By: Charlotte Rogus, MPH, RD, LDN

As an outpatient eating disorder dietitian, I’ve worked with many families providing individualized care for their child or adolescent’s eating disorder. Part of this care involves deciding which treatment modality best fits the needs of their particular child. In part 1, RD Sara Gonet provided a great overview of the different levels of care available to treat eating disorders, and what parents can expect from their child’s dietitian. In this article, I will expand upon Family-Based Treatment (FBT), one of the leading treatment modalities used in the outpatient setting.

 

FBT, What is it?

FBT is the first line of treatment we typically recommend for adolescents in the outpatient setting. FBT is incredibly effective: studies show that after treating with FBT, 75-90% of adolescents remain weight recovered at a five-year follow up (1, 2). Because it is conducted at home, FBT is much less disruptive for adolescents, and can also be more cost effective than other types of eating disorder treatment. 

 

FBT replicates the support that a child may receive at a higher level of care through structured, supervised meals and snacks, implemented at home by their parents or caregivers with guidance from an outpatient treatment team. This approach empowers parents and caregivers to be the core resource for the child’s eating disorder treatment, while emphasizing that they are not the cause of the child’s eating disorder. 

 

Below is more detail regarding the roles and phases of FBT:

 

The Treatment Team

Though the parent or caregiver is at the core of FBT, a treatment team is recommended to help support and guide the process. This team should consist of an FBT-informed dietitian, psychotherapist, primary care physician, and psychiatrist. This team will support both caregivers and the child or adolescent throughout the recovery process. 

 

Phases of FBT

Phase 1: This is the renourishment phase. Caregivers are in charge of all meals and snacks during this phase, meaning they decide what the meals and snacks will be, as well as prepare and plate them, and supervise the child eating them. During this phase the dietitian spends the majority of session times working with the caregivers. The dietitian will create an individualized meal plan for the adolescent and provide guidance to caregivers on how to implement it at home. 

 

Phase 2: This is a gradual return of age-appropriate autonomy to the child or adolescent. This phase begins once they are mostly weight-restored, meal times are going smoothly, and eating disorder behaviors are more controlled. During this phase, the child will start to plate their own food sometimes, or have some meals and snacks unsupervised. Please keep in mind that phase 2 looks different for each family, and that it is common to go back and forth between phases 1 and 2 based on the adolescent’s recovery progress. Having a team to support and guide the process is so important! At this stage the dietitian may spend more time working directly with the child to help them begin developing a healthy identity apart from the eating disorder. This can look like challenging harmful food beliefs, rebuilding trust in hunger and fullness cues, and normalizing eating patterns.

Phase 3: This phase empowers the teen as they regain an age-appropriate level of independence with food. This phase occurs when eating disorder behaviors have subsided, and the child or adolescent is able to eat more independently. At this stage, the registered dietitian spends the majority of appointment time with the adolescent, continuing to help the adolescent develop a healthy sense of self outside of the eating disorder.

 

Important Points to Remember:

Taking charge of your child’s eating disorder treatment can feel overwhelming. I often hear parents voice a lack of confidence in their own ability to implement FBT and handle their child’s distress. Having an outpatient treatment team to guide this process is incredibly important, as caregivers need just as much support as the teen does. Here are some additional points to keep in mind when implementing FBT:

  • Maximum 3-4 hours between eating times (the dietitian will help guide this).
  • Try to stay loving, gentle, and patient. Your child is not their eating disorder. You can strive to picture your child and the Eating Disorder (ED) as separate.
  • Caretakers decide what to serve, prepare it, and expect it to all be eaten. Don’t negotiate with your child to protect them from their eating disorder. Don’t be scared of what your child is scared of.
  • Prioritize and decide what support YOU need as a caretaker.

As you work through the different phases with your child, you will notice that they begin to regain healthy independence. This can look like enjoying previously loved foods, eating freely at social events and on holidays, feeling relaxed and flexible about ingredients and quantities of different foods, and eating freely when they notice hunger. Though this may take some time, full recovery is possible!

 

If you want to learn more or get in touch with a registered dietitian to  help your family, please go to the “Contact Us” link on our website, or send us an email at info@lutzandalexander.com. 

 

Additional FBT Resources:

 

References:

  1. https://www.verywellmind.com/what-is-family-based-treatment-fbt-for-eating-disorders-4052371
  2. Lock J, Le Grange D, Agras WS, Moye A, Bryson SW, Jo B. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Arch Gen Psychiatry.