Evidence has shown Family-Based Treatment (FBT) to be the most effective treatment approach for anorexia and bulimia in children and adolescents, but research on FBT for binge eating disorder (BED) is lacking. This may be, in part, because binge eating disorder tends to develop in adulthood, and so the research has focused on adult treatment. The reality, however, is that binge eating disorder affects children and adolescents as well, with prevalence estimates ranging between 1% and 5%.
FBT has positive outcomes with adolescent bulimia, which is characterized by recurrent binge eating, suggesting that it may also be a promising treatment for adolescent binge eating disorder. In Equip’s new case study, we found that to be true.
The case study, which was published in the journal Cognitive and Behavioral Practice in February 2023, follows an adolescent female with BED, Julia (names have been changed to protect privacy), who came to Equip after gaining weight over the course of a year due to what her parents described as “emotional eating.”
When Julia began treatment, her eating was cloaked in shame and secrecy, and she at first struggled to admit there was a problem at all. Her parents, meanwhile, expressed substantial weight bias, stating that they thought Julia would be happier if she lost weight, and sharing concerns over her BMI. They expressed these sentiments both to their providers and to Julia directly.
In individual treatment, providers would have been able to work with Julia to normalize eating habits and stop eating disorder behaviors, but they would not have been able to target the weight stigma and harmful assumptions that existed within the family. By using Equip’s FBT+ approach, they were able to do both. “FBT gives us the opportunity to work with both patients and families where they are at,” says Jessica Baker PhD, Equip Senior Researcher and an author of the report. “As is emphasized by this case, targeting certain aspects of the family unit are essential for recovery.”
Using a Health at Every Size (HAES) framework, providers were able to validate Julia’s parents’ concerns while also helping them acknowledge the pervasive weight stigma within our society. The family's assumptions were gently challenged during sessions, and they were able to effectively refocus their attention on helping Julia develop a healthy relationship with food. “It’s incredibly meaningful to see eating disorder behaviors change and overall wellness improve as parents challenge deeply ingrained beliefs about weight and shape,” says Jennifer Derenne MD, Equip’s VP of Medical Care and an author of the report.
After 21 weeks of treatment, Julia had achieved full remission of her eating disorder symptoms. What’s more, there was a significant reduction in weight- and food-based shame within the family. This is important, because these types of family-level factors can contribute to and reinforce eating disorder behaviors, and addressing them head-on reduces the chance of relapse and paves the way for lasting recovery.
“The first question that often comes to mind when people think of BED is how to control or restrict the amount of food someone is consuming. This case highlights the ways restriction and food rigidity can perpetuate binge eating, and how vital weight neutrality is in eating disorder treatment approaches,” says Ally Duvall, Equip’s Body Image Program Manager and an author on the report. “As providers, we can shift the cultural narrative that encourages food rigidity and morality by supporting our patients from a HAES+ lens.”
While more research is needed to understand the effectiveness of FBT for binge eating disorder in adolescents, this case study shows that it may be effective, making it an evidence-based approach for adolescents across the eating disorder spectrum. “Our preliminary findings suggest that FBT is an effective treatment approach for all eating disorders,” says Baker.
Read the full case report here: Enhanced Family Based Treatment for An Adolescent with Binge Eating Disorder: A Case Report