Does 24/7 care result in better outcomes for adults with eating disorders? A comparison of inpatient/residential care to partial hospitalization/intensive outpatient care for patients at low BMIs.

Background: Higher level of care (HLOC) treatment for eating disorders (EDs) is sometimes necessary, but research is lacking on whether HLOCs are actually more effective than less structured, lower levels of care. The purpose of the current study was to compare outcomes for patients with EDs at low weights who entered 24/7 care (inpatient and residential) to those entering non-24/7 care (partial hospitalization programming and intensive outpatient programming).

Methods: Participants were 1104 adults with body mass indices (BMI) between 14 and 17 receiving treatment for an ED at a large multisite treatment facility offering HLOCs between August 2019 and February 2024.

Loss of Bone Density in Patients with Anorexia Nervosa Food That Alone Will Not Cure.

Background: Anorexia Nervosa is a highly lethal illness that is also associated with many medical complications. Food restriction and weight loss define this illness. Most of its physical complications are reversible with weight restoration, with the notable exception of the loss of bone density, which is commonly present in anorexia nervosa.

Predictors of treatment outcome in higher levels of care among a large sample of adolescents with heterogeneous eating disorders.

Background: Despite widespread use of higher levels of care in treating eating disorders in adolescents, research supporting the use of these treatments remains limited by small sample sizes and a predominant focus on anorexia nervosa. Further, existing data regarding predictors of outcome have yielded mixed findings. In the current study, we evaluated treatment outcomes and predictors of outcome among a large sample of adolescents with eating disorders presenting to inpatient, residential, partial hospitalization programs, and intensive outpatient programs across the United States.

Evaluation of Mean Plasma Glucose Levels Using HbA1C in Patients With Severe Eating Disorders.

Objective: Hypoglycemia causes significant morbidity and mortality in patients with severe eating disorders. We measured average glycemic levels using hemoglobin A1C (HbA1C) in patients hospitalized for extreme anorexia nervosa (AN) and avoidant restrictive food intake disorder (ARFID).

Methods: This was a prospective, single-center cohort study conducted in an inpatient medical stabilization unit.

Weight gain in anorexia nervosa across age groups in higher levels of care.

Eating disorders (EDs) have historically been thought of as afflictions of younger women, but EDs do occur in midlife/older adults, and the incidence of EDs among older women may be increasing. The present study sought to examine outcomes for patients with anorexia nervosa needing to weight restore across four age groups: under 18, 18-25, 26-39, and 40+. Based on prior research, it was hypothesized that there would be no differences between the age groups in percent of expected body weight (%EBW) gained during treatment.

A systematic review of eating disorders and family functioning.

The purpose of the current review was to address four questions: 1) Are there differences in family functioning or family environment among patients with different eating disorder (ED) diagnoses? 2) Are there differences in the perception of family functioning or family environment among different family members? 3) Is family functioning or family environment related to ED symptomatology? 4) Does family functioning or family environment change as a result of ED treatment? and 4a) If so, does this impact ED treatment outcome? Although most studies found no differences among ED diagnostic groups, those that did generally found worse family functioning among those with binge/purge symptoms than among those with the restricting subtype of anorexia nervosa. Differences in perceptions of family functioning among family members were found, with patients generally reporting worse functioning than their parents. Worse family functioning was generally found to be related to worse ED symptoms.

Scoping review of end-of-life care for persons with anorexia nervosa.

Background: End-of-life (EOL) care is the part of palliative care intended for persons nearing death. In anorexia nervosa (AN), providing EOL care instead of coercing life-sustaining measures is controversial. The existing literature has not been synthesized yet.

Weight gain and eating disorder symptoms among individuals with atypical anorexia nervosa.

Objective: The purpose of this study was to examine the association between weight gain and eating disorder (ED) symptoms among adults receiving treatment for atypical anorexia nervosa (AAN), to determine whether those who had a higher percent of expected body weight (%EBW) at discharge exhibited lower ED symptoms than those who gained less weight, and to compare this group to a matched sample of patients with anorexia nervosa (AN).

Method: Participants were 96 adults receiving treatment at an ED treatment facility between December 2020 and May 2023. The Eating Disorder Examination-Questionnaire (EDE-Q) was completed at admission and discharge, and %EBW was obtained at admission and discharge.

"Terminal anorexia nervosa" may not be terminal: An empirical evaluation.

Gaudiani et al. (2022) presented terminal anorexia nervosa (T-AN) as a potential new specifier to the anorexia nervosa (AN) diagnosis, with criteria including (a) AN diagnosis, (b) age > 30 years, (c) previously participated in high-quality care, and (d) the clear, consistent determination by a patient with decision-making capacity that additional treatment would be futile, knowing death will result. This study's purpose was to empirically examine a subgroup of participants with AN who met the first three criteria of T-AN-and a smaller subset who also met a proxy index of the fourth criterion involving death (TD-AN)-and compare them to an adult "not terminal" anorexia nervosa (NT-AN) group and to a "not terminal" subset 30 years of age or older (NTO-AN).

Comparing eating disorder treatment outcomes of transgender and gender diverse adolescents with those of cisgender adolescents.

Objective: Eating disorder (ED), depression, and anxiety symptoms at admission and discharge were compared, as were admission-to-discharge changes, for transgender and gender diverse (TGD), and cisgender adolescents receiving intensive treatment for EDs.

