If psychiatry is Cinderella, eating disorders (ED) are her even more impoverished younger sister, especially in terms of evidence-based treatments for adolescents and young adults. This paper “maps the evidence” of just how bad things are.
Evidence mapping, unlike systematic review or meta-analysis, doesn’t aim to synthesise results, but just to describe the current state of play, and make the literature “accessible, digestible and usable” (not unlike the elves).
This one (Bailey et al, 2014) set out to ask two questions:
- What evidence exists regarding interventions for eating disorders in the youth population?
- What areas are and are not well researched?
They included all RCTs (randomised controlled trials) and CCTs (controlled clinical trials), systematic reviews and meta-analyses, with a mean participant age of 12-25 years (or where an adolescent/young adult sample was specified) designed to study:
- Prevention of eating disorders (universal or targeted)
- Treatment of DSM/ICD diagnosed eating disorders (where the goal was to relieve patient symptomatology or improve functioning)
- Relapse prevention in individuals with eating disorders who had responded to treatment.
- Anorexia nervosa (AN)
- Bulimia nervosa (BN)
- Eating Disorder Not Otherwise Specified (EDNOS)
- Binge Eating Disorder (BED)
They devised appropriate search terms and searched in three major databases. They were careful not to double count trials where results had been published in more than one paper. Usefully, there is an online searchable database of the included studies. Where they found any meta-analyses or reviews, they summarised their conclusions.
I have summarised the results in a table as this seems to me to be a clearer way to present the results. I have highlighted all prevention, treatment (biological and psychological) and relapse prevention trials, and also given numbers for the most frequently occurring types of treatment investigated.
Published evidence for the prevention and treatment of eating disorders
|AN||BN||BED||EDNOS||Any ED||Review article|
Reviews of prevention studies
- Evidence for effectiveness is modest, for both universal and targeted interventions
- The greatest effect sizes are related to changes in knowledge
- Changes in risk factors, attitudes and reducing eating disorder pathology are small
Reviews of treatment studies
- Reviews of the use of Family Therapy in AN suggests that:
- Up to half adolescents go into remission during treatment
- Remission at follow up is higher in Family Therapy than individual therapy
- It seems to be more effective in younger adolescents with a shorter duration of illness
- They note that the trials are small and there is a notable risk of bias
- Family Therapy is also promising for BN
- A meta-analysis of the use of antipsychotics in AN found no advantage over placebo or treatment as usual for weight gain or symptom resolution
The authors say the results show that:
Promising interventions for this population have been identified, [but] gaps exist and the body of evidence has not firmly established which interventions are most effective.
The paper is thorough and the methodology appropriate. The authors note that they did not review the methodology of included papers, so studies with methodological flaws may be included. This should be addressed by any meta-analyses that are conducted. I would have liked to see an attempt to scan reference lists and contact researchers in the field to try to access any unpublished studies, as publication bias is likely to mean that studies finding no difference between treatment and control groups are less likely to be published.
I agree entirely with the authors’ conclusions. This is a call to arms for researchers and funders to synthesise the existing evidence and fund and conduct well-designed RCTs of prevention programmes including more than psychoeducation, head-to-head trials of different therapies for AN, interventions to treat BED and EDNOS, and to prevent relapse.
Eating disorders are serious illnesses. They cause a huge amount of distress and are associated with a significant increase in mortality (Arcelus et al, 2011) (see also the Mental Elf blog on this paper). We need to have a better understanding of what treatments work. Doing nothing is not an option.
Bailey AP, Parker AG, Colautti LA, Hart LM, Liu P, Hetrick SE. Mapping the evidence for the prevention and treatment of eating disorders in young people. Journal of eating disorders. 2014;2:5.
Arcelus J, Mitchell AJ, Wales J, Nielsen S. Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies (PDF). Arch Gen Psychiatry. Jul 2011;68(7):724-731.
RT @Mental_Elf: Eating disorders: mapping the (lack of) evidence http://t.co/e94I8Hcp3B
Eating disorders: mapping the (lack of) evidence: Helen Bould summarises a recent review that maps the evidenc… http://t.co/rEOyCXFn19
Olivia Cialdi liked this on Facebook.
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Today @DrBould on a review that maps the evidence for prevention & treatment of eating disorders in young people http://t.co/8EsBmo21pt
Eating disorders: mapping the (lack of) evidence – http://t.co/CWyFqeSEss by @Mental_Elf
Why is there so little funding for eating disorders research? http://t.co/8EsBmo21pt
@Mental_Elf people think ED’s are a choice
New review brings together all the high quality research on anorexia, bulimia, EDNOS & binge eating disorder http://t.co/8EsBmo21pt
Mental Elf: Eating disorders: mapping the (lack of) evidence http://t.co/VeR9HPHhrO
Eating disorders: A call to arms for high quality eating disorder research http://t.co/hvmvn1AhWV via @sharethis
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New mapping study highlights the dearth of evidence-based research on eating disorders http://t.co/8EsBmo21pt
Katherine Fox you might find this interesting xx
Don’t miss: Eating disorders – mapping the (lack of) evidence http://t.co/8EsBmo21pt
“@Mental_Elf: Don’t miss: Eating disorders – mapping the (lack of) evidence http://t.co/JhxAeJoHs6” – Goed overzicht over beperkte evidence
More research needed in to what is effective in treating child and adolescent eating disorders http://t.co/C9G3b8vQ2E
Nicola Davies liked this on Facebook.
Eating disorders: mapping the (lack of) evidence http://t.co/wXJWEUTmeP via @sharethis
Eating disorders in young people: mapping the lack of evidence – http://t.co/cgVYHLptMR
Caring for someone with an eating disorder? Take a look at this http://t.co/wU879pqLeJ
[…] Eating disorders are extremely prevalent in adolescents, occurring in 2.8% of the adolescent population (Swanson et al., 2011). Eating disorders have the highest mortality rate of psychiatric disorders in adolescents (Arcelus et al., 2011). However, the risk factors for eating disorders are not well understood. […]