Treatment of Patients With Anorexia Nervosa in the US—A Crisis in Care

Anorexia Nervosa in the US-A Crisis in CareThe 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. 4Approximately 20% of patients with AN develop a severe and protracted illness.No US Food and Drug Administrationapproved medications exist. 2 How the Crisis of Care Has Grown Few TreatmentsAs mentioned previously, evidence-based treatments for AN that are based on biology do not yet exist.Recent innovations in genetic and biobehavioral research elucidate neurobiological contributions to AN disease risk and chronicity but have yet to be translated into clinical interventions.In part, this lack of evidence-based treatment reflects gross underfunding of AN research relative to its disability-adjusted life-years.