PC1271: Pediatric Eating Disorder Treatment Outcomes for Family-based Treatment Delivered Virtually

Background: There is a significant shortage of trained eating disorder treatment providers available for those in need of care. This is particularly true for family-based treatment (FBT), which is the most effective treatment for children and adolescents with an eating disorder. FBT requires intensive training for providers, and for families, barriers to FBT often include lack of access (e.g., rural areas), long waiting lists, and cost. Thus, many families in need of eating disorder treatment for their children are unable to access standard of care. Medical and psychological treatment delivered virtually via telemedicine can improve accessibility to expertly trained eating disorder treatment providers. Here, we evaluate treatment outcomes for a treatment program delivering FBT via telemedicine to a pediatric sample and their caregivers.

Methods: A pre-post observational cohort study of patients (N=504) who received FBT via telemedicine for up to 18 months from September 1, 2020 through March 1, 2022. Patients were aged 6-24 years old, had an eating disorder diagnosis, lived in the states where the program was available, and lived with family willing to participate in treatment. FBT was delivered by a 5-person multidisciplinary team including: therapist, registered dietitian, medical provider (i.e., pediatrician), peer mentor (someone with lived eating disorder experience), and a family mentor (someone who cared for someone with an eating disorder). Families had telehealth visits with each provider on an approximate weekly basis. Quantitative survey measures to examine eating disorder symptoms, depression, and anxiety were collected at admission and varying frequencies throughout treatment to assess treatment outcome of the virtually delivered program. Weight was collected at home by a trained caregiver. Vitals, weight, and medication were monitored by a medical provider.

Results: Patients were, on average, 15.9 (2.8) years old. A majority were cisgender female (83%) white (58%), required weight restoration (87%), and were diagnosed with anorexia nervosa, restricting type (64%). Patients on weight restoration gained approximately one pound per week and the average adjusted weight change after 16 weeks was +12.1lbs (0.53). The average change in eating disorder symptom survey scores was -7.38 (0.62) points. Reductions in depression (-3.15 (0.41)) and anxiety (-3.02 (0.48)) symptom scores were also observed with treatment.

Conclusion: FBT is generally considered the gold standard of care for pediatric eating disorders. However, families often experience multiple barriers to accessing trained FBT providers and multidisciplinary teams, including pediatricians. FBT delivered via telemedicine produced clinically meaningful reductions in eating disorder symptoms as well as symptoms of depression and anxiety. It also resulted in meaningful weight gain for underweight patients. Telemedicine is one avenue that can be implemented to expand access to evidence-based eating disorder treatment for pediatric patients.