Eating Disorders

Adults with Anorexia Nervosa Need Better Therapies

Heather R. Johnson
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Young woman with anorexia sitting alone on bed and feeling unhappy. Anorexia problem concept
The researchers sought to compare stand-alone psychological interventions for adult outpatients with anorexia nervosa with a specific focus on body-mass index, eating disorder symptoms, and all-cause dropout rate.

“There is an urgent need to fund new research to develop and improve therapies for adults with anorexia nervosa,” according to a recent study published in Lancet Psychiatry.

While guidelines recommend some type of outpatient psychological treatment as part of a first-line option for adults with anorexia nervosa, the specifics vary by country. The researchers in the recent study conducted a meta-analysis to compare the UK National Institute for Health and Care Excellence guidelines, which include a combination of cognitive behavioral therapy (CBT), Maudsley anorexia nervosa treatment for adults (MANTRA), and specialist supportive clinical management (SSCM), with “treatment as usual.” Treatment as usual varies by study. Because the researchers worked with a small sample size, they consider their results exploratory but informative.

The researchers searched the Cohrane CENTRAL, CINAHL, MEDLINE, and PsychINFO databases from inception until March 20, 2020. They identified studies that involved anorexia in adults that included pharmacological or non-pharmacological treatment. After finding 270 articles potentially eligible, 13 fit the inclusion and exclusion criteria. Within those studies, 1,047 patients were included in the analysis.

Of all the interventions, only CBT had fewer all-cause dropouts than psychodynamic-oriented psychotherapies (Odds Ratio 0.54, 95% CI 0.31 to 0.93). Psychodynamic-oriented psychotherapies outperformed treatment as usual with both primary nodes (standardized mean difference 0.31, 95% CI 0.05 to 0.57) and secondary nodes (standardized mean difference 0.34, 0.10 to 0.59) for weight change. Among NICE-recommended first-line treatments, enhanced CBT was superior for weight change.

Common threads within the various treatment methods exist: a multi-disciplinary nature, the inclusion of a general practitioner in addition to a psychotherapist, a focus on both behavior and nutrition, medical monitoring, and regular weight and eating habits.

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However, the presence of bias colors many of the studies analyzed. “According to the results of the present work, the superiority of specific psychotherapies over others, at least in adults with a long duration of illness, appears questionable in the eating disorders field,” the researchers stated.

Limitations include that there were differences in treatment dose across studies. Earlier studies were of lower quality, with potentially biased and “inflated” results. There was also significant variability between studies.

Given these variances and the results of the analysis, anorexia nervosa in adults warrants further attention, the researchers concluded. “It appears that currently available outpatient treatments for anorexia nervosa are associated with modest improvements, and even a modest improvement could greatly improve the clinical course and quality of life for an individual,” the researchers said.

“The absence of interventions that are clearly better than treatment as usual, however, suggests an urgent need to improve our outpatient therapies for adults with anorexia nervosa. Large, collaborative, multicenter randomized controlled trials, investigating both novel psychological treatments and biological interventions should be funded.”

Reference

Solmi M, Wade TD, Byrne S, et al. Comparative efficacy and acceptability of psychological interventions for the treatment of adult outpatients with anorexia nervosa: A systematic review and network meta-analysis. Lancet Psychiatry. 2021 Mar;8(3):215-224. doi:10.1016/S2215-0366(20)30566-6