Less is More?

Ok, so this post has nothing to do with television, but it does have to do with a podcast I listened to recently.  This Freakonomics podcast titled How Many Doctors Does It Take to Start a Healthcare Revolution? A New Freakonomics Radio Podcast was first brought to my attention because I do research on fictional medical shows and their impact on the public, and the podcast opens by discussing two studies related to that field.  It then goes on to talk about some interesting findings that raise the issue of “is less more?” when it comes to health care.  It specifically looks at cardiac illness and cardiac procedures (treating heart attack patients with stents versus medication, for example), but of course it got me thinking about how this all relates to eating disorder treatment.

Let me start out by saying that I definitely think intensive eating disorder treatment such as inpatient, residential, and partial hospitalization programs serve a valuable purpose and are definitely necessary for some individuals.  I myself have been in these types of programs numerous times, and they have most definitely helped me.  I truly believe that there were times where my behaviors were at a point or I was at a point mentally (either ED wise or depression wise), that I needed the structure of inpatient or partial to get back on track and keep myself safe.

That being said, I know the use of less intensive treatments for eating disorders, particularly when it comes to adolescents, is a hot area of research, and I definitely think that in many situations less is more when it comes to treatment.

First, there is no doubt that inpatient and residential (and partial to a lesser extent) are false environments.  You are completely (or almost completely) removed from the outside world.  I cannot tell you how many times I have been 100% compliant in inpatient, only to fall flat on my face when I get out into the real world.  Being removed from friends and family can also exacerbate depression and feelings of loneliness.  Thus, I think that, when possible, being able to remain as connected as possible to the real world (i.e. being in a less intensive treatment setting) is important for long term recovery.

I also think that being in intensive treatment like inpatient can bring about this weird conundrum where inpatient/residential becomes a safe or even fun place to be, driving patients to relapse and re-enter treatment.  I think this is particularly a problem with adolescent patients.  I have seen adolescents in an inpatient setting form cliques or treat it like summer camp, posting afterwards on Facebook how much they miss the place and their new found friends.  Now I have definitely made friends in treatment, and I am not saying there is anything inherently wrong with that.  But, when people would rather be in inpatient or residential because it’s “safe” or “fun” or whatever, that is a problem.

Like I said above, I know this is a hot area of research, as evidenced by this recent trial Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial that found no difference in the effectiveness of day treatment versus continued inpatient treatment.

Now, as one comment on the study points out, this study only looked at “anorexia nervosa patients with no previous hospital admissions, which limits the generalisability of the results to more chronic patients.”  It also important to point out that it only looked at adolescents, where there is often more family involvement in treatment (as compared to adults).  Many adults, and especially those with more chronic eating disorders, lack the family or social support needed to make day treatment effective.

So anyway, I am not trying to make a blanket statement that less is more when it comes to ED treatment, or that more is better.  Just like with any illness (heart disease was the one discussed in the podcast), things are complicated.  But, the podcast just made me think, and so here are my thoughts 🙂


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