Adding Nutrition to Family Based Treatment:

Transcription

1 Adding Nutrition to Family Based Treatment: A New Intervention to Help Teens & Young Adults Fight Anorexia Nervosa Shane Fallon MPH Nutrition, Capstone UC Berkeley SPH, Class of 2017

2 Overview Background Specific Aims Study Design Data Analysis Limitations Implications Future Steps

3 Setting R21 (Developmental Research Grant Proposal) National Institutes of Health (NIH) Dr. Andrea Garber & Dr. Daniel Le Grange UCSF Division of Adolescent & Young Adult Medicine Anorexia Nervosa (AN)

4 Background Family Based Treatment (FBT): Current standard of care I. Restoring weight II. Returning control of eating III. Patient development and terminating treatment Let thy food be thy medicine. - Hippocrates

5 Refeeding Parents in complete control of refeeding Underlying assumptions

6 Innovation FBT + NUTRITION

7 Specific Aims 1 2 3

8 Study Population Exclusion Criteria Inclusion Criteria Diagnosis of AN Not assigned to the hospital Assigned and committed to FBT Ages years Diagnosis of bulimia nervosa Currently in remission Currently pregnant Chronic disease Current suicidality or psychosis

9 Study Design

10 Data Analysis: Comparing FBT and FBT-N Weight gain 5 lbs EDE-Q Pre- & PostFBT-N Exam

11 Limitations and Challenges Sample size Female: Male Underestimation

12 Public Health Implications New standard of care time of treatment & recovery burden felt by caregivers $$$

13 Future Steps Phase I: Secure Funding from NIH Build Education Materials Phase II: Run Trial Analyze Data Phase III: R21 R01

14 Special Thanks Dr. Andrea Garber UCSF Adolescent and Pediatric Unit Dr. Daniel Le Grange Dr. Lia Fernald Dr. Barbara Laraia Carly Isman PHN 2017

15 References Jewell, T., Blessitt, E., Stewart, C., Simic, M., & Eisler, I. (2016). Family Therapy for Child and Adolescent Eating Disorders: A Critical Review. Family Process, 55(3), Downs, K. J., & Blow, A. J. (2013). A substantive and methodological review of family-based treatment for eating disorders: The last 25 years of research. Journal of Family Therapy, 35(SUPPL. 1), Godfrey, K., Rhodes, P., Miskovic-Wheatley, J., Wallis, A., Clarke, S., Kohn, M., Madden, S. (2015). Just one more bite: A qualitative analysis of the family meal in family-based treatment for anorexia nervosa. European Eating Disorders Review, 23(1), Golden, N. H., Katzman, D. K., Sawyer, S. M., Ornstein, R. M., Rome, E. S., Garber, A. K., Kreipe, R. E. (2015). Update on the medical management of eating disorders in adolescents. Journal of Adolescent Health, 56(4), Brown, R., & Ogden, J. (2004). Children s eating attitudes and behaviour: A study of the modelling and control theories of parental influence. Health Education Research, 19(3), Sibeoni, J., Orri, M., Colin, S., Valentin, M., Pradère, J., & Revah-levy, A. (2016). The lived experience of anorexia nervosa in adolescence, comparison of the points of view of adolescents, parents, and professionals: A metasynthesis. International Journal of Nursing Studies, 65, Beyond Blue. (2014). Eating disorders, anxiety and depression, 1 6. Retrieved from Bakker, R., Meijel, B. Van, Beukers, L., Ommen, J. Van, Meerwijk, E., & Elburg, A. Van. (2011). Recovery of normal body weight in adolescents with anorexia nervosa: The Nurses perspective on effective interventionsjcap. Journal of Child and Adolescent Psychiatric Nursing, 24(1), Coker, T. R., Zima, B. T., Murphy, J. M., Knapp, P., Richardson, L. P., & Edwall, G. (2014). Common and Costly Hospitalizations for Pediatric Mental Health Disorders. Pediatric, 133, Rienecke, R. D., Accurso, E. C., Lock, J., & Le Grange, D. (2015). Expressed Emotion, Family Functioning, and Treatment Outcome for Adolescents with Anorexia Nervosa. European Eating Disorders Review, 24, Whitney, J., Murray, J., Gavan, K. a Y., Todd, G., Whitaker, W., Ay, M., & Treasure, J. (2005). Experience of caring for someone with anorexia nervosa: qualitative study. British Journal of Psychiatry, 187, Rhind, C., Salerno, L., Hibbs, R., Micali, N., Schmidt, U., Gowers, S., Treasure, J. (2016). The Objective and Subjective Caregiving Burden and Caregiving Behaviours of Parents of Adolescents with Anorexia Nervosa. European Eating Disorders Review, 24(4), Svensson, E., Nilsson, K., Levi, R., & Suarez Carballeira, N. (2013). Parents experiences of having and caring for a child with an eating disorder. Eating Disorders, 21(5), D. Le Grange, E. C. Accurso, J. Lock, S. Agras, S. B. (2011). Early Weight Gain Predicts Outcome in Two Treatments for Adolescent Anorexia Nervosa. Int J Eat Disor, 4(164), Moskovich, A. A., Timko, C. A., Honeycutt, L. K., Zucker, N. L., Merwin, R. M., Moskovich, A. A., Zucker, N. L. (2016). Change in expressed emotion and treatment outcome in adolescent anorexia nervosa. Eating Disorders, 0(0), Bezance, J., & Holliday, J. (2014). Mothers experiences of home treatment for adolescents with anorexia nervosa: an interpretative phenomenological analysis. Eating Disorders, 22(5), Garber, A. K. (2014). R01-Research-Strategy. UCSF. Lock, J. (2010). Treatment of Adolescent Eating Disorders: Progress and Challenges. Minerva Psichiatrica, 51(3), Le Grange, D., Lock, J., Agras, W.S., Moye, A., Bryson, S., Kraemer, H. (2013) Moderators and mediators of remission in family-based treatment and adolescent focused therapy for anorexia nervosa. Behaviour Research and Therapy, 50(2): Andrea Garber. (2016). IRB Study Application 1.0. Gupta, S.K. (2011) Intention-to-treat concept: A review. Perspectives in Clinical Research, 2(3): McCormack, C., & McCann, E. (2015). Caring for an Adolescent with Anorexia Nervosa: Parent s Views and Experiences. Archives of Psychiatric Nursing, 29(3), Coomber, K., & King, R. M. (2012). Coping strategies and social support as predictors and mediators of eating disorder carer burden and psychological distress. Social Psychiatry and Psychiatric Epidemiology, 47(5),

16 Appendixes Materials we will build from scratch: Nutrition Education Modules for Therapists Teaching Preparedness Exam for Therapists 4 Nutrition Modules for FBT-N counseling sessions Pre- & Post- Nutrition Competency Exams for Parents