Background: Higher level of care (HLOC) treatment for eating disorders (EDs) is sometimes necessary, but research is lacking on whether HLOCs are actually more effective than less structured, lower levels of care. The purpose of the current study was to compare outcomes for patients with EDs at low weights who entered 24/7 care (inpatient and residential) to those entering non-24/7 care (partial hospitalization programming and intensive outpatient programming).
Methods: Participants were 1104 adults with body mass indices (BMI) between 14 and 17 receiving treatment for an ED at a large multisite treatment facility offering HLOCs between August 2019 and February 2024. The Eating Disorder Examination-Questionnaire (EDE-Q), assessing ED psychopathology, was completed at admission and discharge. Weight was taken throughout treatment.
Results: In unadjusted analyses, there was a significant difference between those receiving 24/7 care (3.79) versus non-24/7 care (2.17) in BMI increase during treatment. In adjusted analyses controlling for ED diagnosis, length of stay, and admission BMI, results remained the same. Weight gain per week was significantly greater for patients in 24/7 care. Changes in ED psychopathology, as measured by the EDE-Q, were not significantly associated with 24/7 care.
Conclusions: The current study suggests that patients with EDs at low BMIs gain more weight at a faster rate when participating in 24/7 care compared to non-24/7 care. Entering treatment at an appropriate level may result in shorter overall lengths of stay and may increase the chances of a positive long-term outcome.
Keywords: Eating disorders; Inpatient; Intensive outpatient; Outcomes; Partial hospitalization; Residential; Weight gain.
Patients with eating disorders, particularly anorexia nervosa, are known to be ambivalent about receiving treatment. Because of this, they may be reluctant to enter higher level of care treatment, such as inpatient or residential care (24/7 care), because of the highly structured environment and the inability to engage in eating disordered behavior. Inpatient or residential treatment may be the best for them from a clinical standpoint, but there has been no evidence to show that 24/7 care is actually more effective than lower levels of treatment such as partial hospitalization or intensive outpatient programs (non-24/7 care). This study examined outcomes for 1104 adults with body mass indices (BMI) between 14 and 17, representing a fairly severe presentation, receiving either 24/7 or non-24/7 care for an eating disorder. We found that those receiving 24/7 care gained more weight than those in non-24/7 care (3.79 increase in BMI versus 2.17), and gained weight faster. Rate of weight gain has been found to be a significant predictor of good outcome after one year. There were no differences between groups on the Eating Disorder Examination-Questionnaire Global Score or subscales from admission to discharge. The findings from this study could be used as a guide for patients when helping them to make decisions about which level of care is most appropriate.
© 2024. The Author(s).