Traditional approaches to treating eating disorders in young people often involve removing them from their homes—and their parents—for in-patient psychiatric treatment. And sometimes, these hospitalizations are necessary.

But for many, recommended treatment involves staying at home and recovering under a family’s care. Evidence shows FBT, which coaches parents in guiding their child’s recovery by strictly supervising their eating, helps them return to a healthy weight and healthy behaviors more quickly than other treatments. 

Treating the entire family can help with nutrition, exercise, pediatric obesity and stress management, with full nutrition as the critical first step in recovery. FBT gives parents skills and coaching to meet the goals of behavior change and nutrition, focusing less on the eating disorder’s cause and more on promoting recovery and independence. 

Part of the coaching helps parent understand their child’s fear of parental control issue, as in “You are trying to control me, so I’m going to control me better.” Boys, especially young boys whose fathers who travel or who cheat on their mother, sense something is wrong and develop picky eating habits in an attempt to create some control. Picky eating can lead to more serious eating disorders. In these instances, the children are not noticeably skinny, but they are reluctant to try new foods and may have severe reactions to the textures and sounds of eating.

Full parental control. The therapist helps the parents: take charge of meals, help their child reestablish regular patterns of eating and interrupt problematic eating disorder behaviors, such as bingeing, purging and overexercise. Treatment usually includes a family meal in session, so the therapist can observe and coach the family to help their child eat. Weight gain goals are 1-2 pounds per week. 

Gradual return of control to the adolescent. Once weight is mostly restored, meals are going smoothly and behaviors more balanced, control is gradually handed back to the child or adolescent in an age-appropriate manner. For example: the child may have some meals or snacks away from the parent. Parents learn to anticipate backsliding and how to reassert control from time to time, until the child is fully ready.

Establishing healthy independence. When the child or adolescent can eat with age-appropriate independence and no longer exhibits disordered behaviors, treatment can shift focus to developing a healthy identity, dealing with comorbid problems and catching up with developmental milestones. The family learns to reorganize life with a healthier child.

Adolescents who receive FBT recover at higher rates than adolescents who receive individual therapy:

• • At the end of treatment, 2/3 of adolescents with anorexia recovered; 75-90% weight-recovered at a five-year follow-up.
  • Comparing FBT with CBT for bulimia indicated FBT led to faster and sustained abstinence rates for teens.
  • Preliminary research indicated FBT worked for young adults.

FBT appears to be most effective when the illness is under three years. An early positive response (by week four) indicates long-term success.

While research and clinical experience demonstrate many diverse families can successfully implement FBT, it may not apply to every family. FBT may not be recommended, if:

• • Family members cannot make a strong commitment
  • Parents are overly critical
  • Parents are physically or sexually abusive or abuse substances.

Learn more about Evidence-Based Treatments offered at CFI…

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