Eating disorders are serious mental illnesses that require equally serious intervention. For years, enhanced cognitive behavioral therapy (CBT-E) has been considered the gold standard for adult eating disorder treatment—but almost all studies of CBT-E have focused on in-person delivery.

At Equip, we know that virtual treatment is essential, making care accessible to countless people who wouldn’t have an opportunity to recover otherwise. That’s why in our latest peer-reviewed study, published in the Journal of Medical Internet Research, we set out to evaluate the efficacy of Equip’s virtually delivered CBT-E. The results were compelling, and provided insights that will drive us forward on our mission to make treatment that works available to everyone who needs it. Read on to find out what we learned.

Why we conducted this study

Virtual care has become a critical tool in expanding access to mental health services, especially for people living in rural areas, those with limited transportation, or anyone who might otherwise struggle to find a specialist near them. For eating disorders in particular, virtual care helps patients develop skills, learn to manage triggers, and build a recovery-supporting environment in the real world, which can strengthen recovery and protect against relapse.

There have been a number of studies showing the efficacy of virtual eating disorder treatment, including our own research on the remotely delivered FBT. But there is not a large body of data on the efficacy of virtual care for CBT-E, which is the leading evidence-based treatment modality for adults with eating disorders. The research that does exist on virtual CBT-E looks at programs that shifted to virtual care due to circumstance—i.e., the pandemic—rather than intentionally designed, virtual-first programs, like Equip. Our study aimed to help fill that gap.

The study looked at 1,629 adult patients (18+) at Equip, all of whom received CBT-E through a treatment model specifically designed to be delivered remotely. Our goal was to understand how effective virtual CBT-E is for helping patients achieve weight restoration (when needed), reduce eating disorder symptoms, and improve co-occurring symptoms of depression and anxiety (both of which often go hand-in-hand with eating disorders).

Who we studied (and how)

This was a retrospective, real-world study based on data from adult patients treated through our standard care pathways. The patient population represented all eating disorder diagnoses except for ARFID: anorexia nervosa, bulimia nervosa, binge eating disorder, and other specified feeding or eating disorder.

CBT-E is a transdiagnostic therapy, which means that it’s meant to treat all types of eating disorders, rather than just one specific diagnosis. It does this by taking a highly individualized approach that addresses the underlying beliefs and distortions that maintain an eating disorder. Patients in the study met with their providers weekly (which is the clinically recommended cadence) and all sessions were virtual.

Our analysis focused on how symptoms changed over time, especially around the 20- and 40-week marks, which align with the typical length of CBT-E in existing clinical trials.

What we found

Our findings show that virtual CBT-E can drive meaningful improvements in eating disorder symptoms, as well as in common co-occurring conditions like depression and anxiety. The results below show outcomes after 40 weeks of treatment.

Weight restoration

Among patients needing weight restoration

• 50% of patients achieved at least 95% of their expected body weight

Eating disorder symptoms

• 34% improvement in eating disorder symptoms
• 48% of patients achieved subclinical levels of eating disorder symptoms (among patients who began treatment with clinically significant levels of eating disorder symptoms)

Depression

Among patients who began treatment with clinical levels of depression

• 32% improvement in depression symptoms
• 55% saw their symptoms drop below the clinical threshold

Anxiety

Among patients who began treatment with clinical levels of anxiety

• 26.5% improvement in anxiety symptoms
• 56% saw their symptoms drop below the clinical threshold

To put these numbers in context: published clinical trials for in-person CBT-E report weight restoration rates between 41% and 53%; eating disorder symptom improvement of 31–36%, and depression and anxiety improvements of 21% and 17%, respectively (all measured at the 40 week mark). That means Equip’s virtual outcomes are not only within the expected range, they often exceed it.

What this means for virtual care

These findings provide strong evidence that remote, evidence-based eating disorder care can be just as effective as in-person treatment. That’s an important and promising takeaway—not just for Equip, but for the future of eating disorder treatment.

Our paper, taken together with the existing body of research, shows that when CBT-E is adapted for virtual settings and delivered with intention, it can be a powerful tool for eating disorder recovery in adults. Because in-person care can be impractical, inaccessible, or simply overwhelming to many adults—not only those in rural areas or treatment deserts, but also those with children they need to take care of or jobs they can’t put on pause—virtual treatment is often the only pathway to recovery. And, as our study shows, it can be an effective and efficient route.

The bottom line

Eating disorders don’t go away on their own, and often get worse over time—making access to timely, evidence-based treatment essential for the countless adults struggling. Our latest study reinforces that virtual CBT-E can deliver real, lasting results for adults with a wide range of different eating disorder symptoms.

It’s a powerful validation of the work we do at Equip every day, and a reminder that recovery can begin right where you are, in your own life, today.

Note: While our study included a large number of patients (over 1,600), the group wasn’t as diverse as we’d like: the majority were white (71.5%) and cisgender women (86.1%), with a mean age of 30. That reflects broader trends in research, where underrepresented groups are often excluded—intentionally or not. We recognize that, and are committed to continuing to diversify our sample groups, improve our outreach, and ensure that everyone—particularly those historically left out of treatment—has access to the care they deserve.