The Need for Evidence Based Careby Mark Warren, M.D.
Re-posted from Cleveland Center for Eating Disorders (CCED) blog archives. CCED and The Emily Program partneredin 2014.
By Dr. Mark Warren
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 for 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 due 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.
Contributions by Sarah Emerman