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Early Response to Family-Based Treatment for Adolescent Anorexia Nervosa
Peter M. Doyle, PhD1* Daniel Le Grange, PhD1 Katharine Loeb, PhD2,3 Angela Celio Doyle, PhD1 Ross D. Crosby, PhD4,5
ABSTRACT Objective: The purpose of this study was to determine if early weight gain predicted remission at the end of treatment in a clinic sample of adolescents with anorexia nervosa (AN).Method: Sixty five adolescents with AN (mean age 5 14.9 years, SD 5 2.1), from two sites (Chicago n 5 45; Columbia n 5 20) received a course of manualized family-based treatment (FBT). Response to treatment was assessed using percent ideal body weight (IBW) with remission defined as having achieved 95% IBW at end of treatment (Session 20). Results: Receiver operating characteristic analyses showedthat a gain of at least 2.88% in ideal body weight by Session 4 best predicted remission at end of treatment (AUC 5 0.674; p 5 0.024). Discussion: Results suggest that adolescents with AN, receiving FBT, who do not show early weight gain are unlikely C to remit at end of treatment. V 2009 by Wiley Periodicals, Inc. Keywords: adolescent anorexia nervosa; family-based treatment; early treatmentresponse; receiver operating characteristic curves (Int J Eat Disord 2010; 43:659–662)

It has been suggested that eating disorder treatment research should work to disseminate information regarding the factors that influence response, rather than only reporting on the overall efficacy or effectiveness of a particular treatment.1 This is perhaps most relevant in the treatment of anorexianervosa (AN), where identification of responders and non-responders to treatment is made more urgent by the myriad medical complications and relatively high mortality rates associated with the disorder.2 Treatment outcome studies for AN

Accepted 25 August 2009 Work on this paper was supported in part by grants from the NIMH (R01MH070620, PI: le Grange) and the NIH (K23MH074506, PI: Loeb).*Correspondence to: Peter M. Doyle, Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, 5841 S Maryland Ave, MC 3077, Chicago, Illinois 60637. E-mail: pdoyle@yoda.bsd.uchicago.edu 1 Department of Psychiatry and Behavioral Neuroscience, The University of Chicago, Chicago, Illinois 2 School of Psychology, Fairleigh Dickinson University, Teaneck, New Jersey 3 Department ofPsychiatry, Mount Sinai School of Medicine, New York, New York 4 Neuropsychiatric Research Institute, Fargo, North Dakota 5 Department of Clinical Neuroscience, University of North Dakota School of Medicine and Health Sciences, Fargo, North Dakota Published online 8 October 2009 in Wiley Online Library (wileyonlinelibrary.com). DOI: 10.1002/eat.20764 C V 2009 Wiley Periodicals, Inc.

have focused onmany possible factors that predict outcome. However, few published reports have provided meaningful information on treatment progress before the end of a treatment trial. Investigation of weight gain trajectory in adult patients with AN undergoing inpatient treatment has demonstrated that weight trajectory at Week 3 and Week 4 of the inpatient stay can accurately classify a majority of patients asresponders or non-responders to treatment.3 Early response to treatment has also been shown to predict outcome in adults with binge eating disorder (BED)4,5 and bulimia nervosa (BN),6,7 as well as adolescents with BN.8 However, less is known about how early response may predict outcome in adolescents with AN. In the only published report specifically investigating early response to outpatienttreatment as a predictor of outcome in adolescent AN, Lock and colleagues9 found that weight gain by Session 2, 9, or 10 is predictive of positive outcome. These data were obtained in a randomized controlled trial (RCT) using family-based treatment for adolescent anorexia nervosa (FBT-AN). With the stringent inclusion criteria found in an RCT, however, the empirical question remains as to whether...