Harriet Brown once made a near science of packing the most calories possible into everything her daughter ate. A Häagen-Dazs coffee ice-cream milkshake made the way Kitty had always loved it crammed 690 calories into one small glass. That it took two hours of coaxing, pleading, and cajoling to make Kitty swallow it didn't matter. Long after the shake warmed to room temperature, Brown sat with Kitty, her voice soothing and straw in hand, until sip by sip, tear by tear, the milkshake was gone. Her anorexic daughter's life depended on it. She had all but stopped eating and had dropped to 71 pounds, more than 25 pounds below her healthy weight.
Brown, author of Brave Girl Eating: A Family's Struggle With Anorexia, and her husband nursed their 14-year-old daughter back to physical and emotional health, relying on an unconventional method that has been gaining traction. Named for the London hospital where it was devised in the 1980s specifically to treat children with eating disorders, "the Maudsley approach"—also called family-based therapy—emphasizes recovery over cause and care provided by parents, not by doctors. The first priority in the Maudsley program is to feed the child. Examining the issues behind the child's disorder can wait.
According to a report released today in the Archives of General Psychiatry, a family-based treatment approach was found to be effective at the 12-month mark for 42 percent of adolescent participants, meaning their weight was at least 95 percent of normal and they achieved at least an average score on an assessment of eating disorder symptoms. Standard therapy—inpatient care that addresses healthy eating and the psychological underpinnings of the disorder, followed by continued counseling after the child is discharged—was only 23 percent effective. Parents are mere bystanders, says Brown, instructed not to pressure their child to eat or, for that matter, not to talk about food at all to avoid becoming the "food police." And they are viewed as likely to be part of the problem. "They're told to butt out," Brown writes. Conventional therapy holds that eating disorders are not about eating anyway, but about control.
That is why getting at the psychology of the problem is the primary goal of conventional therapy, says Daniel Le Grange, director of the Eating Disorders Program at the University of Chicago Medical Center. But he maintains that it accomplishes little. "There's no evidence that understanding what causes an eating disorder helps the adolescent recover," he says. "But we know that if you give the child medicine—in this case it's food—she has a much better chance of recovery." The reference to "she" may be inadvertent, but it is a fact that some 90 percent of children with eating disorders are girls.
The Maudsley regimen moves through three phases of 6 to 12 months each, depending on the severity of the disorder. Children are hospitalized only if they need medical care. After that, says Le Grange, repeat visits often can be prevented if parents take action immediately and fully embrace the Maudsley approach. In phase one, parents commit to feeding their child three meals and three snacks every day, even if that entails sitting at the table hour after hour to put on pounds. Phase two gradually transfers control to the child after a reasonably healthy weight is attained and she eats without rebelling. Phase three finally introduces counseling, to address the psychological issues that contributed to the disorder.
The program appealed to Brown. "Sending Kitty away to residential treatment just didn't seem right," she says. "I did the research and found the recovery rate for a lot of these hospitals wasn't very good. It seems like they're a bit of a revolving door--people go, they get better, they come back out and they get worse." Kitty would benefit most from a program that kept her at home, Brown thought. "When you send someone away--whether it be for alcoholism or anorexia—they have to come back. You could be very successful in a residential place, but you're always going to have to make the adjustment upon return."
Updated on 10/04/10: This article, originally published on September 16, 2010, has been updated to include the most recent research on family-based therapy for eating disorders.