Treatment of Eating Disorders

Core Principles

The American Psychiatric Association recommends that patients with eating disorders be treated by a coordinated multidisciplinary team that incorporates medical, psychiatric, psychological, and nutritional expertise to optimize outcomes related to morbidity, mortality, and quality of life 1, 2
A multidisciplinary team for eating disorders typically includes a primary care or sports medicine physician, responsible for medical monitoring, physical examinations, laboratory assessments, and coordination of care, as suggested by the British Journal of Sports Medicine and the American Journal of Psychiatry 1, 2
The team should also include a mental health practitioner, who delivers specialized eating disorder-focused psychotherapy, which is the cornerstone of treatment, according to the American Journal of Psychiatry 1, 3
A registered dietitian/nutritionist should provide nutritional rehabilitation, meal planning, and education on healthy eating patterns, as recommended by the British Journal of Sports Medicine and the American Journal of Psychiatry 1, 2

For adults with anorexia nervosa, eating disorder-focused psychotherapy is recommended, focusing on normalizing eating behaviors, weight restoration, and addressing psychological aspects like fear of weight gain and body image disturbance, as suggested by the American Journal of Psychiatry 1, 3
For adolescents and emerging adults with anorexia nervosa, family-based treatment is recommended when caregivers can be involved, with emphasis on caregiver education to normalize eating behaviors and restore weight, according to the American Journal of Psychiatry 1, 3
For adults with bulimia nervosa, eating disorder-focused cognitive-behavioral therapy (CBT) is the first-line treatment, as recommended by the American Journal of Psychiatry 1
Nutritional rehabilitation for anorexia nervosa should include individualized goals for weekly weight gain and target weight, as suggested by the American Journal of Psychiatry 1, 3

Patients with eating disorders may require additional specialists, including a psychiatrist for medication management and complex psychiatric comorbidities, an endocrinologist for hormonal complications, and a cardiologist for cardiac complications, as recommended by the British Journal of Sports Medicine and the American Journal of Psychiatry 1, 2, 4
An exercise physiologist may also be necessary for appropriate physical activity guidance, as suggested by the British Journal of Sports Medicine 2

Regular monitoring of patients with eating disorders is essential, including assessment of vital signs, weight, laboratory values, and cardiac function, as recommended by the American Journal of Psychiatry 1, 4
Comprehensive treatment plans should be documented, culturally appropriate, and person-centered, according to the American Journal of Psychiatry 1
Treatment barriers, such as shame, stigma, long waiting times, and shortage of specialized providers, should be addressed, as noted by the Journal of Medical Internet Research 5, 6, 7

Technology-based interventions, including computer and internet-based interventions, show promise for treating eating disorders, particularly guided CBIs for bulimia nervosa patients, as suggested by the Journal of Medical Internet Research 5, 6, 7
Videoconferencing and mobile interventions may also be effective for delivering care and supporting patients and caregivers, according to the Journal of Medical Internet Research 8, 9, 10

Guided computer-based and internet-based CBT interventions show efficacy for bulimia nervosa, particularly for compliant patients, and can improve access to care when specialized providers are unavailable 11, 12
Videoconferencing represents a promising delivery method for CBT when in-person treatment is not feasible for bulimia nervosa 11, 12
Technology-based interventions show preliminary promise but have insufficient evidence at this stage for anorexia nervosa 13
Internet-based relapse prevention for anorexia nervosa inpatients may be effective for stabilizing treatment success and bridging the gap between inpatient and outpatient therapy 13
Unguided computer-based interventions cannot be recommended for treatment of anorexia nervosa or bulimia nervosa 13
Patient compliance remains a major challenge for technology-based interventions to work effectively for eating disorders 13

The optimal dose in terms of frequency, intensity, and duration of interventions for bulimia nervosa still requires further research 14
Technology-based interventions can serve as a first step in a stepped-care model for bulimia nervosa, particularly for compliant patients, and can improve access to care when specialized providers are unavailable 14

Guided computer-based and internet-based CBT interventions show efficacy for bulimia nervosa, particularly for compliant patients, and can improve access to care when specialized providers are unavailable, although patient compliance remains a major challenge for technology-based interventions to work effectively for eating disorders 14