Method: Participants were 44 TGD and 573 cisgender adolescents admitted to a treatment facility. Participants completed the Eating Disorder Examination Questionnaire (EDE-Q), Patient Health Questionnaire-9 (PHQ-9), and Generalized Anxiety Disorder-7 (GAD-7) at admission and discharge.

Eating disorder virtual intensive outpatient program: patient satisfaction according to age group.

The COVID-19 pandemic has required a shift to telehealth services. However, not all patients are similarly satisfied with this shift, with some studies finding that midlife and older adults are less comfortable with telehealth. The current study examined patient satisfaction with a virtual intensive outpatient program (VIOP) for eating disorders (EDs) among 305 adults (ages 18-25, ages 26-39, and ages 40+), and compared adult satisfaction to satisfaction among children/adolescents ( = 33) receiving VIOP treatment between August 2020 and March 2022 from a large ED treatment facility.

A new conceptual model for anorexia nervosa: A role for connective tissue?

The etiology of anorexia nervosa (AN) remains to be fully elucidated, and current theories also fail to account for the direct effect of starvation on the health of the organs and tissues, specifically the connective tissue present in most organs of the body. Individuals with hereditary disorders of connective tissue manifest with clinical symptoms that overlap with AN, as the abnormal connective tissue also contributes to many of the other extra-articular manifestations of these hereditary disorders. This article hypothesizes that a similar pathophysiology may also contribute to the clinical presentation of AN.

Medical and Psychiatric Characteristics of Patients Hospitalized for Severe Restrictive Eating Disorders: Analysis of 545 Consecutive Patients with Severe Anorexia Nervosa or Avoidant/Restrictive Food Intake Disorder.

Background: People with severe eating and feeding disorders regularly require hospitalization due to complications inherent to their disease, though formal training regarding this care is limited.

Methods: This retrospective study included 545 patients with severe anorexia nervosa (AN) or avoidant restrictive food intake disorder hospitalized in a medical stabilization unit between 2018 and 2021. Biometrics were obtained throughout hospitalization.

Associations between low body weight, weight loss, and medical instability in adults with eating disorders.

Objective: The physical complications of atypical anorexia nervosa remain understudied, with most studies completed in adolescents. This study seeks to examine the impact of various weight measures as predictors of medical instability in a large cohort of adult eating disorder patients.

Methods: In this retrospective cohort study, the impact of admission body mass index (BMI), weight suppression, and recent weight loss (the rate of weight loss within the last 12 months) toward the development of medical complications of malnutrition were examined.

An examination of adults with atypical anorexia nervosa at admission to treatment at higher levels of care: An attempt to increase diagnostic clarity.

Objective: Anorexia nervosa (AN) is a serious illness with a high mortality rate and multiple physiological complications. The vague definition of atypical AN allows for subjective interpretation. This retrospective study aimed to focus future research on the operational definition of atypical AN by examining four factors associated with atypical AN at admission to higher level of care treatment.

Atypical antipsychotic use does not impact weight gain for individuals with extreme anorexia nervosa: a retrospective case-control study.

Background: There are no U.S. Food and Drug Administration (FDA)-approved medications for the treatment of anorexia nervosa (AN).

An open trial for adults in a residential program for binge eating spectrum disorders.

The current study assessed treatment outcome for 99 adult admissions to a residential program specifically designed for binge eating spectrum disorders (BESD). Participants completed self-report measures at admission, discharge, and 12-month follow-up and were asked to complete blood draws at admission and follow-up. Primary outcomes were eating behaviors; secondary outcomes included comorbid symptoms and physiological variables.

A brief examination of treatment outcomes in higher levels of care for individuals with eating disorders across age groups.

Objective: Although eating disorders (EDs) occur throughout the lifespan, little research has been conducted with midlife/older adults, particularly those in higher levels of care (HLOC). The current study examined outcomes among 2009 patients with EDs receiving HLOC treatment at a large multisite facility between January 2020 and June 2022, across different age groups (ages <18, 18-25, 26-39 and ≥40). It was hypothesised that patients aged 40+ would exhibit less improvement on measures of ED psychopathology and depression than other age groups.

Characterising use of recovery record among a large, transdiagnostic sample of adults with eating disorders across higher levels of care.

Objective: Smartphone applications (i.e., apps) designed to target mental health symptoms have received increasing public and empirical attention, including in eating disorder|eating disorders (EDs) treatment.

Myocardial mechanics and cardiac biomarkers in adults with severe anorexia nervosa.

Background: Anorexia nervosa (AN) is associated with left ventricular (LV) atrophy and unexplained sudden death. Myocardial mechanics have not been well studied in adults with AN. Whether LV mass or illness duration, markers of AN severity, correlate with abnormal strain imaging is unknown.

Expressed emotion and early treatment response in family-based treatment for adolescent anorexia nervosa.

This study examined the effect of pre-treatment levels of parental expressed emotion (EE) on early treatment response for adolescent anorexia nervosa (AN). Data were collected from 121 adolescents, ages 12-18, who met DSM-IV criteria for AN excluding the amenorrhea criterion, and their parents. Participants were randomized to family-based treatment (FBT) or adolescent-focused therapy (AFT).