Originally developed in the late 1970s and dubbed the Maudsley Method, FBT has demonstrated full remission rates of over 40% in adolescents with anorexia. The premise is simple, but execution can be challenging if not impossible without proper support: It involves the participation of a patient’s family in every aspect of recovery. That means parents, guardians, siblings, and/or any close contacts in the patient’s life are tasked with helping their loved one recover through planning, serving, and supervising meals. It means these caregivers have to constantly be on the lookout for potential setbacks, like after-meal bathroom trips that could indicate purging or secret workout sessions to burn much-needed calories.
“It’s not that people with eating disorders are choosing not to eat—it’s that their brains aren’t letting them,” Saffran says. “There’s really strong evidence that FBT is effective, but it can still suck for a whole host of reasons. For me, it wasn’t covered at all by my insurance, so my family had to pay out of pocket for multiple appointments a week. Driving to appointments was time-consuming, and often only one family member could attend sessions because both my parents were working. It’s a logistical nightmare.”
Compounding those obstacles is, of course, the financial burden of care. Intensive outpatient programs, which often include daytime therapy and/or group sessions, can cost several thousand dollars per month. Higher-level residential programs where patients live full-time and receive meal support, multidisciplinary treatment, and individual and group therapy (which aren’t necessarily proven to be effective) can cost up to and beyond $1,000 per day. And as I learned in my own search for treatment, insurance doesn’t always make a difference and claims are often rejected on the basis of weight, progress, medical history, and more.
To address the complicated realities of treatment, Saffran and Parks teamed up with several insurance partners and are working to secure contracts with Medicaid plans and other carriers. Equip also offers a sliding scale for services, although families are likely to receive a year’s worth of treatment for the same cost as just one month in a residential facility if they were to pay out of pocket.
To navigate the nonfinancial complexities of treatment, Parks and Saffran have developed what they consider “super-charged FBT”: In addition to incorporating family members, their treatment protocol involves a five-person care team for each patient, including a peer mentor (someone who has recovered from an eating disorder) and a family mentor (someone who has helped their loved one through an eating disorder). The program is customized to include weekly sessions with each member of the care team as well as unlimited check-ins in between sessions to address questions or difficult experiences that arise. “We expect most families to do intensive work during the first four months of treatment for symptom-reduction and weight-restoration goals, followed by a second phase of eight months of treatment dedicated to relapse prevention and skill development,” Saffran says.
