National Eating Disorders Association

BackgroundGuided self-help family-based treatment (GSH-FBT) is emerging as a promising, more efficient alternative to traditional family-based treatment (FBT). The present study is designed to examine the real-world implementation of GSH-FBT at pediatric treatment sites across nine provinces in Canada.MethodsImplementation teams at each site consisting of a GSH-FBT coach, a medical provider, and a program administrator will be formed. Clinician coaches will be trained in this new modality and supported with weekly GSH-FBT consultation. Each site will recruit ten families with an adolescent with anorexia nervosa and the parents will undergo ten virtual GSH-FBT sessions. The implementation approach will be evaluated using qualitative and quantitative methods. Outcomes of interest include (1) treatment fidelity, (2) treatment wait times, (3) change in adolescent symptoms and parent/caregiver self-efficacy, (4) change in provider readiness, attitudes, and confidence towards the intervention, and (5) the overall experience of the implementation of the intervention from the perspective of the provider teams, and participant families.DiscussionThe findings of this study will help to identify factors important to the acceptability and implementation of GSH-FBT in real-world clinical settings.Trial registrationThis study was first registered with clinicaltrials.gov (registration # NCT06851273) on February 12, 2025 (url: https://clinicaltrials.gov/study/NCT06851273?id=NCT06851273&rank=1).

Abstract Background: Eating disorders are increasing in prevalence and confer serious physical, emotional and social impacts on individuals, families, communities and systems. Tertiary education of health professionals is key to addressing these impacts. Yet, graduates of key health professions may not complete their studies with the necessary knowledge, skills and confidence to prevent, identify, refer and provide safe care within their role and scope of practice. This study reports on current eating disorder-focused teaching, and opportunities for improvements, within Australian tertiary training programs for key medical and allied health professional groups. Methods: Tertiary leaders and educators (n=205) representing 42 Australian tertiary education institutions completed an online survey including closed and open text questions exploring the relevance, importance, barriers and enablers of eating disorder-focused teaching. Results: Three quarters (76.1%) of participants indicated that students had the opportunity to learn about eating disorders within the current curriculum. Identification (54.1%) and treatment (46.3%) were most likely to be taught; prevention (40.5%) and eating disorder safe care (31.2%) were less likely to be taught. Most respondents (85.9%) reported that teaching about eating disorders, disordered eating and body image within their program was either important (23.9%) or very important (62.0%). Perceived challenges to enhancing content included a crowded curriculum, lack of appropriately skilled educators and lack of clarity regarding basic profession-specific competencies and when these should be taught. Potential facilitators include developing materials and networks for implementing best practice training, support of accreditation/professional bodies and use of lived experience educators. Conclusions: Most Australian healthcare educators consider eating disorders important and relevant to their curricula. However, there are limited time and practical opportunities for learning about eating disorders within current curricula. There is a need for guidance and resource development to help support educators to enhance eating disorder content in relevant curricula.

Brief cognitive-behavioral therapy for non-underweight eating disorders (CBT-T) has been shown to be clinically useful in non-underweight samples, when delivered one-to-one. This pilot study assessed the acceptance, compliance and feasibility levels of a group version of CBT-T, which has the potential to enhance patient access. A group CBT-T protocol was developed and piloted in two therapy groups (N=8). Eating disorder attitudes and behaviors, depression and anxiety were assessed at the beginning and end of treatment. A third of all patients approached accepted the offer of group CBT-T, and entered treatment. Among that group of treatment starters, none were lost to treatment. The therapy was feasible in practical terms, including online delivery. Finally, mean scores on measures suggested improvement in clinical profiles. This pilot study demonstrated that a group CBT-T is a feasible intervention for non-underweight eating disorders in adults, with low acceptance but high compliance. Group CBT-T has the potential to reduce demand on services and in turn increase availability of treatment to those with eating disorders. The present research contributes to the treatment of non-underweight adults with eating disorders. Group CBT-T was shown to be feasible in this pilot study. It was associated with low acceptance but strong compliance. If supported by further research, group CBT-T has the potential to reduce waitlists, ensure throughput in services, and ultimately improve the lives of many who are affected by eating disorders.

Scaling an online screen that provides referrals may be key in closing the treatment gap for eating disorders (EDs), but we need to understand respondents' help-seeking intentions and behaviors after receiving screen results. This study reported on these constructs among respondents to the National Eating Disorders Association online screen who screened positive or at high risk for an ED. Respondents completed the screen over 18 months (February 9, 2018-August 28, 2019). Those screening positive or at high risk for an ED (n = 343,072) had the option to provide data on help-seeking intentions (after screen completion) and behaviors (2-month follow-up). Of eligible respondents, 4.8% (n = 16,396) provided data on help-seeking intentions, with only 33.7% of those reporting they would seek help. Only 7.6% of eligible respondents opted in to the 2-month follow-up, with 10.6% of those completing it (n = 2,765). Overall, 8.9% of respondents to the follow-up reported being in treatment when they took the screen, 15.5% subsequently initiated treatment, and 75.5% did not initiate/were not already in treatment. Preliminary results suggest that among the small minority who provided data, only one-third expressed help-seeking intentions and 16% initiated treatment. Online screening should consider ways to increase respondents' motivation for and follow-through with care.

The treatment gap between those who need and those who receive care for eating disorders is wide. Scaling a validated, online screener that makes individuals aware of the significance of their symptoms/behaviors is a crucial first step for increasing access to care. The objective of the current study was to determine the reach of disseminating an online eating disorder screener in partnership with the National Eating Disorders Association (NEDA), as well to examine the probable eating disorder diagnostic and risk breakdown of adult respondents. We also assessed receipt of any treatment. Participants completed a validated eating disorder screen on the NEDA website over 6 months in 2017. Of 71,362 respondents, 91.0% were female, 57.7% 18-24 years, 89.6% non-Hispanic, and 84.7% White. Most (86.3%) screened positive for an eating disorder. In addition, 10.2% screened as high risk for the development of an eating disorder, and only 3.4% as not at risk. Of those screening positive for an eating disorder, 85.9% had never received treatment and only 3.0% were currently in treatment. The NEDA online screen may represent an important eating disorder detection tool, as it was completed by >71,000 adult respondents over just 6 months, the majority of whom screened positive for a clinical/subclinical eating disorder. The extremely high percentage of individuals screening positive for an eating disorder who reported not being in treatment suggests a wide treatment gap and the need to offer accessible, affordable, evidence-based intervention options, directly linked with screening.