Eating Disorders: Outcome, Prevention and Treatment of Eating Disorders

David I. Ben-Tovim


Curr Opin Psychiatry. 2003;16(1) 

In This Article

Abstract and Introduction

Purpose of Review: Eating disorders remain hard to treat, and difficult to prevent. Recent publications on the outcome of eating disorders, and structured analyses of attempts at prevention, point to a field in need of fresh approaches.
Recent Findings: The outcome of anorexia nervosa does not appear to have altered in the last 50 years. A recent large-scale outcome study found that existing treatments for eating disorders seemed without effect, though many patients with bulimia nervosa did well without making use of specialized treatment. Comprehensive reviews failed to find primary prevention programs to be of benefit and existing theories of the causation of eating disorders seem to lack specificity.
Summary: Much of the literature on the treatment and outcome of eating disorders lacks methodological robustness and ignores basic epidemiological principles. The absence of authoritative evidence for treatment effectiveness makes it increasingly hard to protect resource intensive treatments in anorexia and bulimia nervosa, and existing theories of the causation of the disorders are too non-specific to generate effective programs of prevention. New models are urgently required.

2002 is the 30th anniversary of the year I treated my first patient with anorexia nervosa. In 1972, the primary treatment in the unit I was working in consisted of: prolonged admission to hospital to gain weight to a prespecified target; individual, group and family psychotherapy; multidisciplinary social and occupational therapy: and prolonged outpatient follow-up after discharge. Controversies between the small numbers of specialist centres then involved in treating eating disorders centred on the still unresolved role of nasogastric feeding[1*] and the place of psychotropic medication in treatment programmes. Whilst we were concerned with the particular characteristics of young women with eating disorders who binged and vomited, it was only with the publication of the Diagnostic and Statistical Manual-111 in the early 1980s that the condition of bulimia nervosa came into clear sight.

In the ensuing years, the overall burden of mortality and morbidity generated by eating disorders has become more explicit.[2**] Are we responding to that burden with rigorous evaluations of existing treatments and a drive towards continuous, evidence-based improvement in care? Hardly. Treatment programmes for patients with anorexia nervosa have remained largely unchanged for decades[3] and treatment studies in bulimia nervosa are either short in duration or lacking key elements that would confirm their validity.[4*] A number of recent publications on outcomes and prevention may however increase the pressure to re-evaluate existing attempts at both treatment and primary prevention, or at least stimulate discussion on the effectiveness of existing approaches.