For many patients, early response can predict remission.
Early response to treatment for an eating disorder is often linked to a positive outcome, and to remission. Changes in behavior in the first weeks of treatment, such as a reduction in binge- eating and purging behaviors, or early weight gain in anorexic patients, can predict remission after a variety of treatments, regardless of the type or duration (Appetite. 2009. 52:805). This factor also enables clinicians to personalize treatment to improve outcome.
A group from King’s College, the University of Palermo, Italy, and the Federal University of Rio de Janeiro, Brazil, conducted a systematic review and meta-analysis of the literature to see how predictive early response actually is for patients with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED) or eating disorders not otherwise specified (Eur Eat Disord Rev. 2017. 25:67).
Early responses were keyed to the disorder
One of the initial findings reported by Dr. Bruno Palazzo Nazar and his colleagues was how the definition of “early response” varied according to the individual eating disorder. For patients with AN, the main outcome was attaining 95% of ideal body weight (IBW). In contrast, for patients with BN, it was a percentage reduction in binge eating and/or purging over a variable time period. For AN patients, early weight gains by outpatient adolescents with AN were predictive of remission in studies that used family-based therapy (Psychothotherapy, Chicago IL. 2016. 53:251) and cognitive behavioral therapy. This pattern was the same for inpatient AN treatment, where early weight gains at different time points during the first 6 weeks of therapy could predict remission (Psychother Res. 2007. 17:218; J Eat Disord Assoc. 2016. 10:1002/erv.2443). In contrast, for BN patients, the predictive pattern was far weaker, and early response was only moderately linked to better outcome. In BED studies, early response had only a fair capacity to predict good outcome.
Clinical implications of the findings
The study results indicated that failure to respond to outpatient psychological treatment during the early phase of treatment is linked to persistent symptoms in patients with AN at one year. The authors also reported there is a 77% chance that a patient who responds early will have a remission of symptoms at the end of treatment.
Among patients with BED, early response to treatment showed a high specificity and low sensitivity in predicting remission—there was an approximately 30% increase in the chances of remission in a patient with BED with an early response, and these individuals were 5 times more likely to achieve remission than were patients with slower responses (Clin Psychol Rev. 2012. 32:292).
In contrast to the positive effects of early response among patients with AN and BED, early response among BN patients did not strongly predict remission. In fact, an early response to treatment by patients with BN increased their chances of remission only by 15%.
These results should spur interest in identifying modifications to existing treatments to increase the likelihood of early response.