Hellner Megan, Steinberg Dori, Baker Jessica H, Blanton Camilla
Equip Health, Carlsbad, CA, United States.
JMIR Res Protoc. 2023 Jan 26;12:e41837. doi: 10.2196/41837.
Eating disorders (EDs) affect 9% of the United States population, and anorexia nervosa (AN), specifically, has the second highest mortality rate of all psychiatric disorders. Yet, only 20% are able to access treatment. Access to care issues include long waitlists, lack of trained specialists, financial, and geographic barriers, all of which highlight the need for effective telehealth interventions. Family-based therapy (FBT) is a first-line treatment for adolescents and young adults with EDs, and weight gain early in treatment is considered a primary predictor of success with FBT. However, nutrition requirements for patients with EDs are uniquely complex. A variety of dietary interventions for guiding the renourishment process are used in practice, but empirical data on the effectiveness and acceptability of the various interventions are sparse. The significance of nutritional restoration and issues with access to first-line treatments underscore the need for further research exploring virtually delivered dietary interventions.
Our objective is to compare the effectiveness and acceptability of 2 digitally delivered dietary interventions frequently used in eating disorder treatment settings: (1) calorie-based meal plans and (2) the Plate-by-Plate approach. Specifically, we will explore any potential differences in weight restoration achieved over 8 weeks of treatment as a primary measure of effectiveness, as well as additional treatment outcomes (ED symptoms, anxiety, depression, caregiver burden, and perceived effectiveness and acceptability for both caregivers and clinicians).
Patients (N=100) with either AN or avoidant restrictive food intake disorders (ARFID) aged 6-24 years seeking treatment at a nationwide virtual eating disorder treatment program, were enrolled between May and August 2022. Upon admission, patients were randomly assigned to receive either the calorie-based intervention or Plate-by-Plate approach from their registered dietitian, all of whom have received training as study interventionists. While we were primarily interested in responses during the first 8 weeks of treatment, patients will be followed for up to 12 months. Descriptive statistics were used to describe patient characteristics and demographics. Weight changes and other treatment outcomes between groups will be compared using generalized linear models. Semistructured caregiver and clinician interview transcripts will undergo qualitative analysis.
Enrollment ran from March to August 2022, and we anticipate completion of data collection by November 2022. Analyses will be completed in January 2023.
This study contributes to existing FBT literature by thoroughly exploring the acceptability of dietary interventions and their influence on weight restoration, an area in which research is sparse.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/41837.
饮食失调（EDs）影响着9%的美国人口，其中神经性厌食症（AN）在所有精神疾病中的死亡率排名第二。然而，只有20%的患者能够获得治疗。获得护理的问题包括漫长的等候名单、缺乏训练有素的专家、经济和地理障碍，所有这些都凸显了有效远程医疗干预措施的必要性。基于家庭的治疗（FBT）是青少年和年轻成人饮食失调的一线治疗方法，治疗早期体重增加被认为是FBT成功的主要预测指标。然而，饮食失调患者的营养需求极为复杂。实践中使用了多种饮食干预措施来指导重新营养的过程，但关于各种干预措施有效性和可接受性的实证数据却很稀少。营养恢复的重要性以及获得一线治疗的问题强调了进一步研究虚拟提供的饮食干预措施的必要性。
我们的目的是比较饮食失调治疗环境中常用的两种数字提供的饮食干预措施的有效性和可接受性：（1）基于卡路里的饮食计划和（2）逐盘法。具体而言，我们将探讨在8周治疗期间体重恢复方面的任何潜在差异，作为有效性的主要衡量指标，以及其他治疗结果（饮食失调症状、焦虑、抑郁、照顾者负担以及照顾者和临床医生对有效性和可接受性的感知）。
2022年5月至8月期间，在全国范围内的虚拟饮食失调治疗项目中寻求治疗的6至24岁患有AN或回避性限制性食物摄入障碍（ARFID）的患者（N = 100）入组。入院时，患者被随机分配接受注册营养师提供的基于卡路里的干预措施或逐盘法，所有注册营养师均接受过作为研究干预者的培训。虽然我们主要关注治疗前8周的反应，但患者将被随访长达12个月。描述性统计用于描述患者特征和人口统计学。将使用广义线性模型比较两组之间的体重变化和其他治疗结果。半结构化照顾者和临床医生访谈记录将进行定性分析。
入组时间为2022年3月至8月，我们预计2022年11月完成数据收集。分析将于2023年1月完成。
本研究通过全面探索饮食干预措施的可接受性及其对体重恢复的影响，为现有的FBT文献做出了贡献，而这一领域的研究较为稀少。
国际注册报告标识符（IRRID）：DERR1-10.2196/41837
