Completed Projects

FBT is the first-line treatment for youth with AN, yet less than 50% of treatment completers achieve full remission. The initial phase of FBT prioritizes renourishment of adolescents, with rapid weight gain a key prognostic marker of outcome. In FBT, caregivers are charged with making all decisions around nutrition and ensuring that their child completes all meals and snacks. Parents can, at times, struggle with adapting to their child’s new diet. Anecdotally, parents report that they need to shift the way in which they shop for and think about preparing food.

We modified and piloted a simulated grocery shopping tool, OSOG, to support parents to identify calorically dense foods. During this project, we engaged Parent Research Partners (PRPs) for initial feedback on the tool. We piloted this tool with parents of adolescents with AN hospitalized for medical stabilization. Qualitative feedback suggested that parents experience high levels of burden during the refeeding process and that this process is made more challenging by feelings of being overwhelmed and self-doubt. A majority of parents suggested that OSOG was helpful in applying nutritional learnings, providing confidence, and identifying new ideas for food preparation. However, participants noted a further need for support in understanding caloric density and a desire for greater integration with other aspects of information, education, and online shopping.

Makara A, Howe H, Cooper M, Heckert K, Weiss S, Kellom K, Scharf D, Ubel P, Orloff N, Timko CA. Modifying an Open Science Online Grocery for parents of youth with anorexia nervosa: A proof-of-concept study. Int J Eat Disord. 2023 May;56(5):1011-1020. doi: 10.1002/eat.23902. 

Anorexia Nervosa (AN) is a serious eating disorder characterized by restriction of food intake and reduction of body weight below what is healthy or expected for someone of the same age and height. AN has the highest mortality rate of all psychiatric disorders and is associated with significant morbidity. There has been a call to understand the underlying neurobiology of AN, and to use this to inform new treatment development and treatment refinement.  A number of new theories have focused on a disruption in the reward system and impaired set shifting abilities as important maintenance factors.

Focusing on adults with AN is informative, but also raises the question as to whether or not any disruption observed is a state-based phenomenon, a biological cause of the illness, a consequence of being ill for a prolonged period of time, or a risk factor for developing a chronic course of illness. Researchers will often include individuals recovered from AN as a control or comparison group in order to begin to address the question as to whether or not disruptions are state based or a risk factor for illness. Many women who are recovered demonstrate some degree of normalization of the reward system; however, in comparison to women who never had eating disorders there continue to be clear abnormalities after weight restoration and symptom remission. These findings are typically taken to mean that a disruption in reward systems may be a biomarker for AN and, therefore, play a causal role in its development. The error in this assumption stems from the population typically studied. Adult women with AN represent only ⅓ of all individuals ever diagnosed. Age of onset is typically in adolescence; 1/3 of adolescents typically recover and 1/3 continue to display subclinical symptoms of AN or begin to engage in symptoms typical of bulimia (a phenomenon known as diagnostic crossover). Thus, individuals who continue to present with clinical AN into adulthood represent a unique subset of all women ever diagnosed with AN; research findings from this sample may not be generalizable to all individuals diagnosed with AN.  In order to fully understand dysregulation in the reward system in AN, it is necessary to study it in an adolescent population

For this study, we administered a multi-modal assessment of eating disorder symptomatology, reward and inhibition, executive functioning, and intellectual capabilities. This included questionnaires, neuropsychological assessment, and fMRI scan of structural and connectivity components.