What Are Eating Disorders?
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This JAMA Patient Page describes the most common types of eating disorders, risk factors for eating disorders, and treatment options.
Feeding and Eating Disorders
Eating Family Meals Together at Home
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Eating meals at home together as a family is important for both parents and children.
Eating dinner together at least 3 or 4 times per week has positive effects on child development and has been linked to children’s lower rates of overweight and obesity, substance abuse, teen pregnancy, depression, and eating disorders; higher self-esteem; and better academic performance. Eating family meals also has nutritional benefits. Families who eat dinner together eat more fruits and vegetables and fewer fried foods and sugary drinks. Family meals also help adults and children learn to like a variety of foods.
Therapist-guided remote versus in-person cognitive behavioural therapy: a systematic review and meta-analysis of randomized controlled trials
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Background: Cognitive behavioural therapy (CBT) has been shown to be effective for several psychiatric and somatic conditions; however, most randomized controlled trials (RCTs) have administered treatment in person and whether remote delivery is similarly effective remains uncertain. We sought to compare the effectiveness of therapist-guided remote CBT and in-person CBT.
Methods: We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from inception to July 4, 2023, for RCTs that enrolled adults (aged ≥ 18 yr) presenting with any clinical condition and that randomized participants to either therapist-guided remote CBT (e.g., teleconference, videoconference) or in-person CBT. Paired reviewers assessed risk of bias and extracted data independently and in duplicate. We performed random-effects model meta-analyses to pool patient-important primary outcomes across eligible RCTs as standardized mean differences (SMDs). We used Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidance to assess the certainty of evidence and used the Instrument to Assess the Credibility of Effect Modification Analyses (ICEMAN) to rate the credibility of subgroup effects.
Results: We included 54 RCTs that enrolled a total of 5463 patients. Seventeen studies focused on treatment of anxiety and related disorders, 14 on depressive symptoms, 7 on insomnia, 6 on chronic pain or fatigue syndromes, 5 on body image or eating disorders, 3 on tinnitus, 1 on alcohol use disorder, and 1 on mood and anxiety disorders. Moderate-certainty evidence showed little to no difference in the effectiveness of therapist-guided remote and in-person CBT on primary outcomes (SMD -0.02, 95% confidence interval -0.12 to 0.07).
Interpretation: Moderate-certainty evidence showed little to no difference in the effectiveness of in-person and therapist-guided remote CBT across a range of mental health and somatic disorders, suggesting potential for the use of therapist-guided remote CBT to facilitate greater access to evidence-based care. Systematic review registration: Open Science Framework (https://osf.io/7asrc).
Summary of Revisions: Standards of Medical Care in Diabetes—2020
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No abstract available.
Keywords
Canadian practice guidelines for the treatment of children and adolescents with eating disorders
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Abstract
Objectives: Eating disorders are common and serious conditions affecting up to 4% of the population. The
mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no
Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to
which treatment they should use. Our objective was to produce such a guideline.
Methods: Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation
(GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high
quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders.
Results: Strong recommendations were supported specifically in favour of Family-Based Treatment, and more
generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family
Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical
antipsychotics were confirmed.
Conclusions: Several gaps for future work were identified including enhanced research efforts on new primary and
adjunctive treatments in order to address severe eating disorders and complex co-morbidities.
Keywords: Guidelines, Adolescent, Anorexia nervosa, Bulimia nervosa, Avoidant/restrictive food intake disorder
