JAMA psychiatry | 2021
Treatment of Patients With Anorexia Nervosa in the US-A Crisis in Care.
Abstract
The United States is facing a crisis in the treatment of anorexia nervosa (AN)—a debilitating, expensive, and frequently fatal illness. Annually, eating disorders cost the US more than $65 billion.1 Despite scientific advances, treatments do not yet exist that target the core biology of AN. Moreover, the absence of standards of care has left a vacuum to be filled by programs offering untested interventions. Many academic medical center programs have dwindled or closed, functionally steering insured patients and families to private programs and limiting treatment access for the uninsured and underinsured. Herein, we describe the crisis and propose solutions. Anorexia nervosa frequently requires prolonged hospitalization for weight restoration and medical and psychiatric stabilization.2 Relapse rates approach 50%, and the standardized mortality ratio is approximately 6,3 rendering it one of the most lethal of psychiatric disorders. Although empirically supported treatments in youth, such as family-based treatment, have moderate success, recovery is often prolonged, and the evidence base for treatment in adults is weak.4 Approximately 20% of patients with AN develop a severe and protracted illness. No US Food and Drug Administration– approved medications exist.2