Family-Empowered Treatment in Higher Levels of Care for Adolescent Eating Disorders: The Role of the Registered Dietitian Nutritionist

Family-based treatment (FBT) is the leading evidence-based treatment for adolescents with eating disorders,1 and has particularly strong research support for the treatment of anorexia nervosa (AN).2 FBT is an outpatient treatment consisting of 3 phases.2 In phase 1, because patients with AN are often ambivalent about treatment and recovery, parents are given the responsibility for weight restoration. This involves making all eating-related decisions for their child, including deciding what will be eaten and when, how much will be eaten, monitoring all meals and snacks, and curtailing physical activity. Once the patient has gained weight, eating disordered behaviors have lessened, and the adolescent’s thoughts and behaviors are no longer being driven by the eating disorder, responsibility for eating is gradually handed back to the adolescent—to whatever extent is age-appropriate—in phase 2. In phase 3, the treatment team ensures that the adolescent is back on track with healthy development. FBT has also been found to be effective for bulimia nervosa.3 Although the phases of treatment are the same for bulimia nervosa, the focus of treatment is on developing a regular pattern of eating and eliminating binge eating and purging.