Treatment is based primarily on psychological approaches including psychoeducation about eating disorders and cognitive behavioural therapy (CBT-ED) typically requiring up to 40 sessions over 40 weeks. Family therapy may be appropriate for children and younger adults with an eating disorder.³

Programmes recommended for adults with anorexia nervosa include the Maudsley Anorexia Nervosa Treatment for Adults (MANTRA) and specialist supportive clinical management (SSCM), each based on 20 or more weekly sessions. Focal psychodynamic therapy (FPT) over 40 weeks may be an alternative.

While drugs may be part of a treatment approach, NICE advises that medication should not be the sole option for treating eating disorders. Fluoxetine is indicated for bulimia nervosa in the UK, and lisdexamfetamine has been approved for BED in the USA and Canada.^3,16,17

BED may also respond to selective serotonin uptake inhibitors (SSRIs) such as fluoxetine, fluvoxamine, sertraline, and citalopram, although studies record high placebo response and drop-out rates.¹⁷

The best ‘medicine’ for anorexia nervosa is food. Naso-gastric feeding (NGT) will be considered in some circumstances, such as where the patient is accepting of NGT, there is biochemical instability or where there has been a life-threatening weight loss.^14,17

Olanzapine has been used for helping with extreme anxiety in anorexia nervosa, which may make it easier to adhere to a meal plan. Benzodiazepines may also have a role if a patient is highly anxious or strongly resisting feeding.¹⁴

Antidepressants for mood disturbance lack evidence for use in the underweight state, and nor do antipsychotics help with delusional body image distortion. Drugs which stimulate appetite or which induce weight gain as a side effect are unlikely to make any positive impact in anorexia. However, once someone with anorexia has regained body weight, pharmacotherapy may help address long-term mood and anxiety disorders.¹⁷

Health issues can remain following successful treatment. Adults aged over 40 who have ever been underweight but regain weight to a BMI above 18.5 kg/mg² may still be at higher risk of fractures compared to adults with a normal or higher body weight.⁷