leading treatments for helping adolescents recover from anorexia. Parents play an essential role in this treatment, yet little is known about how parents translate the principles of FBT into day-to-day life. We studied four cases of five parents while they were using FBT to help their adolescent recover from anorexia. Overall, we found these parents’ actions were guided by three common and overarching goals. First, parents were focused on progressing toward health and well-being, using processes like keeping a focus on adolescent development, trusting, and monitoring progress. Second, parents were focused on creating psychological, emotional, and financial capacity to be successful in FBT, where many of their actions were shaped and constrained by the resources available to them. Finally, parents were focused on negotiating and coordinating partnerships with their co-parent (primarily), as well as others, to stay united in their efforts.

Schleider et al. (2023, International Journal of Eating Disorders, current issue) propose multiple applications of single‐session intervention (SSI) models to the eating disorders (EDs) intervention spectrum. In this commentary, we propose extending the potential of SSIs to target parents as agents of change for youth with restrictive EDs, particularly anorexia nervosa (AN). Directing SSIs to parents of children with AN can circumvent psychological barriers to care while capitalizing on the unique level of motivation in a parent to protect a child and advance their capacity to thrive. Key design components of effective SSIs map well onto the core principles of family‐based treatment (FBT), which can be distilled to inform the development of SSIs for parents of youth at risk or exhibiting emerging or diagnostic AN. The participatory action research framework highlighted by Schleider et al. (2023) speaks to the importance of developing SSIs using co‐design methodologies with parents. Doing so reflects the FBT principle of parent empowerment, acknowledges the research on parental self‐efficacy as a mediator of FBT, and recognizes parents as both key stakeholders in the prevention and treatment of child and adolescent EDs, and as the intended recipients of the SSIs created for this population. Public Significance: Schleider et al. (2023, International Journal of Eating Disorders, current issue) propose multiple applications of single‐session intervention (SSI) models to eating disorders (EDs). In this commentary, we extend the potential of SSIs to target parents as agents of change for youth with restrictive EDs. Parent‐focused SSIs can circumvent psychological barriers to care while capitalizing on the unique level of motivation in a parent to advance their child's capacity to thrive. [ABSTRACT FROM AUTHOR]

Family-based treatments for specific disorders have been shown to be efficacious and cost-effective. However, there is no transdiagnostic model for treatment-resistant, severely ill children and adolescents. This article describes a new family-based model, Intensive In-Home Family Treatment (IIFT) designed to fill this gap. IIFT is based on the theory that children and their families are in a state of bidirectional mutual influence that contributes to the child's mental health condition, which can be mitigated through clinical interventions. A case study highlights IIFT's underlying theory and demonstrates the interventions used to achieve significant clinical improvement and prevent higher-level mental health care. [ABSTRACT FROM AUTHOR]