Family-Based Treatment for Anorexia Nervosa Symptoms in High-Risk Youth: A Partially-Randomized Preference-Design Study

Katharine L Loeb, Ruth Striegel Weissman, Sue Marcus, Cassandra Pattanayak, Lisa Hail, Kelly C Kung, Diana Schron, Nancy Zucker, Daniel Le Grange, James Lock, Jeffrey H Newcorn, C Barr Taylor, B Timothy Walsh, Katharine L Loeb, Ruth Striegel Weissman, Sue Marcus, Cassandra Pattanayak, Lisa Hail, Kelly C Kung, Diana Schron, Nancy Zucker, Daniel Le Grange, James Lock, Jeffrey H Newcorn, C Barr Taylor, B Timothy Walsh

Abstract

This pilot study adapted family-based treatment (FBT) for youth with potentially prodromal anorexia nervosa (AN). Fifty-nine youth with clinically significant AN symptom constellations, but who never met full Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.) (DSM-IV) criteria for AN, were enrolled in a partially randomized preference design study. Participants were offered randomization to FBT or supportive psychotherapy (SPT); those who declined to be randomized because of a strong treatment preference were entered into a parallel, non-randomized self-selected intervention study. Without accessing outcome data, an observational analysis with three diagnostic subclasses was designed based on AN symptom severity profiles, combining randomized and non-randomized participants, such that participants receiving FBT and SPT within each subclass were similar on key baseline characteristics. Outcomes of this pilot study were explored by calculating effect sizes for end-of-treatment values within each subclass, and also with a longitudinal mixed effect model that accounted for subclass. Weight trajectory was measured by percent expected body weight. Psychological outcomes were fear of weight gain, feeling fat, importance of weight, and importance of shape. Results show that the pattern of symptom observations over time was dependent on subclass of SAN (least symptomatic, moderately symptomatic, or most symptomatic) and on the target outcome variable category (weight or psychological). Results from this study, which should be considered in the context of the small sample sizes overall and within groups, can generate hypotheses for future, larger research trials on early treatment strategies. Feasibility findings illustrate how the innovative partially randomized preference design has potential broader application for AN intervention research.

Clinical trial registration: ClinicalTrials.gov, identifier NCT00418977.

Keywords: anorexia nervosa; early identification; early intervention; family-based treatment; partially-randomized preference design.

Copyright © 2020 Loeb, Weissman, Marcus, Pattanayak, Hail, Kung, Schron, Zucker, Le Grange, Lock, Newcorn, Taylor and Walsh.

Figures

Figure 1
Figure 1
Participant flow chart following Consolidated Standards of Reporting Trials guidelines for family-based treatment (FBT) and supportive psychotherapy (SPT) conditions in the randomized and non-randomized study arms.
Figure 2
Figure 2
Raw means for percent expected body weight (EBW) outcome, by subclass. Figures of time series for psychological outcomes are not shown because psychological outcomes were measured at only two time points. Lines are shaded to reflect the number of participants in each group, and at each time point within each group, with darker shading indicating greater numbers.

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