Guest editorial--A quiet revolution in the treatment of youth with eating disorders

Until recently, disordered eating behaviors and thinking were confronted directly. It was believed that disordered eating had to be brought under control as rapidly as possible, even if this meant using coercive methods. The belief was that the patients had lost their ability to make changes because of their illness and were in imminent danger medically. Indeed, a number of patients were helped with this approach. However, a significant number also found the experience traumatizing and unhelpful.

For the past 4 years, neither nasogastric tube refeeding and bed rest nor wheelchairs have been used in the Eating Disorders Program at BC’s Children’s Hospital. Starting within days of their hospitalization, all patients participate in an exercise program. Within a month, most patients serve their own meals and eat some of their other meals in the cafeteria. Patients gain weight at the same rate they did before with more coercive care. Both patient and family satisfaction with treatment have greatly increased, and no patient has been certified for treatment in the past 3 years. 

I do not believe that it is the patients who have changed, but rather our approach. 

The articles in this issue provide a theoretical framework for this new approach. The articles also provide information to help physicians manage medical complications, practical suggestions for establishing a therapeutic alliance with youth, advice for dealing with the strong feelings that can be aroused by intense treatment relationships, recommendations for working with family members, and specific strategies to use when intensive treatment, including hospitalization, is needed.

Working with youth and adults with eating disorders over the years has made me aware of the risk of letting the authority associated with scientific knowledge devalue the patient’s knowledge or silence the patient’s voice. A 1925 quote from a nurse, Adelaide Nutting, best summarizes these concerns for us: “We need to realize and affirm a view that ‘medicine’ is one of the most difficult of arts. Compassion may provide the motive but knowledge is our only working power. Perhaps, too, we need to remember that growth in our work must be preceded by ideas, and that conditions that suppress thought must therefore retard growth. Surely we will not be satisfied with merely perpetuating methods and traditions; surely we should be more and more involved in creating them.”

—Pierre Leichner, MD, FRCPC
Psychiatric Director, Eating Disorders Program, BC’s Children’s Hospital
Clinical Professor, Department of Psychiatry, UBC