Caring for Adults With Eating Disorders in Primary Care

2022 ◽  
Vol 24 (1) ◽  
Author(s):  
Diana C. Lemly ◽  
Melissa J. Dreier ◽  
Shana Birnbaum ◽  
Kamryn T. Eddy ◽  
Jennifer J. Thomas
Author(s):  
Phillipa J. Hay ◽  
Angélica de M. Claudino

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.


Author(s):  
Phillipa J. Hay ◽  
Angélica de M. Claudino

This chapter comprises a focused review of the best available evidence for psychological and pharmacological treatments of choice for anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified and unspecified feeding and eating disorders (OSFED and UFED), discusses the role of primary care and online therapies, and presents treatment algorithms. In AN, although there is consensus on the need for specialist care that includes nutritional rehabilitation in addition to psychological therapy, no single approach has yet been found to offer a distinct advantage. In contrast, manualized cognitive behavior therapy (CBT) for BN has attained “first-line” treatment status with a stronger evidence base than other psychotherapies. Similarly, CBT has a good evidence base in treatment of BED and for BN, and BED has been successfully adapted into less intensive and non-specialist forms. Behavioral and pharmacological weight loss management in treatment of co-morbid obesity/overweight and BED may be helpful in the short term, but long-term maintenance of effects is unclear. Primary care practitioners are in a key role, both with regard to providing care and with coordination and initiation of specialist care. There is an emerging evidence base for online therapies in BN and BED where access to care is delayed or problematic.


2021 ◽  
pp. 135910452110095
Author(s):  
Jacinta O A Tan ◽  
Imogen Spector-Hill

Background: Co-morbid diabetes and eating disorders have a particularly high mortality, significant in numbers and highly dangerous in terms of impact on health and wellbeing. However, not much is known about the level of awareness, knowledge and confidence amongst healthcare professionals regarding co-morbid Type 1 Diabetes Mellitus (T1DM) and eating disorders. Aim: To understand the level of knowledge and confidence amongst healthcare professionals in Wales regarding co-morbid T1DM and eating disorder presentations, identification and treatment. Results: We conducted a survey of 102 Welsh clinicians in primary care, diabetes services and eating disorder services. 60.8% expressed low confidence in identification of co-morbid T1DM and eating disorders. Respondents reported fewer cases seen than would be expected. There was poor understanding of co-morbid T1DM and eating disorders: 44.6% identified weight loss as a main symptom, 78.4% used no screening instruments, and 80.3% consulted no relevant guidance. The respondents expressed an awareness of their lack of knowledge and the majority expressed willingness to accept training and education. Conclusion: We suggest that priority must be given to education and training of all healthcare professionals in primary care, diabetes services and mental health services who may see patients with co-morbid T1DM and eating disorders.


2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Jocelyn Lebow ◽  
Cassandra Narr ◽  
Angela Mattke ◽  
Janna R. Gewirtz O’Brien ◽  
Marcie Billings ◽  
...  

Abstract Background The primary care setting offers an attractive opportunity for, not only the identification of pediatric eating disorders, but also the delivery of evidence-based treatment. However, constraints of this setting pose barriers for implementing treatment. For interventions to be successful, they need to take into consideration the perspectives of stakeholders. As such, the purpose of this study was to examine in-depth primary care providers’ perspective of challenges to identifying and managing eating disorders in the primary care setting. Methods This mixed methods study surveyed 60 Pediatric and Family Medicine providers across 6 primary care practices. Sixteen of these providers were further interviewed using a qualitative, semi-structured interview. Results Providers (n = 60, response rate of 45%) acknowledged the potential of primary care as a point of contact for early identification and treatment of pediatric eating disorders. They also expressed that this was an area of need in their practices. They identified numerous barriers to successful implementation of evidence-based treatment in this setting including scarcity of time, knowledge, and resources. Conclusions Investigations seeking to build capacities in primary care settings to address eating disorders must address these barriers.


2019 ◽  
Vol 64 (2) ◽  
pp. S50
Author(s):  
Jocelyn Lebow ◽  
Angela Mattke ◽  
Janna Gewirtz O'Brien ◽  
Cassandra Narr ◽  
Marcie Billings ◽  
...  

1998 ◽  
Vol 169 (6) ◽  
pp. 342-343
Author(s):  
Kay A Wilhelm ◽  
Simon D Clarke

Author(s):  
Joel Yager ◽  
Philip S. Mehler ◽  
Eileen D. Yager ◽  
Alison R. Yager

Binge eating disorder, bulimia nervosa, and anorexia nervosa, particularly milder cases, often go unrecognized and untreated in primary care practice settings. Eating disorders are frequently associated with shame, and masked by other prominent physical and psychiatric conditions that demand attention. Among adults, binge eating disorder, the most prevalent of the eating disorders, occurs with increasing frequency, in tandem with higher rates and degrees of obesity, across all age ranges, and in both genders. Bulimia nervosa and anorexia nervosa are more common in females, and although they are most often seen in pediatric and adolescent medicine practices cases, they are also seen in adult practice populations. This chapter describes pathways by which primary care practices can implement integrated and collaborative care treatment programs, likely to benefit large numbers of patients, and effectively coordinate with specialist levels of care, as necessary.


1996 ◽  
Vol 19 (2) ◽  
pp. 65-69 ◽  
Author(s):  
ANN MARADIEGUE ◽  
ELIZABETH K. CECELIC ◽  
MARY JEAN HOZZELL ◽  
GAIL FRENCES

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