Family-Based Treatment

Family-based treatment (FBT) is considered the gold standard outpatient treatment and is the recommended first line treatment for medically stable children and adolescents with eating disorders. Compared to individual treatment, children and adolescents who engage in FBT are more likely to achieve full recovery, avoid hospitalization and have a reduced risk of relapse.

The goal of FBT is to reverse medical and psychological complications associated with weight loss and malnutrition. Early and complete weight restoration via nutritional rehabilitation is the cornerstone of this treatment method. FBT aims to restore the child or adolescent to a healthful weight based on age, previous growth trends, and current and/or expected height. Because there is no conclusive agreement regarding the use of medication for the treatment of AN, food remains the most successful “medicine” for its treatment. Once total weight restoration has been achieved, cognitive and emotional issues can be addressed.

FBT considers parents (who are the true experts on their child) an essential component of the multidisciplinary treatment team. Therapists serve as supportive consultants to parents. Supervision by a physician is essential to ensure medical stability. Registered dietitians can often offer helpful adjunctive support.

5 Key Tenets of FBT

Three Phases of FBT

Family-based treatment is intended to be a short term treatment, typically lasting 9 to 12 months. Treatment consists of three phases. Phase I involves rapid and complete weight restoration. Physical activities are limited and parents are completely responsible for all meals and snacks, while the child’s only responsibilities are eating and resting. Phase II slowly transitions age-appropriate responsibility back to the adolescent, and Phase III addresses any remaining issues that may interfere with achievement and maintenance of recovery


During the initial refeeding period of Phase I, families may use the “Magic Plate” technique, which involves the parents taking complete control of all meal planning, grocery shopping, and meal preparation, and the child’s only job is to eat. This technique is a compassionate way of alleviating the anxiety experienced by the child when deciding what or whether to eat. Without the stress of having to make a choice, affected adolescents are able to focus their effort on the present task and accept that eating is what is expected of them. Parents are encouraged to present a united front, thus preventing ED behaviors from emerging during gaps in the treatment plan. According to Lock and Le Grange, parents need to be “not just on the same page, but the same line, the same word and the same letter” so that the adolescent with ED hears only one powerful message from parents: “We know this is hard, but we love you and you have to eat.”

Because there is no approved medication for the treatment of EDs, weight restoration is accomplished using adequate calories from food as medicine in the form of three meals and three snacks per day prepared entirely by the parents.6 Foods that were enjoyed in the past should be reintroduced and overall variety should be increased, including any “fear foods” that may have developed over the course of the disease. Diet foods are discouraged and exercise is temporarily restricted in an effort to shunt all available energy towards weight restoration. Although many practitioners may argue that this approach interferes with the autonomy of the maturing adolescent, FBT recognizes that malnutrition has temporarily impaired the teen’s ability to make sound decisions regarding food, weight, and exercise, but as soon as the malnutrition is resolved, age-appropriate control can and should be returned to the teen.

Denial on the teen’s part regarding the severity of his or her malnutrition symptoms is common in both AN and BN. AN is egosyntonic, meaning that those with this disease cherish it, find comfort in it, and value it as an important part of their personality that they will fight to protect against treatment attempts. BN is considered egodystonic, so while the adolescent may deny the severity of the symptoms, there is less pride and more guilt and shame associated with binge/purge behaviors, making it difficult to seek out help. In both situations, affected teens are unlikely to be ready and willing to take steps towards recovery on their own, and even less likely to do so with a smile. Parents are encouraged to avoid rationalizing, arguing, discussing, or negotiating; they are asked to focus on feeding their child until weight is restored. The goal of Phase I is resignation—the teen has only to be resigned to eat and accept that he or she has no choice.


Phase II is initiated when the adolescent becomes accustomed to eating what is placed in front of them by the parents, is gaining weight steadily and has reached 90% goal weight. At this point, the therapist encourages parents to help their child take more control over eating and exercise in an age-appropriate manner. This phase typically lasts 2 to 3 months.


Phase III commences when the adolescent is able to maintain weight above 95% of the goal weight and self-starvation has ceased. The goal in therapy at this point is to increase personal autonomy as the adolescent establishes a healthy identity free from the ED. Phase III is brief and typically encompasses no more than a few sessions over several months.

Multi-family Groups

  • To overcome the illness-related isolation of the family
  • To take on responsibility for managing the illness-specific symptoms and everyday situations.
  • To connect with other parents/guardians to share experiences and strategies.
  • To improve intra-familial conflict management.
  • To strengthen parental/caregiver bonds with children and develop conciliation skills.
  • To change problematic interactions and relationship patterns around their child's eating.
  • To highlight personal psychological issues if these affect the child's specific problems adversely.

Individual Treatment

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