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Eating Disorders
Navigating Childhood and Adolescent Eating Disorders
Parents can guide eating disorder recovery with a home-based approach.
Posted July 14, 2024 Reviewed by Lybi Ma
Family-based treatment an evidence-based approach for treating anorexia nervosa in children and adolescents. It also shows promise as a primary treatment for young individuals with bulimia nervosa.
A strong emphasis is placed on empowering parents or primary caregivers by equipping them with the skills, techniques, and confidence needed to assist their children in normalizing their eating habits and achieving a healthy weight. A notable advantage of FBT is its ability to provide treatment within the familiar surroundings of the patient's home, thereby reducing the need for disruptive hospitalization, even in severe cases of eating disorders.
The Basics
Before initiating FBT, the patient will need medical clearance from a qualified family doctor or pediatrician. Additionally, they will have to be monitored closely throughout treatment with particular attention and visit frequency in the first few weeks or even months of treatment. This treatment is suitable even for severe cases of eating disorders, provided the patient is medically stable and monitored.
A complete treatment typically spans six to 12 months. Sessions are once a week and generally 60 minutes in duration. Criteria for suitability are quite broad, in addition to medical stability, the patient needs to be living with parents or caregivers willing to actively participate in treatment.
Among the Benefits
FBT is a remarkably efficient and cost-effective approach as it replaces residential or partial hospital treatment with just one family session per week. As hard as it may be to imagine, this one hour a week is usually enough to successfully “create a hospital at home” for even severe eating disorders. As parents embrace their central role, all meals and snacks are hearty, varied, and closely supervised to support completion. We often say, “If you don’t see it eaten, it doesn’t count.” A trusted adult must be present and attuned, to ensure that the eating disorder doesn’t get in the way of the child’s completion of their full “dose” of food at every meal and snack.
It is structured to reduce parental and patient dependence on providers; instead, parents are given the knowledge and tools to take over and trust in themselves that their love and commitment to their child can fuel their capacity to lead in the hard work of recovery. It's so unusual for parents to have the capacity to single-handedly help their child heal from a serious illness.
While FBT is challenging for the child and parents alike, there is typically great appreciation for the ability to do this work at home as opposed to in a hospital or residential treatment center. The child can attend school (as long as meals are supervised), socialize (meals at home first), and engage in meaningful activities (around mealtimes). As long as food comes first, life can mostly continue with only minimal disruption. Healing happens within the context of real life so there is no need for extensive transitions from one level of care to another.
Feeding First
FBT is a highly behavioral approach, prioritizing feeding over more typical therapy objectives like emotional exploration or insight building. The rationale for the focus on feeding first is that no amount of psychotherapy can effectively heal a starved body and brain. We know that starvation has a profound [negative] effect on brain structure and function which in turn, affects mood and behavior. Extended periods of food restriction and weight loss are known to induce irritability, anxiety, and impaired cognitive function as the body prioritizes survival over emotional regulation and higher cognitive processes. Additionally, prolonged starvation can induce changes in personality, social withdrawal, obsessive preoccupation with food and deep emotional despair as the body and brain cope with extreme deprivation.
Food is the medicine for anorexia. With every meal, the child is healing. Parents often note how their child seems “more like themselves” even just a few weeks into treatment if feeding and weight gain are consistent.
Once nutrition and weight are stabilized, the focus can broaden to address issues that may have contributed to the development and maintenance of the eating disorder. When the child is no longer under the influence of starvation, treatment can expand to assess and address individual therapy needs, such as targeted treatment for anxiety, depression, or OCD.
Guiding Principles
Empowering Parents
Parents are central in recovery. Until weight restoration is achieved, the primary focus is on building parental confidence and capabilities. The therapists are experts in eating disorders, while parents are seen as experts in their own child.
Separating the Child from the Illness
Distinguish the illness from the individual. We do not view food refusal as stubbornness or willfulness; rather, we see it as the eating disorder rearing its ugly head and exerting control over your child.
Focus on the Here and Now
Prioritize immediate intervention to address the eating problem without getting bogged down in exploring the root causes of the illness right away.
Practical and Behavioral
Using a behaviorally focused approach emphasizes practical and concrete strategies. It centers on specific implementation details such as meal planning, portion sizes, timing, and strategies for addressing resistance in children and teens.
Maintain the Urgency
Respond with urgency to ensure prompt nourishment and facilitate recovery. Even as progress is made, providers remain vigilant because we recognize that eating disorders can resurface unexpectedly if vigilance wanes.
Beacon of Hope for Families
By empowering parents and caregivers to take an active role in their child's recovery, family-based treatment not only addresses the immediate nutritional needs of the child, but also strengthens family relationships and resilience. As we continue to advocate for early intervention and comprehensive support, FBT remains a pivotal approach in guiding young individuals toward lasting recovery. As research continues to underscore its effectiveness, treatment can offer hope and a structured pathway towards healing, highlighting the transformative impact of collaborative and family-centered care in the fight against eating disorders.
