The Need for Evidence-Based Care
Re-posted from the Cleveland Center for Eating Disorders (CCED) blog archives and updated with additional Emily Program client thoughts. CCED and The Emily Program partnered in 2014. Contributions by Sarah Emerman,
A recent article by Dr. Russell Marx, The National Eating Disorder Association’s chief science officer, discussed evidence-based treatment. The article noted Harriet Brown’s New York Times piece, which we have discussed in previous blogs, concerning why surprisingly few patients get evidence-based care. Dr. Marx discusses the NICE guidelines, which is the National Institute for Health and Care Excellence in the United Kingdom. What’s particularly exciting about this article was that it noted the growing evidence for the efficacy of FBT and general family-based interventions for clients with anorexia. The NICE guidelines are of significance specifically in the United Kingdom but are utilized worldwide in understanding evidence basis for eating disorder treatment. In the NICE guidelines, Dialectical Behavioral Therapy is noted as a treatment well conducted with clinical studies for binge eating disorder but is not included as a proven treatment for anorexia or bulimia. These guidelines were last completed in 2011 and will be reviewed again in 2014. It is our hope that recent studies on DBT will show the effectiveness of this treatment for other eating disorder diagnoses.
As the NICE criteria made clear, there is an absolute need for more evidence-based treatment for eating disorders. For anorexia, there are no studies rated as an intervention with the highest rating. The importance of developing “A” or “A+” ratings for those with eating disorders is key. Since FBT has not been rated in adults, the NICE guidelines offer no evidence-based therapy for adults with anorexia. Programs such as ours and others across the country struggle with this reality by using CBT, DBT, and adult versions of FBT. We are fortunate that both CBT and DBT have been shown to have some efficacy for bulimia and binge eating disorder. As Harriet Brown notes, it is difficult to shift treatment and most providers must make do with limited or incomplete data. We have great hope that upcoming years will produce significant changes in evidence-based care. Our task is to try what we know, recognize when things are not working, and have the willingness to shift and try new things until health and recovery are achieved.
ABOUT THE AUTHOR
Mark Warren, MD
Dr. Mark Warren (he/him) is the Chief Medical Officer of Accanto Health, the parent company of The Emily Program and Gather Behavioral Health. His primary focus enhancing patient safety and providing comprehensive treatment that addresses both the physical and psychological aspects of eating disorders. Working alongside our executive team and our medical staff, Dr. Warren is dedicated to helping all of our patients embark on a path toward a meaningful and joyful life.
Dr. Warren is a Distinguished Fellow of the American Psychiatric Association and a Fellow of the Academy of Eating Disorders, where he co-founded the special interest group (SIG) for Professionals and Recovery and the SIG for Males and Eating Disorders. He is a two-time recipient of the Exemplary Psychiatrist Award of the National Alliance for the Mentally Ill, and a winner of the Woodruff Award. He has published and spoken extensively on males and eating disorders, professionals and recovery, and DBT and FBT in the treatment of eating disorders.
Dr. Warren is a founding member and former co-chair of the Academy of Eating Disorders Medical Care Standards Committee and serves on the FEAST Medical Advisory Board and The Visiting Committee of the Case Western Francis Payne Bolton School of Nursing.
Having personally experienced an eating disorder as a young man, Mark feels privileged to be working in the field of eating disorders for over two decades.