Long-Term Benefits of Eating Disorder Therapy Found Mixed

SEATTLE — Initial improvements in anorexia nervosa and bulimia nervosa achieved in an intensive residential treatment program are largely sustained an average of 4 to 5 years later, researchers reported.

“Data on long-term follow-up of individuals with anorexia nervosa and bulimia nervosa following intensive inpatient or residential treatment are limited,” said Dr. Timothy D. Brewerton, a psychiatrist at the Medical University of South Carolina, Charleston.

Dr. Brewerton and his colleagues surveyed patients with eating disorders who had received at least 30 days of treatment in the Monte Nido Residential Treatment Program, in Malibu, Calif. Dr. Brewerton reported that he was paid as a consultant by Monte Nido to collate, analyze, and present the survey data.

Outcomes on the Eating Disorder Inventory-2 (EDI-2), Beck Depression Inventory (BDI), and a structured eating disorder assessment were evaluated at admission, discharge, and the most recent of 13 postgraduate follow-ups (range from 1 to 10 years).

The analyses were based on 85 patients with anorexia and 71 patients with bulimia. The mean time between discharge and postgraduate follow-up was 4.5 and 4.1 years, respectively. On average, the patients in each group were aged about 30 years (range, 17–57).

In the anorexia group, mean body mass index (BMI) scores increased significantly between admission and discharge (from 16 to 18 kg/m

By discharge, anorexia patients had significant improvements in 9 of 11 EDI-2 subscales, with further significant improvements in five of the subscales—body dissatisfaction, drive for thinness, interoceptive awareness, immaturity fears, and asceticism—between discharge and postgraduate follow-up.

The percentage of anorexia patients with a good outcome, defined as a return of BMI to at least 18 and normal menses, increased between discharge and postgraduate follow-up (from 19% to 41%). There also was a decrease in the percentages with an intermediate outcome, defined as restoration of BMI or normal menses (from 48% to 46%), and a poor outcome, defined as restoration of neither BMI nor menses (from 33% to 12%).

The frequency of 3 of 10 eating- disordered behaviors—bingeing, laxative use, and vomiting—was significantly higher at postgraduate follow-up than at discharge, and the values remained significantly or marginally lower than those at admission.

Scores on the BDI decreased significantly between admission and discharge, and remained so at postgraduate follow-up. About 85% of patients reported they were improved or significantly improved at the latter assessment.

Patients in the bulimia group had significant improvements in all 11 EDI-2 subscales by discharge, and the benefits persisted to postgraduate follow-up, reported Dr. Brewerton, who also is in private practice in Mt. Pleasant, S.C. Their BMIs were in the normal range at all three assessments.

Between discharge and postgraduate follow-up, there was a decrease in the percentage of bulimic patients with a good outcome, defined as complete cessation of bingeing, purging, and other compensatory behaviors (from 97% to 62%) and an increase in the percentages with an intermediate outcome, defined as a reduction in those behaviors by at least half (from 3% to 19%) and a poor outcome, defined as a reduction of less than half (from 0% to 19%).

The frequency of 7 of the 10 eating-disordered behaviors decreased significantly by discharge and remained at that level at the postgraduate follow-up. BDI scores in this group also fell by discharge and remained steady. About 85% of patients said they were improved or significantly improved.

Receipt of therapy during follow-up is still being analyzed, said Dr. Brewerton.

SEATTLE — Initial improvements in anorexia nervosa and bulimia nervosa achieved in an intensive residential treatment program are largely sustained an average of 4 to 5 years later, researchers reported.

“Data on long-term follow-up of individuals with anorexia nervosa and bulimia nervosa following intensive inpatient or residential treatment are limited,” said Dr. Timothy D. Brewerton, a psychiatrist at the Medical University of South Carolina, Charleston.

Dr. Brewerton and his colleagues surveyed patients with eating disorders who had received at least 30 days of treatment in the Monte Nido Residential Treatment Program, in Malibu, Calif. Dr. Brewerton reported that he was paid as a consultant by Monte Nido to collate, analyze, and present the survey data.

Outcomes on the Eating Disorder Inventory-2 (EDI-2), Beck Depression Inventory (BDI), and a structured eating disorder assessment were evaluated at admission, discharge, and the most recent of 13 postgraduate follow-ups (range from 1 to 10 years).

The analyses were based on 85 patients with anorexia and 71 patients with bulimia. The mean time between discharge and postgraduate follow-up was 4.5 and 4.1 years, respectively. On average, the patients in each group were aged about 30 years (range, 17–57).

In the anorexia group, mean body mass index (BMI) scores increased significantly between admission and discharge (from 16 to 18 kg/m

By discharge, anorexia patients had significant improvements in 9 of 11 EDI-2 subscales, with further significant improvements in five of the subscales—body dissatisfaction, drive for thinness, interoceptive awareness, immaturity fears, and asceticism—between discharge and postgraduate follow-up.

