Adolescent girls with anorexia
nervosa may be able to safely participate in outpatient treatment,
according to a new study from Germany.
While outpatient treatment for anorexia nervosa is not
common in many countries, researchers found that adolescent girls who took part
in a day-treatment program didn't do any worse than those who stayed at a
hospital for months of therapy.
"I have quite a lot of experience with adolescent
patients and I've been working with anorexic patients for about 20 years,"
Dr Beate Herpertz-Dahlmann told Reuters Health. "When I saw them when they
were a little bit older, they would tell me they lost their youth by being in
the hospital so long." Herpertz-Dahlmann is the study's lead author and
director and chair of the Department of Child and Adolescent Psychiatry at RWTH
Aachen University in Germany.
Lengthy hospital stay
Anorexia nervosa is an intense fear
of gaining weight that result in self-starvation and the loss of an
unhealthy amount of weight. In many European countries, treatment for moderate
and severe anorexia nervosa requires a lengthy stay in a hospital.
In the US inpatient
treatment typically lasts about a month and is followed by some type of
outpatient treatment that's matched to the individual's degree of illness.
The researchers write in The Lancet that outpatient
treatment has been criticized because of increasing rates of people returning
to hospitals and unsatisfactory weight gain. But inpatient treatment has also
been criticized for high relapse rates and return hospital stays. Inpatient
treatment is also more expensive, they write.
For the new study, they recruited 172 girls between 11 and
18 years old, who were seeking treatment for moderate to severe anorexia
nervosa at six hospitals in Germany between February 2007 and April 2010.On
average, the girls weighed less than 98% of the girls their age at the start of
After three weeks of treatment in a hospital, the
researchers then randomly assigned 87 to receive treatment as a so-called day
patient. The rest remained at the hospital for inpatient treatment.
In both cases, the participants received the same therapies
for anorexia nervosa. The only difference was that day patients were allowed to
go home at night instead of living at the hospital.
The participants stayed in therapy until they maintained a
target weight for two weeks. It took about 15 weeks for the inpatients and 17
weeks for the day patients to reach that point.
With their families
After 12 months, the researchers found that the weight of
the girls in each group had improved. The participants at that point weighed
less than 83% of peers in their age group.
In addition, the day patients performed better than
inpatients on measures of mental health, which Herpertz-Dahlmann said is
probably a result of the girls being allowed to live in their homes with their families.
The day patient program also cost about 20% less than the inpatient
program."This treatment is cheaper than the other one and I think it is
not that bad for the patients," Herpertz-Dahlmann said.
Kamryn Eddy cautioned that the cost analysis in the study
may differ in the US, where inpatient treatment typically costs much more.
Eddy was not involved in the new study but she is
co-director of the Eating Disorders Clinical and Research Programme at
Massachusetts General Hospital and assistant professor of psychology at Harvard
Medical School in Boston.
A wide range of programmes
She also said people shouldn't generalise the findings of
the study to all forms of outpatient anorexia nervosa treatment."There's a
wide range of inpatient and residential programmes globally and in the US,"
"Their focuses are a little different. So it's
important we don't generalise the results from the study." Dr Evelyn Attia
of Columbia University Medical Centre and Weill Cornell Medical College in New
York also said the intensity and duration of the treatment used in the study
would not be available to many Americans through their insurance.
"I think the important take-home message from this
study is that a lot of treatment effects can be delivered in a somewhat less
structured and yet more economically efficient setting," Attia, who wrote
an accompanying commentary, said.
But both Attia and Eddy also pointed out that the
improvements observed among both groups in the new study were not so
great."The finding from this study should mobilise all of us to redouble
our efforts to continue to identify treatment that will work for these
patients," Eddy said.