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August 9, 2013

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.


Mark Warren, MD

Dr. Mark Warren is the Chief Medical Officer for The Emily Program and Veritas Collaborative. He is also one of the original founders of the Cleveland Center for Eating Disorders, which became The Emily Program – Cleveland in 2014. A Cleveland native, he is a graduate of the Johns Hopkins University Medical School and completed his residency at Harvard Medical School. He served as Chairman of the Department of Psychiatry at Mt. Sinai Hospital and Medical Director of University Hospital Health System’s Laurelwood Hospital. A past vice-chair for clinical affairs at the Case School of Medicine Department of Psychiatry, he continues on the Clinical Faculty of the Medical School, teaching in both the Departments of Psychiatry and Pediatrics. He is currently a faculty member and former chair of the Board of Governors at the Gestalt Institute of Cleveland. Dr. Warren is a Distinguished Fellow of the American Psychiatric Association, 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 leads the Males and Eating Disorders special interest group for the Academy of Eating Disorders.

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