Comparing Outcomes for Telehealth Versus In-Person Family-Based Treatment: A Retrospective Chart Review

Abstract

Objective: Telehealth services have become part of many eating disorder (ED) treatment settings; yet, few studies have examined the effectiveness of family-based treatment (FBT) delivered via telehealth. This study compared in-person and telehealth FBT in rates of weight restoration, treatment completion, and metrics of treatment progress, and explored potential moderators of these outcomes. Method: Retrospective chart review identified 169 adolescents (10–18 years) with restrictive EDs who received FBT in person before the COVID-19 pandemic (n = 92) or via telehealth during the pandemic (n = 77). Regression models examined the effect of FBT format, controlling for baseline percent of expected body weight (%EBW). Zip code-based geospatial analyses compared the distance each format reached. Results: Treatment format (in-person versus telehealth) did not predict whether patients were weight restored to ≥ 95% of EBW at the end of treatment (OR = 0.74) or completed treatment (ORs = 0.53–1.74). Older age predicted lower odds of treatment completion among in-person but not telehealth patients; there was no moderating effect of age on weight restoration or of baseline %EBW on either outcome. Patients who received FBT via telehealth were less likely to be early responders (i.e., gained 2.3 kg by session four; OR = 0.33). FBT format did not predict the number of sessions to 95% EBW (f2 = 0.01), hospitalization frequency, or distance reached (d = 0.27). Discussion: Results suggest no significant differences between telehealth and in-person FBT in restoring weight or preventing hospitalization for adolescents with restrictive EDs, and support continued use of telehealth FBT to improve treatment accessibility and scalability. Additional research using a randomized design and ED psychopathology measures is needed.