Introduction
My name is Anna Lutz, I am an RD and co-owner of Lutz, Alexander & Associates Nutrition Therapy, a private practice in North Carolina. I work with an amazing team of eating disorder specialized dietitians, providing nutrition therapy for eating disorders and co-occurring conditions and clinical supervision. I am also the co-creator of Sunny Side Up Nutrition, a blog and podcast to support parents in feeding their children. I specialize in eating disorders, family based treatment-informed care and family feeding. I am passionate about keeping diet culture out of parenting and supporting parents to make food simple and stress-free.
What is Family Based Treatment?
Family Based Treatment (FBT) (formerly known as the Maudsley Method) is an evidence-based outpatient treatment for eating disorders in children and adolescents. In the early 2000’s, research conducted by James Locke and Daniel LeGrange showed that FBT was an effective model of treatment for children and adolescents with eating disorders.
Why was FBT developed?
At the time, the only option for treatment of severe eating disorders was inpatient and residential care. This was often disruptive to the family and outcomes were not always positive. Sadly, parents were often told they were part of the problem and were not included in treatment. A key tenant of FBT is that parents are empowered to help their child recover.
What type of patient is FBT suitable for?
Family based treatment is manualized and as it is written is not always possible for all families. It requires caregivers to be in charge of their child’s food and be present at all meals and snacks, which isn’t possible for many working or single parents. Also, there may be situations with trauma or abuse that FBT is not appropriate care for. If there is a refeeding risk, a patient needs to be closely medically monitored or inpatient care may be the safer option.
Interestingly, manualized FBT does not include the role of the dietitian on the treatment team. So, dietitians nowadays practice “FBT-informed” care. The research of FBT has greatly influenced eating disorder care, even when manualized FBT is not possible. We have learned from FBT that parents and family members need to be included in eating disorder treatment as much as possible. In my practice, this may look like empowering the family member to be “in charge” of meals and snacks and refeeding their child or it may be including parents and family members in other ways as much as possible, regardless of the patient’s age.
What success and drawbacks come with FBT?
Nutrition is imperative for the brain to heal. It is amazing the positive changes that can take place when an individual is more nourished, as work in therapy can be more effective with a nourished brain. I have seen many times that when the parents “take over” the food, the child/adolescent is able to heal, rather than expecting the person with the eating disorder to change their eating. A metaphor that is often used is instead of teaching a person that is drowning how to swim, we need to pull them out of the water. Putting the parents in charge of the patient’s food is pulling the drowning child out of the water. The drawbacks are that it can be very challenging and exhausting for the parents and can put immense strain on the parent-child relationship. Although a part of FBT is externalizing the eating disorder from the child, the parents have to daily combat the illness each time they feed their child.
Give us an example of how you would use an FBT approach.
When I do an assessment for a child or young teen, one of my jobs is to determine what level of care is appropriate for the patient. Level of care is determined by many factors including motivation, severity of behaviors and medical stability. If a child or young teen meets the criteria of residential care, I would suggest to the family that with their PCP’s oversight, FBT is an option. There is research that shows if weight restoration is needed, if a patient gains 4 pounds in 4 weeks they are likely to do well with FBT.
Often, for a teen whose eating disorder is not as severe and residential care is not warranted, we are still including the family in the care as much as possible.
What are some resources available to learn more about FBT?
I recommend the resources that EDRDPro has about FBT, including their FBT course. I learned a lot about FBT from clinical supervision and working with therapists who were trained in manualized FBT care. I also recommend the book How to Nourish Your Child Through an Eating Disorder by Crosbie and Sterling.
