Highlights from #ICED2014: The FBT Debate

Drs. Le Grange and Strober
Drs. Le Grange and Strober

ICED 2014 in New York provided a wonderful opportunity to connect with colleagues from around the world who share a commitment to providing treatment to those suffering from eating disorders. Among the highlights for me were the well-attended, first-ever tweetUP and my official appointment as Board Director for Outreach of the Academy for Eating Disorders.

Among the workshops, I was very excited to attend A Comprehensive and Measured Critique and Discussion of Maudsley and Family Based Therapy: The Civilizing Influence of Rigorous and Impartial Debate.   In this workshop, UCLA Eating Disorders Program director Dr. Michael Strober, one of the more vocal critics of Maudsley Family Based Treatment (also known as FBT), went head to head with Dr. Daniel LeGrange, director of the University of Chicago’s Eating Disorder Program and one of the developers of FBT. As one of a handful of therapists in Los Angeles certified in FBT, I am highly aware of Dr. Strober’s criticisms of the treatment.

Dr. Strober introduced the packed-room debate by saying, “there will be no flowing of blood at the FBT debate.” Dr. LeGrange presented first and cited the empirical evidence for FBT, admitting “it is no panacea” as there are only 7 published controlled trials. He reported the “most compelling” study of FBT showed that 45% of those who received FBT fully remitted, versus only 20% of those who received Adolescent Focused Therapy. He noted that FBT is particularly helpful in rapid weight restoration and in a reduction of the need for hospitalization.

Dr. Strober countered by stating, “there is [only] a sprinkling of evidence in support of FBT.” He argued that the evidence for FBT was actually weak, with only 3 published comparative studies. He pointed out there was no statistically significant end of treatment outcome for FBT. Strober concluded that there is a lack of evidence to suggest FBT is the treatment of choice for all patients. He cautioned that the “glossy language” used by FBT’s proponents needs nuance: “The public discussion is the problem; well-trained clinicians have been accused of acting unethically by not recommending FBT.” Strober stated that his questions regarding FBT’s efficacy have led to hostile, finger-pointing treatment from others. “It’s not that ‪FBT lacks value but that [any critique or questioning of it is dismissed as unethical & unfounded]”. He conceded that FBT should not be dismissed: “I recommend it at times when the rationale is sound.” He joked, “I have been asked why I hate families; as far as I can tell the only family I hate is mine; I quite fancy the others.”

In his rebuttal, Le Grange agreed with Dr. Strober, “It concerns me too that FBT is being touted as the be-all-end-all.” However, he noted that it was still the approach that currently has the best evidence supporting its overall efficacy. LeGrange acknowledged “we are clutching at straws” to find effective treatments for eating disorders. “I agree we need to move forward, with much more rigor, to continue to evaluate the efficacy not just ‪ of FBT but also other ED treatments.”

In summary, there was more agreement than disagreement. Both experts acknowledged that while FBT has value, the research is still young. The audience encouraged them to write a paper together on the strengths and limitations of FBT, with the objective of depolarizing the eating disorder community.

For my part, in the outpatient setting in which I work, I will continue to offer FBT to adolescents with eating disorders and their families when the illness duration is under three years, when the adolescent is medically stable and cleared for outpatient treatment, and when the home environment is stable and the parents are committed to FBT. If early weight gain is not achieved, I always recommend a higher level of care.

I’m moving my office

On August 1, my office is moving to

4929 Wilshire Boulevard, Suite 245!

(Only one mile east of my old office)

office moving flyer_Aug2013

Since eating disorders are best addressed by a multidisciplinary approach, I am excited to be able to offer expanded services at this new and larger space.  I am pleased to announce my affiliation with Katherine Grubiak, RD, who will be working in my suite part-time.  Ms. Grubiak brings a wealth of experience with eating disorders in both adolescents and adults, and her approach is consistent with the latest evidence-based treatments.

Katherine Grubiak, RD/Biography

Katherine Grubiak is a Registered Dietitian with a focus on blending Western & Eastern philosophies regarding nutritional healing.  She graduated from the University of Texas at Austin and first pursued a career in public health surrounding herself with different cultures and a mission to honor all those seeking healthcare nutritional support. Continue reading “I’m moving my office”

Empirically Validated Treatments

Empirically Validated Treatments For Eating Disorders

Today’s Los Angeles Times contained an article which highlights Family Based Treatment and Cognitive Behavioral Treatment, two treatments I provide:

Today, doctors and therapists focus on a handful of treatments that have been validated by clinical studies. For teens with anorexia, the first-line treatment is something called family-based therapy, in which parents and siblings work with the patient at home to help restore normal eating habits, said Dr. James Lock, an adolescent psychiatrist at Stanford University who specializes in treating eating disorders. Treating patients at home instead of in a hospital setting is less disruptive to their lives and is thought to promote recovery.

The therapy cures about 40% of patients in three to six months, and another 40% to 50% improve but remain ill, studies have found. The remaining 10% stay the same or get worse.

Researchers are still investigating the best way to treat teens with bulimia. Evidence is mounting in favor of cognitive behavioral therapy, which involves helping individuals change their attitudes and thoughts about food and body image. Studies show that about 40% of people with bulimia will recover after three to six months and another 40% will improve but still struggle with the disease; 20% remain the same or get worse, according to a 2010 review in the journal Minerva Psychiatry.

Full article available here: