New approach to anorexia nervosa ‘transforms’ outcomes

Providing uninterrupted, stepped mental health counselling, care and support can transform outcomes for adults with anorexia nervosa, a study has suggested.

Research by psychiatrists at Oxford Health NHS Foundation Trust reviewed outcomes for 212 adults admitted to UK hospitals with severe anorexia nervosa between 2017 and 2020 through the HOPE Provider Collaborative.

They included 34 people who had consented to receive integrated cognitive behaviour treatment (I-CBTE), what the Royal College of Psychiatrists has described as an innovative approach to treating the condition.

According to charity Beat Eating Disorders, approximately 1.25 million people in the UK have an eating disorder, such as anorexia nervosa or bulimia nervosa. Anorexia nervosa, in particular, can affect people of any age and gender, and is often referred to as the deadliest mental health condition.

Yet, the royal college has pointed out that the vast majority of deaths are preventable with early treatment and support.

For patients who require inpatient admission outcomes are often poorer, however, and many are readmitted after their condition deteriorates.

The Oxford study demonstrated the value of providing specialist integrated hospital and community care to such adults with eating disorders, the college has argued.

One year after discharge from hospital, 70% of patients with anorexia had achieved a healthy weight with no signs of binging or purging and only 14% had been readmitted to hospital during this period.

By comparison, among those who received ‘treatment as usual’, less than 5% had achieved a good outcome and 62% had been readmitted to hospital within the same period.

The I-CBTE approach, adapted from a model developed in Italy, combines a planned 13-week admission to hospital with seven weeks stepped down day treatment and further outpatient treatment over a total period of 40 weeks.

The study, published as a preprint, found that those who received I-CBTE as an inpatient, day patient and outpatient fared much better than those who received conventional treatment in line with current UK practices.

Dr Agnes Ayton, study lead and chair of the Eating Disorders Faculty at the college, said: “People who have anorexia nervosa are admitted to hospital, often involuntarily, when their condition becomes life threatening. They are often discharged when still malnourished and readmission rates are as high as 50 to 60%.

“We adapted an integrated approach, building on work from Italy and Oxford over the last 20 years. We found providing uninterrupted stepped care to adults who agreed to the treatment transformed their outcomes.

“The positive results were beyond our expectations. This treatment model offers hope to those who have suffered with anorexia nervosa for many years,” she added.

Earlier this year, guidance developed by a team led by the National Institute for Health Research published guidance to help health professionals recognise the symptoms of eating disorders such as anorexia nervosa or bulimia nervosa.

The guidance, published in the BMJ Postgraduate Medical Journal, is designed to help health practitioners become better at detecting, understanding and managing eating disorders.