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Girls with anorexia may do fine with day treatment

By Andrew M. Seaman

NEW YORK (Reuters Health) - Adolescent girls with anorexia nervosa may be able to safely participate in outpatient treatment, according to a new study from Germany.

While outpatient treatment for anorexia nervosa is not common in many countries, researchers found that adolescent girls who took part in a day-treatment program didn't do any worse than those who stayed at a hospital for months of therapy.

"I have quite a lot of experience with adolescent patients and I've been working with anorexic patients for about 20 years," Dr. Beate Herpertz-Dahlmann told Reuters Health. "When I saw them when they were a little bit older, they would tell me they lost their youth by being in the hospital so long."

Herpertz-Dahlmann is the study's lead author and director and chair of the Department of Child and Adolescent Psychiatry at RWTH Aachen University in Germany.

Anorexia nervosa is an intense fear of gaining weight that results in self-starvation and the loss of an unhealthy amount of weight.

In many European countries, treatment for moderate and severe anorexia nervosa requires a lengthy stay in a hospital. In the U.S. inpatient treatment typically lasts about a month and is followed by some type of outpatient treatment that's matched to the individual's degree of illness.

The researchers write in The Lancet that outpatient treatment has been criticized because of increasing rates of people returning to hospitals and unsatisfactory weight gain. But inpatient treatment has also been criticized for high relapse rates and return hospital stays. Inpatient treatment is also more expensive, they write.

For the new study, they recruited 172 girls between 11 and 18 years old, who were seeking treatment for moderate to severe anorexia nervosa at six hospitals in Germany between February 2007 and April 2010.

On average, the girls weighed less than 98 percent of the girls their age at the start of the study.

After three weeks of treatment in a hospital, the researchers then randomly assigned 87 to receive treatment as a so-called day patient. The rest remained at the hospital for inpatient treatment.

In both cases, the participants received the same therapies for anorexia nervosa. The only difference was that day patients were allowed to go home at night instead of living at the hospital.

The participants stayed in therapy until they maintained a target weight for two weeks. It took about 15 weeks for the inpatients and 17 weeks for the day patients to reach that point.

After 12 months, the researchers found that the weight of the girls in each group had improved. The participants at that point weighed less than 83 percent of peers in their age group.

In addition, the day patients performed better than inpatients on measures of mental health, which Herpertz-Dahlmann said is probably a result of the girls being allowed to live in their homes with their families.

The day patient program also cost about 20 percent less than the inpatient program.

"This treatment is cheaper than the other one and I think it is not that bad for the patients," Herpertz-Dahlmann said.

Kamryn Eddy cautioned that the cost analysis in the study may differ in the U.S., where inpatient treatment typically costs much more.

Eddy was not involved in the new study but she is co-director of the Eating Disorders Clinical and Research Program at Massachusetts General Hospital and assistant professor of psychology at Harvard Medical School in Boston.

She also said people shouldn't generalize the findings of the study to all forms of outpatient anorexia nervosa treatment.

"There's a wide range of inpatient and residential programs globally and in the U.S.," Eddy said. "Their focuses are a little different. So it's important we don't generalize the results from the study."

Dr. Evelyn Attia of Columbia University Medical Center and Weill Cornell Medical College in New York also said the intensity and duration of the treatment used in the study would not be available to many Americans through their insurance.

"I think the important take-home message from this study is that a lot of treatment effects can be delivered in a somewhat less structured and yet more economically efficient setting," Attia, who wrote an accompanying commentary, said.

But both Attia and Eddy also pointed out that the improvements observed among both groups in the new study were not so great.

"The finding from this study should mobilize all of us to redouble our efforts to continue to identify treatment that will work for these patients," Eddy said.

SOURCE: http://bit.ly/1fZZRY7 and http://bit.ly/1g0aoT5 The Lancet, online January 17, 2014.

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