Eating Disorder Assessment and Treatment Program – Outpatient Treatment

Outpatient treatment for eating disorders at CHOP consists of a behavioral family therapy model often known as Family Based Treatment (FBT). This treatment model is designed to empower caregivers to stimulate their children to eat appropriately and stop eating disordered behaviors. Sessions involve direct discussions of weight, eating and activities in initial phases of treatment, with increased attention to age-appropriate expressions of feelings and behaviors in later phases of treatment, as patients become less acutely ill.

We recognize that weekly outpatient treatment may not offer enough support for every family. There are times when the symptoms or behaviors of the eating disorder make it difficult to manage without more intensive support. In these cases, we offer an Intensive Services Program including our Partial Hospitalization Program (PHP) and Intensive Outpatient Program (IOP).

Our intake coordinators will complete an initial screening in order to recommend the appropriate level of care for your child. Our Intensive Services Program provides care in the PHP on Monday through Friday (8:30 a.m. –2 p.m.), and in the IOP on Monday through Thursday (2 – 5 p.m.). In contrast, in outpatient FBT, we aim to meet once weekly at first, and then discuss reducing the frequency of visits as your child continues to make progress. Families in all levels of care also meet regularly with providers in CHOP’s Division of Adolescent Medicine.

We ask that all parents and involved caregivers attend behavioral health sessions, as this improves outcomes.  

More about our philosophy

  • We aim to help you lovingly set limits on unsafe behaviors, such as not eating, that significantly affect your child’s mental and physical health. The ultimate goal is for your child to develop the capacity to again take care of themselves appropriately.   
  • Food is medicine for a malnourished body and brain. We aim to help you stimulate eating for your child in a way that meets their current needs, even when it’s distressing and difficult.

FAQs about treatment

Will an adult have to supervise all eating? What about at school?

We usually recommend that an adult supervise all eating in the initial phase of treatment, until we are all confident that your child is eating the amount they need and would do so even without monitoring. We help you work with your child’s school to arrange supervision at school if needed.

Will we have to limit my child’s physical activity?

Yes, most likely. It is usually not safe for your child to engage in sports, gym class or other physical activity during the weight restoration process. Too much activity poses a medical risk, can reinforce eating disorder cognitions, and works against our goal of helping your child fuel their body for recovery. We will work to gradually reintroduce joyful movement over time.

What happens if my child doesn’t eat what we serve?

If your child didn’t present any resistance to eating a larger volume and variety of food, you probably wouldn’t need our support! Discussion of a patient’s resistance to completing tasks (such as eating) that their caregivers view as important for their health will be a key part of treatment.

Will you help my child understand why they need to eat?

Lack of awareness of the importance of eating is a hallmark feature of an eating disorder. The most powerful way to gain insight, in this case, is through behavior, specifically the behavior of eating feared foods and learning that the outcomes are tolerable. This means your child needs to increase their eating before they understand why it’s important.

My child needs someone to talk to on their own. Will you meet individually with my child?

Our main therapeutic modality is family treatment, as it has shown the greatest evidence for the successful resolution of an eating disorder.

Will you address their depression, anxiety, self-esteem and other concerns?

We always assess for safety as it relates to harm to self or others, and we work to help your child identify and express their feelings. We also know that depression and anxiety can improve as your child becomes renourished (indeed, symptoms of malnutrition can include anxiety, sadness, irritability, fatigue, low interest and more). We can focus more directly on other concerns and will have much more traction as your child’s brain and body become healthier.

My child denies trying to lose weight or change their body. Is this still an eating disorder?

It may be. Eating disorders can take many forms, and they often don’t include the expression of body image distress or dissatisfaction. Additionally, children may express more body image distress as they become renourished. If your child is unable to eat sufficient calories such that they fall below their expected growth trajectory, they may meet criteria for an eating disorder.

Suggested reading for parents

Books:

  • When Your Teen Has an Eating Disorder: Practical Strategies to Help Your Teen Recover from Anorexia, Bulimia, and Binge Eating
    By Lauren Mulheim
  • Anorexia and other Eating Disorders: How to help your child eat well and be well
    By Eva Musby
  • Brave Girl Eating
    By Harriet Brown
    (or start with this New York Times article)
  • Survive FBT
    By Maria Ganci
  • Eating with Your Anorexic: How My Child Recovered Through Family-Based Treatment and Yours Can Too
    By Laura Collins

Online resources:

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Eating Disorder Assessment and Treatment Program
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215-590-7555