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New Study Reveals Long-Term Outcomes in Eating Disorders

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A new comprehensive study has shed light on the long-term outcomes for individuals suffering from eating disorders (EDs). Conducted by a team of international researchers, the study provides a systematic review, meta-analysis, and multivariable meta-regression analysis of 415 studies from around the world.

This expansive research offers valuable insights into recovery, chronicity, and mortality rates among those diagnosed with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other specified feeding and eating disorders (OSFED). The findings were published in the journal World Psychiatry.

The study revealed that, across all EDs, the overall recovery rate was 46%. Recovery rates increased over time, from 42% at less than two years to 67% at ten or more years of follow-up. Chronicity, defined as the continued presence of an ED diagnosis, was found in 25% of patients, with the highest rates within the first four years of follow-up, subsequently decreasing to 18% at ten or more years.

Distinct differences were observed between the various types of EDs. Recovery rates for binge eating were highest in OSFED (83%) and lowest in AN (31%). Similarly, abnormal weight recovery was highest in OSFED (69%) and lowest in BED (17%). These findings highlight the varied nature of recovery and the necessity for tailored treatment approaches for each specific disorder.

Mortality rates across all EDs were 0.4%, with significant variations depending on the type of ED. Observational studies indicated a mortality rate of 5.2 deaths per 1,000 person-years, with the highest rates in mixed EDs and the lowest in BN. Hospitalisation occurred in 26% of patients, with the highest rates in AN (32%) and the lowest in BN (4%).

The study also examined diagnostic migration, where patients initially diagnosed with one type of ED later met the criteria for another. For instance, 8% of patients with AN migrated to BN, while 19% of those with BED moved to OSFED. These shifts underline the dynamic and often overlapping nature of ED diagnoses, necessitating flexible and adaptive treatment strategies.

Children and adolescents had significantly higher recovery rates and lower chronicity and mortality rates than adults. This suggests the critical importance of early intervention in improving long-term outcomes for ED patients. Nutritional interventions emerged as the primary treatment component associated with the highest recovery rates across all EDs. Cognitive-behavioural therapy (CBT) and family-based therapy were particularly effective for AN, while self-help, CBT, and dialectical behaviour therapy (DBT) were beneficial for BN. For BED, pharmacotherapy combined with CBT and DBT showed the most promise.

The study’s findings have significant implications for clinical practice. Early identification and treatment, particularly in children and adolescents, are crucial for improving outcomes and preventing chronicity and mortality. The research supports a multi-faceted treatment approach, combining nutritional, psychological, and pharmacological interventions tailored to each specific ED.

The study also highlights the need for long-term observational studies to better understand the trajectories of EDs and to refine treatment approaches further. There is also a call for international consensus on defining recovery, improvement, chronicity, and relapse in ED populations to standardise research and clinical practices.

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