Results from the implementation of eating disorder treatment in primary care

A new therapy for eating disorders (EDs) in primary healthcare improves treatment accessibility. Because untreated EDs relates to complex comorbidity, this may ease the stress on health services.

Background: Prevalence of eating disorders (EDs) has increased, but the number offered treatment is limited due to low ED-literacy among health personnel, high barriers to treatment seeking behavior, and a limited capacity in specialized healthcare services. The suffering and consequences for patients with ED are exacerbated by a high rate of mental and physical comorbidity if the ED is left untreated, which further increases the stress on public healthcare services. In a randomized controlled trial (RCT) Physical Exercise and Dietary Therapy (PED-t) was equivalent to cognitive behavior therapy in treating EDs, which is an important finding considering the need for scalable therapies that can be delivered with minimal barriers. The aim of the current study was to investigate the acceptability and effectiveness of PED-t in a naturalistic context within primary healthcare service.

Methods: Four therapists (3 exercise physiologists and a dietitian) at an “exercise referral center” (ERC) organized in municipal health service in Norway were trained to recruit and screen persons with bulimia nervosa or binge-eating disorder, and to deliver the PED-t. The therapy consists of 20 therapy sessions carried out in groups of 8-10 patients of same gender, with therapy consisting of 60 min resistance training and 60 min dietary therapy. Patients’ expectation to and experiences from treatment were explored by semi structured interviews and thematic analyses. Changes in symptom severity of the eating disorder (Eating disorder examination questionnaire, EDE-q), depression (Beck Depression inventory, BDI), satisfaction with Life (SWLS), and compulsive exercise (Compulsive Exercise Test) were explored by questionnaires pre- and post-treatment.

Results: 20 women qualified for, and 16 completed treatment. Preliminary analyses from interviews highlight a patient group that have suffered for years; not being identified or taken seriously by their GP, and that PED-t emerged as solution to a long-required need. The ERC was reported to have high credibility, and experiences of professionalism were positive. EDE-q and binge-eating were significantly reduced, and symptoms of depression improved. In total 56% of the treatment completers were in remission after therapy.

Conclusions: The PED-t and ERC appear as an acceptable and effective combination of therapy and arena for treatment delivery. Remission rate replicated the RCT-finding and matches results from psychotherapy. There is a need to replicate these findings with larger and more diverse patient groups and more ERC’s involved. These findings point to a potential to make ED-treatment more accessible, and to prevent a complex health burden in these patients, which typically causes a high demand for health services.