New guideline on the diagnosis and treatment of eating disorders

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The 8 year old NICE guideline on eating disorders should be updated fairly soon. In the meantime, researchers in Germany have published a new clinical practice guideline on anorexia nervosa, bulimia nervosa and binge eating disorder. The guideline contains evidence- and consensus-based recommendations for the diagnosis and treatment of eating disorders.

The guideline is available in free full-text on PubMed Central and contains the following treatment recommendations:

Recommendations for treatment of anorexia nervosa

  • Treatment should be adapted to the disorder and should take into account the physical aspects of the disease (clinical consensus point [CCP]).
  • Outpatient, day patient, and inpatient treatments should take place in centers or with therapists with expertise in the treatment of eating disorders and should contain disorder-specific elements (CCP).
  • In the treatment it should be borne in mind that the healing process usually takes many months if not years (CCP).
  • Forced treatment of anorexia nervosa should only take place when all other measures have been exhausted, including contact with other centers (CCP).
  • With young patients (children, adolescents) who are still living with their family of origin, the parents, close relatives, or guardians should be involved in the treatment (grade of recommendation B).
  • In inpatient treatment, the attempt should be made to restore weight to normal or near normal (grade of recommendation B).
  • In the inpatient setting, a weight gain of between 500 g and a maximum of 1000 g per week should be aimed at; in the outpatient setting, the goal should be a gain of 200 to 500 g per week. Patients should be weighed at the same time regularly in the morning wearing light clothing (CCP).
  • In everyday clinical routine, the best guide to the appropriate nutrition to give during treatment for anorexia nervosa is body weight (CCP).

Recommendations for treatment of bulimia nervosa

  • Psychotherapy is the treatment of choice for bulimia nervosa (BN).
  • Treatment should be symptom-oriented according to the disorder (clinical consensus point [CCP]).
  • Cognitive behavioral therapy (CBT) is regarded as the treatment of choice in children, adolescents, and adults.
  • Treatment should last for at least 25 sessions at a frequency of at least 1 session per week (CCP).
  • In bulimia patients with co-morbidities, e.g., borderline symptoms, treatment should be enhanced with further disorder-adapted therapeutic elements (CCP).
  • In the case of children and adolescents with BN, family members should be involved in the treatment (CCP).
  • For some patients with BN, an evidence-based self-help program carried out under guidance (guided self-help) and based on elements of CBT may represent adequate treatment (B, level of evidence Ia).
  • Administration of selective serotonin reuptake inhibitors (SSRIs) is the drug therapy of choice. In Germany, only fluoxetine in combination with psychotherapy is licensed for use in adults with BN (B, level of evidence Ia).

Herpertz S, Hagenah U, Vocks S, von Wietersheim J, Cuntz U, Zeeck A. The diagnosis and treatment of eating disorders. Dtsch Arztebl Int. 2011 Oct;108(40):678-85. Epub 2011 Oct 7.

I’ve included a few other pathways and guidelines in the list below, for those readers who wish to delve into this topic more deeply.

Links

Eating Disorders: Core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders (PDF). NICE, 28 Jan 2004.

Eating disorders: suspected. Map of Medicine, 13 Oct 2011.

Eating disorders: management. Clinical Knowledge Summaries, 19 Oct 2009.

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