Family-based treatment of children and adolescents with anorexia nervosa: Guidelines for the community physician

Question 1

What percentage of adolescent women in Canada have experienced an eating disorder?

Answer 1

5%

Question 2

What are recommendations regarding family based treatment for parents?

Answer 2

1. Do not cause eating disorders and should not be blamed
2. Can be angry at the eating disorder, not at their child who is suffering with an eating disorder. A child or teenager with an eating disorder is not doing it on purpose or for attention
3. Need to understand that anorexia nervosa is a serious condition that probably would not improve without treatment
4. Need to be responsible for their child’s weight gain. Weight restoration is the first step in treatment
5. Must be in charge of eating and exercise until the child has returned to health
6. Should support and supervise their child’s meals and snacks
7. Must appreciate that eating disorders affect a child’s ability to make reasonable decisions about food and exercise; parents must temporarily manage these areas of the child’s life
8. Parents should receive feedback at every visit. If weight is not increasing, the physician, together with the parents and patient, should try to ascertain why weight is not increasing. Any excessive activity may need to be stopped or any unsupervised eating may need to be supervised.

Question 3

What are the recommendations regarding medical visits in family based treatment?

Answer 3

1. Should be frequent at first, such as weekly or biweekly
2. Should include checking the patient’s weight and vital signs at each visit (incld. orthostatic)
3. Should include meeting with the patient alone to review his or her eating attitudes, behaviours and challenges at each visit
4. Should include feedback about weight and vitals to both the parents and patient at each visit
5. Should include frequent reminders and encouragement to the parents about the need to insist on adequate nutrition and limit setting

Question 4

What are recommendations regarding behavioral management in family based treatment?

Answer 4

1. Encourages parents to use ‘natural consequences’ for food refusal. For example, do not allow the teenager to attend a sports practice until a proper dinner is eaten
2. Involves a gradual return of the responsibility from the parents back to the child once the re-feeding is going well
3. Includes slowly integrating exercise back into the child’s life once weight is steadily increasing

Question 5

What should be done if patients and family do not respond to outpatient interventions?

Answer 5

Advocate for intensive pediatric eating disorder treatment, which may include inpatient or day hospital services