Table 12 Summary of key recommendations
From: Management of eating disorders for people with higher weight: clinical practice guideline
Recommendations for the management of people with eating disorders who are of higher weight | Level of evidence |
|---|---|
Management overview | |
All treatment should be provided in the context of interprofessional collaborative practice | C |
Psychological therapy for adults | |
Psychological treatment should be offered as first-line treatment approach for bulimia nervosa or binge-eating disorder (BED) | A |
Cognitive behaviour therapy (CBT) for an eating disorder either in standard form or therapist guided self-help should be considered as first-line treatment in adults with bulimia nervosa or BED | B |
Other psychological treatments with evidence such as interpersonal psychotherapy (IPT) and dialectical behaviour therapy (DBT) should be considered as second-line treatment options in adults with bulimia nervosa or BED | B |
Other feeding or eating disorder (OSFED), unspecified feeding or eating disorder (UFED) or subsyndromal eating disorders should be treated with treatment recommended for the most similar disorder | C |
Consider using therapies utilising non-dieting principles and interventions to reduce disordered eating | D |
Therapies with demonstrated efficacy for the treatment of anorexia nervosa* in general, that is cognitive behaviour therapy-enhanced (CBT-E), specialist supportive clinical management (SSCM), Maudsley model of anorexia nervosa treatment for adults (MANTRA) and focal psychodynamic therapy (FPT) should be considered as treatment options | D |
Psychological therapy for children and adolescents | |
Psychological treatment for an eating disorder should be offered as first-line treatment approach | A |
Family based treatment should be considered as first-line treatment for children and adolescents with bulimia nervosa and anorexia nervosa* | B |
Other psychological treatments with evidence such as adolescent focused therapy (AFT) and CBT for an eating disorder should be considered as second-line treatment options in children and adolescents with anorexia nervosa* (AFT, CBT) or with bulimia nervosa (CBT) | B |
Other psychological treatments with evidence such as CBT for an eating disorder should be considered as second-line treatment options in children and adolescents with bulimia nervosa | B |
Children and adolescents with higher weight should be offered a first line evidence-based treatment approach for eating disorders as those who do not have higher weight | C |
OSFED, UFED or subsyndromal eating disorders should be treated with treatment recommended for the most similar disorder | C |
Pharmacotherapy | |
Consider using psychotropic medications with evidence in the treatment of eating disorders | B |
Monitor for any non-prescribed use of medication in the context of an eating disorder | D |
Physical activity | |
Physical activity interventions should focus on physical activity for positive physical and mental health benefits and away from exercising for weight or shape change | C |
If compulsive exercise is present, referral to an exercise physiologist experienced in working with larger-bodied people and eating disorders populations is desirable | D |
Family and other interventions for adults, adolescents and children | |
Include families and other carers when indicated for anyone with an eating disorder | B |
Family psychoeducation around impacts of body and eating conversations should include modelling body image acceptance, weight stigma and a focus on health in recovery | D |
Nutritional and medical management | |
Nutritional/medical guidance should minimise language that can reinforce poor self-worth and contribute to worsening eating disorder behaviours | C |
Irrespective of body size, addressing malnutrition and poor diet quality is essential | C |