Eating disorders are extremely complex in cause as well as in the medical and psychological consequences that can ensue. Although the field has come a long way in recent years, we still have a lot to learn about how best to successfully prevent and treat these disorders in all patients. UCSF is known internationally for the expertise of its faculty in the biomedical and behavioral sciences. Our goal is to conduct research that will inform the design and dissemination of more effective prevention and treatment so we can bring better care to more individuals who either have an eating disorder or who are at risk for developing eating disorders.
Ongoing research studies include:
Examining the Efficacy/Mechanism of Adaptive Family Based Treatment for Adolescent Anorexia Nervosa
JAMES LOCK, PHD; DANIEL LE GRANGE, PHD
UCSF and Stanford have teamed up in a new study, confirming the efficacy of adaptive family based treatment for adolescent anorexia! If you have, or know, an adolescent (12-18 years old) whose family may be interested in pursuing treatment with us, please direct them to our clinical research coordinator, Claire Trainor, at 415-476-0622, or at [email protected], for information about study eligibility and enrollment. Please see below for more details about the study, eligibility criteria, and contact information!
StRONG: The Study of Refeeding to Optimize iNpatient Gains
ANDREA GARBER, PHD, RD
The Study of Refeeding to Optimize iNpatient Gains is a prospective randomized controlled trial examining two different diets for nutritional rehabilitation during hospitalization, among patients 12 to 24 years old. Unlike previous studies in this area of research, participants will be followed for one year after leaving the hospital. The purpose is to study the relationship between dietary style of refeeding during hospitalization and the rate of recovery and relapse in the outpatient setting. Safety, efficacy, and cost effectiveness will all be taken into account. Patients who are hospitalized may choose to participate in this study without changing any aspect of their care plan except for participation in additional assessment procedures such as completion of psychological questionnaires, interviews, and five brief follow-up study visits over the course of a year, which may be coordinated with standard outpatient visits.
Online Training in Family Based Therapy
Stanford University and University of California, San Francisco are conducting a study funded by the National Institutes of Mental Health to examine an enhanced form of online training in Family Based Treatment for adolescents with anorexia nervosa.
For more information about this study, please go to: http://online-training-in-family-based-therapy.launchrock.com/
Learn more about the training under investigation here: https://www.youtube.com/watch?v=zFF5fDIlACo&feature=youtu.be
DANIEL LE GRANGE, PHD
The purpose of this study is to examine the emotional impact of administering family-based treatment and to determine whether a therapist-guided, internet-based chat support group for parents who are implementing family-based treatment would be helpful. For more information about this study, please go to: http://www.edparentsupport.net/website/projectinfo.php
DANIEL LE GRANGE, PHD
We are currently conducting a research study that involves coding audio-recorded sessions of family-based treatment for anorexia nervosa to examine therapists' adherence to the family-based treatment manual. This study aims to optimize the efficacy of family-based treatment. For more information about this study, please go to: https://psychiatry.uchicago.edu/page/optimizing-fidelity-family-based-treatment-adolescent-anorexia-nervosa
The National Eating Disorder Quality Improvement Collaborative
The National Eating Disorder Quality Improvement Collaborative is a national collaborative of Adolescent Medicine sites that provide care to patients with eating disorders. The initial goal of this collaboration was to collect and pool outcome data in order to compare effectiveness of different programs in the context of available services. The belief was that this would help to explain which program-specific factors led to improved outcomes. UCSF participated in this initial work and has remained a part of this collaborative as it broadens and expands its research scope.
Study of Hospitalized Adolescents with Anorexia Nervosa (SHAAN)
ANDREA GARBER, PHD, RD
Weight gain during hospitalization predicts better outcomes for patients with Anorexia Nervosa. However, weight gain is difficult to achieve and little is known about optimal diets to safely maximize nutritional recovery. The SHAAN study is a prospective examination of refeeding during hospitalization among patients 9 to 20 years old. The purpose is to study the relation between diet and weight change, so that better nutritional approaches can be developed. Patients who are hospitalized may choose to participate in this study without changing any aspect of their care plan except for participation in several additional assessment procedures such as completion of psychological questionnaires, a bone scan, and echocardiogram (ultrasound of the heart).
Treatment Outcomes for Anorexia Nervosa: Our Recent Meta-Analysis
Daniel Le Grange, Ph.D., FAED, Katharine Loeb, Ph.D., FAED, and Stuart Murray, Ph.D.
Every study that the scientific field conducts contributes, metaphorically speaking, only one piece to a very large puzzle. This is particularly true for complex disorders like anorexia nervosa. Even a meta-analysis represents just one piece of such a puzzle. With that in mind, below is a summary to highlight some of what our recent meta-analysis1 has underscored for us as both scientists and practitioners in the field of eating disorders.
First, the positive or negative nature of a study should be judged by the scientific integrity of the research, rather than the implications of the results. Meta-analytic designs are well-suited to investigate pooled patterns of findings across multiple, separate studies. The intrinsic statistical limitations of a meta-analysis, and the corresponding risks of over- or mis-interpretation of the results, are mitigated by study’s clarity of presentation regarding: the specific, targeted research question(s); the criteria for selection of studies to include in the analysis; and the conclusions that can be drawn from the results. It is always beneficial to read an original research paper rather than relying on media-based summaries, regardless of whether a study’s findings appear to support or refute scientific and popular beliefs.
Our study aimed to examine aggregate outcomes in RCTs for AN by delineating two different symptom dimensions: the physical (i.e., body weight indices) and the psychological (i.e., fear of weight gain and other clinically significant body concerns). The distinction between these two domains is important because clinical and empirical observations suggest that there is often a disconnect – in timing if not in mechanisms – between pathways to recovery in each. Our research questions were not directed at a particular intervention, but rather at treatment studies in general, relying on the original investigators’ designation of specialized vs. comparator modalities. Our analyses address these interacting sets of questions, that is, how do specialized vs. comparator interventions fare in achieving positive change in weight vs. psychological symptoms for AN?
Our results indicate that weight and psychological AN symptoms follow distinct trajectories throughout treatment. Our results also highlight that as a field, we need to continue to focus on precision methods to achieve and sustain psychological relief for our patients. While we believe such relief is predicated on sufficient weight gain, reliably realizing durable remission across both symptom domains will require further study of the core mechanisms underpinning psychological AN psychopathology. Research efforts to accomplish this goal, and to apply findings to shape more potent treatment strategies (e.g., within a transdiagnostic framework2), are ongoing in the field. To facilitate further investigation of these questions, researchers would ideally always report outcomes from treatment studies of AN as both separated (weight vs. psychological symptoms) and combined indices.
What to do in the meantime, while AN scientists continue to try to solve an endlessly shifting jigsaw puzzle? This meta-analysis does not try to answer that. For an answer, we turn to other pieces of the puzzle, particularly to the findings from well-designed RCTs. FBT, CBT-E, and other available specialized intervention modalities are indeed efficacious and reflect current best practices for the treatment of eating disorders.
1Murray, S., Quintana, D., Griffith, S., Loeb, K., & Le Grange, D.Treatment Outcomes for Anorexia Nervosa: A Systematic Review and Meta-Analysis of Randomized Controlled Trials, Psychological Medicine, 2018 Aug 13:1–10. Doi: 10.1017/S0033291718002088.
2Fairburn CG, Cooper Z, Doll HA, O'Connor ME, Palmer RL, Dalle Grave R. Enhanced cognitive behaviour therapy for adults with anorexia nervosa: A UK-Italy study. Behaviour Research and Therapy 2013; 51: 2-8.