The percentage of anorexia patients with a good outcome, defined as a return of BMI to at least 18 and normal menses, increased between discharge and postgraduate follow-up (from 19% to 41%). There also was a decrease in the percentages with an intermediate outcome, defined as restoration of BMI or normal menses (from 48% to 46%), and a poor outcome, defined as restoration of neither BMI nor menses (from 33% to 12%).

The frequency of 3 of 10 eating- disordered behaviors—bingeing, laxative use, and vomiting—was significantly higher at postgraduate follow-up than at discharge, and the values remained significantly or marginally lower than those at admission.

Scores on the BDI decreased significantly between admission and discharge, and remained so at postgraduate follow-up. About 85% of patients reported they were improved or significantly improved at the latter assessment.

Patients in the bulimia group had significant improvements in all 11 EDI-2 subscales by discharge, and the benefits persisted to postgraduate follow-up, reported Dr. Brewerton, who also is in private practice in Mt. Pleasant, S.C. Their BMIs were in the normal range at all three assessments.

Between discharge and postgraduate follow-up, there was a decrease in the percentage of bulimic patients with a good outcome, defined as complete cessation of bingeing, purging, and other compensatory behaviors (from 97% to 62%) and an increase in the percentages with an intermediate outcome, defined as a reduction in those behaviors by at least half (from 3% to 19%) and a poor outcome, defined as a reduction of less than half (from 0% to 19%).

The frequency of 7 of the 10 eating-disordered behaviors decreased significantly by discharge and remained at that level at the postgraduate follow-up. BDI scores in this group also fell by discharge and remained steady. About 85% of patients said they were improved or significantly improved.

Receipt of therapy during follow-up is still being analyzed, said Dr. Brewerton.

SEATTLE — Initial improvements in anorexia nervosa and bulimia nervosa achieved in an intensive residential treatment program are largely sustained an average of 4 to 5 years later, researchers reported.

“Data on long-term follow-up of individuals with anorexia nervosa and bulimia nervosa following intensive inpatient or residential treatment are limited,” said Dr. Timothy D. Brewerton, a psychiatrist at the Medical University of South Carolina, Charleston.

Dr. Brewerton and his colleagues surveyed patients with eating disorders who had received at least 30 days of treatment in the Monte Nido Residential Treatment Program, in Malibu, Calif. Dr. Brewerton reported that he was paid as a consultant by Monte Nido to collate, analyze, and present the survey data.

Outcomes on the Eating Disorder Inventory-2 (EDI-2), Beck Depression Inventory (BDI), and a structured eating disorder assessment were evaluated at admission, discharge, and the most recent of 13 postgraduate follow-ups (range from 1 to 10 years).

The analyses were based on 85 patients with anorexia and 71 patients with bulimia. The mean time between discharge and postgraduate follow-up was 4.5 and 4.1 years, respectively. On average, the patients in each group were aged about 30 years (range, 17–57).

In the anorexia group, mean body mass index (BMI) scores increased significantly between admission and discharge (from 16 to 18 kg/m

By discharge, anorexia patients had significant improvements in 9 of 11 EDI-2 subscales, with further significant improvements in five of the subscales—body dissatisfaction, drive for thinness, interoceptive awareness, immaturity fears, and asceticism—between discharge and postgraduate follow-up.

The percentage of anorexia patients with a good outcome, defined as a return of BMI to at least 18 and normal menses, increased between discharge and postgraduate follow-up (from 19% to 41%). There also was a decrease in the percentages with an intermediate outcome, defined as restoration of BMI or normal menses (from 48% to 46%), and a poor outcome, defined as restoration of neither BMI nor menses (from 33% to 12%).

The frequency of 3 of 10 eating- disordered behaviors—bingeing, laxative use, and vomiting—was significantly higher at postgraduate follow-up than at discharge, and the values remained significantly or marginally lower than those at admission.

Scores on the BDI decreased significantly between admission and discharge, and remained so at postgraduate follow-up. About 85% of patients reported they were improved or significantly improved at the latter assessment.

Patients in the bulimia group had significant improvements in all 11 EDI-2 subscales by discharge, and the benefits persisted to postgraduate follow-up, reported Dr. Brewerton, who also is in private practice in Mt. Pleasant, S.C. Their BMIs were in the normal range at all three assessments.

Between discharge and postgraduate follow-up, there was a decrease in the percentage of bulimic patients with a good outcome, defined as complete cessation of bingeing, purging, and other compensatory behaviors (from 97% to 62%) and an increase in the percentages with an intermediate outcome, defined as a reduction in those behaviors by at least half (from 3% to 19%) and a poor outcome, defined as a reduction of less than half (from 0% to 19%).

The frequency of 7 of the 10 eating-disordered behaviors decreased significantly by discharge and remained at that level at the postgraduate follow-up. BDI scores in this group also fell by discharge and remained steady. About 85% of patients said they were improved or significantly improved.

Receipt of therapy during follow-up is still being analyzed, said Dr. Brewerton.