![]() ![]() Randomized controlled trials (limited-quality patient-oriented outcome) Medications should not be used as monotherapy in the treatment of anorexia nervosa or bulimia nervosa. Randomized controlled trials (patient-oriented outcome) 3, 33įamily-based therapy should be a first-line treatment for youths with anorexia nervosa and bulimia nervosa. The outpatient care team should include an experienced therapist, a dietitian, and a clinician knowledgeable about eating disorder–specific medical evaluations. ![]() Most patients with eating disorders receive optimal care in an outpatient setting. ![]() Observational studies and a meta-analysis of observational studies In patients with eating disorders, early intervention and symptom improvement decrease the risk of a protracted course with long-term pathology. Prevention should emphasize a positive focus on body image instead of a focus on weight or dieting. Remission is suggested by healthy biopsychosocial functioning, cognitive flexibility with eating, resolution of disordered behaviors and decision-making, and if applicable, restoration of weight and menses. Evidence supports select antidepressants or topiramate for bulimia nervosa and lisdexamfetamine for binge-eating disorder. Treatment options may include cognitive behavior interventions that address body image and dietary and physical activity behaviors family-based therapy, which is a first-line treatment for youths and pharmacotherapy, which may treat co-occurring conditions, but should not be pursued alone. Weight gain of 2.2 to 4.4 lb per week stabilizes cardiovascular health. A healthy weight range is determined by the degree of malnutrition and pre-illness trajectories. The escalation of care should be based on health status (e.g., acute food refusal, uncontrollable binge eating or purging, co-occurring conditions, suicidality, test abnormalities), weight patterns, outpatient options, and social support. Additional care team members (i.e., dietitian, therapist, and caregivers) should provide a unified, evidence-based therapeutic approach. After diagnosis, visits should include the sensitive review of psychosocial and clinical factors, physical examination, orthostatic vital signs, and testing (e.g., a metabolic panel with magnesium and phosphate levels, electrocardiography) when indicated. Clinicians should interpret disordered eating and body image concerns and carefully monitor patients' height, weight, and body mass index trends for subtle changes. Early intervention may decrease the risk of long-term pathology and disability. Eating disorders are potentially life-threatening conditions characterized by disordered eating and weight-control behaviors that impair physical health and psychosocial functioning. ![]()
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