Canadian practice guidelines for the treatment of children and adolescents with eating disorders
Canadian eating disorder guideline group… · 2020 · Canada
Source and licence
- Authors
- Jennifer Couturier, Leanna Isserlin, Mark Norris et al.
- Title
- Canadian practice guidelines for the treatment of children and adolescents with eating disorders
- Journal
- Journal of Eating Disorders, 2020
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC6995106
Licence statement of the original publication
Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Medications that are not recommended
- Selective Norepinephrine Reuptake Inhibitors – no evidence.
- Mood Stabilizers - no evidence.
- Buproprion - not recommended for use in eating disorders, due to the elevated risks of seizures in this population.
Care within an inpatient treatment environment
- Inpatient treatment may promote weight restoration regardless of model of care provided, but requires more study to determine the critical treatment elements related to weight restoration.
- Cognitive Behavioural Therapy (CBT) and family-based inpatient treatment may lead to improvement in eating disorder symptoms.
- Inpatient treatment combined with day treatment follow-up may be helpful in weight restoration, symptom change and motivation for children and adolescents with Anorexia Nervosa.
- Adjuncts to inpatient treatment, such as non-selective menus, meal support, cognitive remediation and bright light therapy may be helpful for certain children and adolescents with eating disorders.
- Inpatient treatment alone or in combination with day treatment for Bulimia Nervosa and Avoidant/Restrictive Food Intake Disorder requires more study.
- Peer support during inpatient treatment by other parents would be an asset.
Preparing for discharge from inpatient care
- Any transition in care is a period of high risk for deterioration and adverse events. Bridging these transitions with added supports is needed to prevent young people from suffering from adverse outcomes due to disruptions in continuity of care.
- Parental support is needed in order to prepare parents for discharge and the treatment that follows.
- Patient and parent preferences should be considered when planning for discharge.
- Issues of consent and capacity should also be considered when making decisions around admission and discharge.
Care within a day treatment environment
- Day treatment may promote weight restoration in Anorexia Nervosa regardless of model of care provided, but requires more study to determine the critical treatment elements related to weight restoration.
- Multimodal, CBT and family-based day treatment may lead to improvement in eating disorder symptoms.
- Day treatment for Avoidant/Restrictive Food Intake Disorder may be helpful in weight restoration and improved outcome.
- Resistance training may be offered to children and adolescents who do not have a history of compulsive exercise while participating in day treatment, but it remains unclear whether this intervention imparts any benefit.
- Day treatment varies significantly from study to study, so comparison is difficult. The common element appears to be a group-based treatment program with meal support.
- Equity and access to day treatment are issues to be considered. Families must live close to such a program in order to be able to attend, or must abandon their home/career to move close to a day treatment program in order for their child to attend.
Care within a residential treatment program
- Although literature was lacking to support a formal recommendation for residential treatment, many of the panel members opined that residential treatment is an essential component of treatment for some individuals with eating disorders who need lengthier treatment in a setting away from home. Based on expert opinion and those with lived experience, it was agreed that individuals who have had repeat admissions to the hospital and those with complex comorbid conditions, might benefit from residential treatment.
Abstract
Objectives: Eating disorders are common and serious conditions affecting up to 4% of the population. The mortality rate is high. Despite the seriousness and prevalence of eating disorders in children and adolescents, no Canadian practice guidelines exist to facilitate treatment decisions. This leaves clinicians without any guidance as to which treatment they should use. Our objective was to produce such a guideline.
Methods: Using systematic review, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, and the assembly of a panel of diverse stakeholders from across the country, we developed high quality treatment guidelines that are focused on interventions for children and adolescents with eating disorders.
Results: Strong recommendations were supported specifically in favour of Family-Based Treatment, and more generally in terms of least intensive treatment environment. Weak recommendations in favour of Multi-Family Therapy, Cognitive Behavioural Therapy, Adolescent Focused Psychotherapy, adjunctive Yoga and atypical antipsychotics were confirmed.
Conclusions: Several gaps for future work were identified including enhanced research efforts on new primary and adjunctive treatments in order to address severe eating disorders and complex co-morbidities.
Contents of the original publication
The section headings of the original.
- Plain English summary
- Introduction
- Review of existing guidelines
- Objectives
- Research questions
- Methods
- Overview
- Synthesis methods
- Identifying potentially eligible studies
- Applying eligibility criteria and extracting data
- Appraising studies
- Guideline-related frameworks
- The guideline team
- Procedures
- External review
- Results
- Family therapy
- Individual and group outpatient psychotherapies
- Medications
- Level of care
- Inpatient
- Inpatient adjunctive treatments
- Day treatment
- Residential treatment
- Recommendations
- Family therapy
- Individual or group outpatient psychotherapies
- Medications
- Level of care – inpatient/day treatment/residential care
- Discussion
- Limitations
- Future directions
- Conclusions
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