1. Family Based Treatment NHS Lanarkshire CAMHS
Mary Graham, Specialist ED Dietitian, CAMHS

2. Overview What is FBT FBT: first line treatment Pre-FBT
Three phases of treatment
The role of the Dietitian in FBT

3. What is FBT?
The family working together to help the young person recover from Anorexia Nervosa
Focus on weight restoration
Parents take charge of eating initially
Some families may need to take time away from work/school

4. Background to FBT
Developed at the Maudsley Hospital in London in the 1980s
Refined at the University of Chicago and Stanford University
James Lock and Daniel Le Grange manualised FBT

5. The Model Theoretically agnostic Externalisation
Distinct roles for parents and siblings
Empowerment – family is a resource
Team approach
Therapist joins with family
Food is medicine, priority is weight restoration

6. FBT: first line treatment
NICE Guidance, May 2017
Consider FBT for all young people with AN
Typically sessions over 1 year
Psychoeducation re malnutrition and re-feeding

7. First Line Treatment for AN
Approximately 80% significantly improve and 50% achieve full remission when treated with FBT
Lock, J (2011). Evaluation of family treatment models for eating disorders. Current Opinion in Psychiatry, 24:

8. First Line Treatment for AN
CAMHS Matrix 2015
There is increasing evidence for family-based treatments of adolescent Anorexia Nervosa over individual treatments, particularly in long-term maintenance of treatment gains and notably low attrition rates – a common problem in ED trials14,36
14 Couturier, J., Kimber, M., & Szatmari, P (2013). Efficacy of family-based treatment for adolescents with eating disorders: A systematic review and meta-analysis. International Journal of Eating Disorders, 46(1), 3-11
36 Hay, P.P. (2013). A systematic review of evidence for psychological treatment in eating disorders: ( International Journal of Eating Disorders, 46(5),

9. Suitability for FBT – the patient
Most families are considered suitable for FBT
Most patients with AN are considered suitable for FBT

10. Pre-FBT Medical assessment and stabilisation as required
CAMHS assessment
Diagnosis of AN/EDNOS given
Dietetic assessment of re-feeding syndrome
Re-feeding issues to be resolved prior to FBT

11. Three Phases of FBT Phase 1 Phase 2 Phase 3
James Lock, MD, PhD
Three Phases of FBT
Parents in charge of weight restoration
Phase 1
(Sessions 1-10)
Parents hand control over eating back to the adolescent
Phase 2
(Sessions 11-16)
Discuss adolescent developmental issues
Phase 3
(Sessions 17-20)

12. Phase One Parents take control of weight restoration
5-10 sessions (usually paced weekly)
Designed to help parents do what nurses on re- feeding unit do at home
Aim to help parents disrupt AN
Includes family meal – one extra bite

13. Phase Two Patient eats without significant struggle
Parents report they feel empowered to manage illness
Assist parents in managing the ED and in navigating return of control
Transfer food/weight control to adolescent

14. Phase Three
Weight restored but some shape and weight concerns may remain
Focus on normal adolescent development
establish that patient is back on normal trajectory in all domains
Relapse plan

15. The Role of the Dietitian
The FBT manual encourages minimal Dietetic intervention
‘The therapist may say… “You know how to feed a starving child and you don’t need expert nutritional advice” in an attempt to bolster parent confidence’ (Lock & Le Grange, 2012, p. 89)
‘The therapist should leave most of the decisions as to how to accomplish weight restoration to the parents’ (Lock & Le Grange, 2012, pp )
In a poll of FBT therapists, only 15% agreed with the FBT model of not including a dietitian
(Couturier, Kimber, Jack, Niccols, Van Blyderveen, & McVey, 2013)

16. The Role of the Dietitian
Establishing weight history
Managing re-feeding risk pre-FBT
Psychoeducation regarding starvation and Anorexia Nervosa
Education re;
nutritional rehabilitation
growth and development
age and stage

17. The Role of the Dietitian

18. The Role of the Dietitian
Usually involved at the start of treatment for 1-3 sessions
Consult with colleagues throughout treatment
Often brought back later in treatment
Involved where there are complicating factors:
Diabetes
Vegetarian/vegan
Those very involved in sport

19. The Role of the Dietitian

20. The Role of the Dietitian

21. When is the Patient Well
Physically back to normal
Menstruation
Temperature
Energy levels
Attitude to food has returned to normal, conversations are relaxed
They can have pizza and Haribo nights!