What do you do if your child or teen has an eating disorder? For years, the answer in Alaska involved out-of-state inpatient treatment, with families navigating a rough transition home with little support or relocating to seek care for their child.
Over the last several years, organizations such as the Alaska Eating Disorder Alliance (AKEDA) have raised awareness of the need for eating disorder treatment in Alaska, provided training for providers and families, and resources for families and patients.
At Alaska Behavioral Health, we have long been aware of the need for better treatment options in the state. Our IOP program has offered eating disorder treatment within its programming since fall 2024, and we are pleased to now be offering outpatient clinic treatment for eating disorders for children and adolescents in Anchorage, Wasilla, and Fairbanks, and statewide via telehealth.
Why It Matters
Eating disorders affect up to 9% of the population and are among the deadliest mental health conditions. Specifically, anorexia nervosa has a mortality rate of about 10% within 10 years, and 20% within 20 years. One in five of these deaths is by suicide. Those with any eating disorder are 11 times more likely to die by suicide than their peers.12
AKBH Chief Operating Officer Joshua Arvidson says it can be intimidating for clinicians and health care practitioners to treat eating disorders because of the severity. “And so we needed to develop the systems, leaders, staff and expertise to be able to do it well. We are doing that.”
Why FBT?
Family Based Therapy is widely considered to be the leading evidence-based treatment for eating disorders in children and adolescents. 3
Studies show that adolescents treated with FBT gain weight faster than peers in individual therapy, and have greater symptom reduction 6 to 12 months after therapy ends.
FBT also fits with Alaska Behavioral Health’s philosophy that caregivers are the experts on their children and are the best resources to support them. As Arvidson says, “It’s not always possible, but whenever we can, we want to keep kids at home, with their families. That’s where they need to be able to thrive, so that’s where we want to focus treatment.”
Training Staff
About 30 AKBH staff, from psychiatric prescribers to primary care NP’s to clinicians, attended training in Family Based Therapy. During two days of training delivered by model developer Dr. James Lock from Stanford University, staff learned the philosophy behind FBT, the structure of treatment, and role-played scenarios to practice skills.
The Principles of FBT
FBT is a family-centered approach that empowers caregivers to disrupt eating disorder behaviors with the goal of gradually helping adolescents develop healthy eating patterns.
- FBT does not focus on exploring the cause of the illness and especially does not blame families for an eating disorder, instead focusing on the family as a resource in changing behavior.
- Therapists guide families through treatment, but leave decision-making to the caregivers, who are the experts on their own children and what works in their families.
- Parents are empowered to take on their role as the primary agents of change. FBT does not include prescribed meal plans, as it is up to parents to decide what to feed their children.
- The eating disorder is treated as separate from the adolescent. Parents are encouraged to see themselves as fighting the disease, while remaining compassionate with their child.
- FBT is focused on symptom reduction – in other words, gaining weight. Clients are weighed at the beginning of each session, and their progress is charted. FBT asks families to put aside other behavioral concerns until weight is restored.
FBT requires a collaborative approach with the family, therapist, medical and psychiatry providers working together to support the client with eating disorders.
Anchorage clinician Sarah Pype, LCSW, likes that FBT empowers caregivers and centers their expertise on their child, but also uses the whole family system to fight an eating disorder. She appreciates that the treatment is structured and time-bound with a narrow focus on addressing the eating disorder.
Think FBT is right for your family?
Who can be treated with FBT?
FBT is designed for children, adolescents and young adults who have a diagnosis of anorexia nervosa or bulimia nervosa and who are living with caregivers who can be involved in their treatment and meals. While generally more effective with younger patients, motivated young adults living with family caregivers may also benefit. FBT can be a step down directly from inpatient hospital care or used to prevent the need for hospitalization, but clients must be medically stable before beginning. That is defined as:
- Able to stand on their own and maintain stable vital signs for at least 24 hours after moving to light intensity (stand) activity level.
These vital signs include:
- Heart rate is at least 45 at night and at least 50 during the day.
- Blood pressure is at least 90/45 mm of Hg.
- No big orthostatic changes when moving from lying down to standing up.
- Weight is at least 75% of the normal weight for their age and height.
- Lab values are in the normal range for potassium, phosphorous, sodium, and magnesium without using supplements.
Family Commitment
FBT does require significant commitment of time from caregivers, particularly in the beginning. For the first few weeks, caregivers must supervise three meals a day. Patients may need to stay home from school at first, and later parents may need to make arrangements with schools to accommodate lunch visits. (Some families meet their child at school and eat in the car.)
FBT Treatment Structure
FBT treatment typically lasts 6 to 12 months. Treatment starts with weekly sessions including all family members living in the household and may gradually move to longer intervals depending on progress. FBT appointments begin with a weight check and a brief check-in one on one with the client before the rest of the family joins.
Treatment is divided into three phases:
- Phase 1: Focused on weight restoration, 8-10 sessions
- Phase 2: Gradually returning control of food to the adolescent, 5-6 sessions
- Phase 3: Launching back into normal life and addressing developmental delays caused by the eating disorder, 3 – 4 sessions
For more information
To learn more about eating disorder treatment using FBT:
Resources
- Call 907-563-1000 to schedule an assessment at Alaska Behavioral Health.
Information in this post and our website is provided for informational/educational purposes only, is not a substitute for professional healthcare, and does not establish any kind of patient-client relationship by your use of this site. In providing this content, including treatment resources, we are in no way representing or warranting that this information is appropriate or effective for your individual needs. If you are struggling with mental or physical health, please contact a qualified healthcare professional or reach out to the national mental health hotline at 988.
