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Data Inadequate on Best Setting for Eating-Disorder Treatment

February 27, 2019

By Reuters Staff

NEW YORK—There is not enough evidence to determine the best setting for treatment of anorexia nervosa (AN) or bulimia nervosa (BN), according to a new Cochrane review.

Outpatient care is the most widely recommended approach for treating most eating disorders, although guidelines vary on outpatient treatment for AN, Dr. Phillipa J. Hay of Western Sydney University in Penrith, Australia, and colleagues note.

"Those who are at medical or psychiatric risk of harm or suicide, and those with anorexia nervosa who are severely underweight or rapidly losing weight may not be safe in an outpatient setting," they write in the Cochrane Database of Systematic Reviews, online January 21.

The authors reviewed five trials, including four in AN patients (n=511) and one in BN patients (n=55). There was little or no difference between specialist inpatient care and active outpatient care or between combined brief hospital and outpatient care for AN, based on weight gain 12 months from baseline, with low-quality evidence.

Patients were significantly more likely to finish treatment in outpatient settings (risk ratio, 0.75), but the finding, based on three trials, was "uncertain" and the evidence was of very low quality.

No trials looked separately at manualized individual outpatient care for adults with AN, which is "a major gap in the evidence for this population," the authors note.

"This review found insufficient evidence for superiority of any treatment setting (inpatient, outpatient, reduced length of inpatient followed by outpatient, or partial hospital care) for anorexia nervosa or any other eating disorder," Dr. Hay and her team write. "Patient safety (severity of medical and psychiatric illness) and preference, access to levels of care, and cost are important considerations in determining treatment setting in anorexia nervosa (and other eating disorders)."


Cochrane Database Syst Rev 2019.

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