Pioneering study will compare two anorexia therapies

Youths between ages 12 and 18 are needed for the largest trial ever of two anorexia treatments

JamesLock

Spotting someone who’s dangerously underweight is relatively easy. Knowing what to do about it is another matter, especially if that someone is a child. Because there have been few controlled comparisons of treatment options for anorexia nervosa, even close family members and physicians can be baffled about how best to intervene.

That may be about to change. A researcher at Lucile Packard Children’s Hospital is looking for volunteers to compare the effectiveness of two very different psychological treatments for the life-threatening disorder. The first attempts to address the reasons behind a patient’s reluctance to eat, while the second concentrates strictly on getting the patient to eat more and exercise less.

“These two treatments approach the same disorder in diametrically opposite manners,” said child psychiatrist James Lock, MD, PhD. “They are very different strategies and proponents of each could debate each other endlessly, so we need a controlled study to compare outcomes.”

Lock, who co-directs the Comprehensive Eating Disorders Program at the hospital, recently received a $2 million grant from the National Institutes of Health to conduct the study, which will be done in collaboration with researchers at the University of Chicago. Sixty patients will enroll at each site, making it the largest controlled study ever of anorexia nervosa treatments for adolescents.

Although about one in 200 adolescents in this country struggles with anorexia nervosa, the disorder is notoriously difficult to combat.

“It’s hard to find an effective treatment when you’re working with a young person enmeshed in family, school and a newly developing social life,” said Lock, who is also an associate professor of psychiatry and behavioral sciences. “Additionally, even though this is a very serious medical condition, there is usually very little urgency on the part of the patient to acknowledge the problem or seek out treatment. Parents of kids with eating disorders are also less likely to want to stand up and demand research funding, perhaps because they are often told that they cause their child’s condition.”

Teens with anorexia nervosa typically have trouble asserting themselves and developing an independent sense of their own views and wishes. Anorexia is a way of coping with these challenges, allowing adolescents to feel focused and productive while distracting them from their other problems.

In the study, patients will be randomly assigned to one of two groups that will undergo very different therapeutic treatments. The first works directly with patients to focus on what some physicians believe is the root cause of the disorder. It strives to teach adolescents how to combat the negative thinking associated with their reluctance to eat by helping them to become more aware of their feelings and more assertive and confident.

“In this treatment parents identify ways in which they can support these processes in their child, without interfering with eating decisions, confidence and mastery over herself,” said Lock.

A clinical trial conducted in 1999 found that this “individual-based treatment” was effective in about two-thirds of patients. It is the most common form of treatment for the disorder in the United States.

The second approach tackles the physical issues of anorexia head-on, without assuming an underlying psychological cause. Parents are put in charge of re-feeding their children – taking control of their eating in an effort to break the downward spiral of food refusal, overexercise and weight preoccupation. This “family based” approach deals only with the symptoms of anorexia nervosa and its related health effects. It rejects the idea that a fundamental psychological problem must exist with the child or the family.

“The notion is that if you are able to sufficiently disrupt the anorexia behaviors for long enough, you can then gradually turn control back over to the child,” said Lock. “The focus of the treatment is on eating, helping parents be successful, and keeping everyone from losing their wits.”

First studied at the Maudsley Hospital in London, this approach seems to be equally successful as the individual-based treatment. However, the two methods have never been directly compared in a large study.

Prospective participants can be boys or girls between the ages of 12 and 18 with a diagnosis of anorexia nervosa. Although they must be medically stable, participants’ weight must be less than 85 percent of the ideal body weight for their height or they must have a body mass index of below 17.5. They must speak English and cannot currently be substance dependent. Participants in each group will receive about 20 hours of treatment at the hospital free of charge. They will be followed during the yearlong treatment and for one subsequent year. To obtain more information or to volunteer, contact Judy Beenhakker at 723-7885.