Eating disorders (EDs) are complex, pervasive and damaging at many levels.
Although they tend to develop in adolescence or early adulthood, EDs can span across a lifetime and alongside the harm they bring to the individual, they affect wider support systems and present long-term challenges to healthcare systems locally and nationally. They affect up to 15% of women and 5.5% of men in Western countries. Mortality rates in this group are almost twice as high as the general population.
With EDs becoming more prevalent and starting at a younger age, King’s researchers have identified the need for interventions at different stages of disease progression and developed three innovative approaches to deliver care in an integrated and holistic way:
- an early intervention approach to all eating disorders (FREED)
- treatment for anorexia nervosa (MANTRA)
- family and carer support (ECHO).
By developing a suite of evidence-based approaches for eating disorders King’s researchers have placed the person and their carers at the centre, providing flexibility and adaptability to reach as many people as possible.
These approaches have been integrated into National Institute for Health and Care Excellence (NICE) guidelines, and been adopted internationally, saving and changing the lives of those with EDs and their families.
We are delighted and proud that our evidence-based interventions and models of care are being adopted widely within the NHS. A lot of our efforts have gone into translating our research-based interventions into user-friendly, easily scalable formats, to ensure that we reach the ‘silent majority’ of eating disorder sufferers up and down the country– Professor Ulrike Schmidt, Professor of Eating Disorders
The importance of early intervention: FREED
Based on research showing that young adults with eating disorders experience particularly long delays in accessing evidence-based treatments, King’s developed FREED (First episode Rapid Early intervention for Eating Disorders) to facilitate rapid care for young people aged 16-25, tailored to their developmental and illness stage.
Evaluation of FREED showed a reduction in the duration of untreated EDs by 5-6 months, and also led to markedly improved weight outcomes in those with anorexia nervosa. FREED was also shown to be more acceptable and accessible for young people and recovery rates were around 60% at one year compared to 16% with the usual treatment. It also reduced the need for in-patient treatment.
The best thing to ever happen to me was this, I don’t know where I would have been, genuinely don’t know where I would have been, if I hadn’t got the support when I did– FREED Participant
FREED is now a cornerstone of NHS England’s (NHSE) commitment to increase community mental health services as part of the NHSE Long Term Plan. It has been adopted by the Academic Health Sciences Networks which covers 15 regions in England. A FREED- like service based on King’s research has also been established in Australia.
Since 2018 FREED has been used to treat over 1,100 patients.
Helping adults with anorexia nervosa: MANTRA
One fifth of people with eating disorders can have severe and enduring disease, lasting for many years and having a hugely debilitating effect on the sufferers and their families, as well as incurring an enormous cost to the NHS. Mortality rates amongst those with anorexia nervosa are approximately six times as high as in the general population.
Based on their findings of psychological and neurobiological distinctions between persistent anorexia nervosa and early stage eating disorders, King’s developed MANTRA (Maudsley model of Anorexia Nervosa Treatment for Adults) which was developed to be an accessible and user-friendly approach which addresses the cognitive and emotional aspects of anorexia nervosa, in addition to weight and eating.
Crucially, it has garnered greater levels of acceptability from participants compared to other treatments, with results maintained at two years. This is important because those with persistent anorexia nervosa are often ambivalent about treatment.
Absolutely, deﬁnitely feel a bit more comfortable within myself, you know I feeling very hopeless going back to sort of this time last year… but sort of since working through those issues I’ve managed, I’m actually in a different job now… and I’m a lot happier there and I’m going out and doing more things…– MANTRA Participant
MANTRA is recommended as a first line treatment for adults with AN in the 2017 NICE Guideline 69 Eating disorders: recognition and treatment. Since 2016 is estimated more than 700 therapists have been trained in the UK in total.
In 2021, a three-year contract worth £471k was awarded to design and deliver the MANTRA training programme to experienced clinicians across the country.
Supporting parents and carers: ECHO
Drawing on research insight from collaborating with carers for over 25 years, King’s has developed a specific intervention for carers for people with severe anorexia nervosa called ECHO.
This runs in parallel to out- and in-patient treatment, providing carers with information about the illness and how to provide support, without breaching confidentiality. King’s developed and tested a module based on this model for carers and demonstrated its clinical effectiveness.
ECHO has been used by several services to support carers of those with eating disorders for example through the New Maudsley Carers group, with over 1,000 carers reached.
I cannot emphasize strongly enough, my belief in the importance and inclusion of carer guidance resources and psychoeducational skills in the treatment of eating disorders… [to] equip carers with skills that empower them and give them the confidence to provide the best possible support to their loved one on their quest towards recovery– Carer of a family member with anorexia nervosa
The ECHO approach has been taken up in a peer-coaching format by the UK’s largest eating disorder charity BEAT. Two books have also been published using the ECHO methods: Skills-based Caring for a Loved One with an Eating Disorder and Caring for a Loved One with an Eating Disorder. The former has sold 42,000 copies over two editions, and the latter 700 copies.
In this story
Professor of Adult Psychiatry
Professor of Eating Disorders