Treating adolescents with severe eating disorders through prolonged, disruptive stays in hospitals and residential programs addresses the symptoms but ignores the complex mental health roots of the illness. The new Intensive Program at Mount Sinai’s Center of Excellence in Eating and Weight Disorders features an innovative model that shifts the locus of treatment from the institution to the home, where parents are trained by clinicians to manage and effectively cope with the day-to-day demands of a child’s eating or weight disorder. Early results from this unique program have been very encouraging.
“Most traditional programs separate children from their families and normal lives by putting them into a 30-day hospital or 60-to-90-day residential program,” said Tom Hildebrandt, PsyD, Director of the Center of Excellence in Eating and Weight Disorders and creator of the Intensive Program at the Icahn School of Medicine at Mount Sinai. “Our experience shows that integrating families into the intensive process for kids with eating and weight disorders has the greatest impact. Sending adolescents home every night makes it much more likely they’ll stay at a healthy weight over the long run.”
Central to the initiative are support groups, educational lectures, and instruction involving family members, each conducted (prior to COVID-19) at the Intensive Program’s integrated clinical and research space on East 96th Street in Manhattan. Part of the treatment regimen consists of the family sharing a meal on-site with the program’s clinicians so parents can get feedback on how to set limits around eating while encouraging their children to eat in a healthful way. During COVID-19, the program successfully adapted to remote and saw an influx of patients.
“We believe anxiety is the main obstacle to kids being able to feed themselves, and that anxiety could be a combination of fear, worry, and disgust,” said Dr. Hildebrandt. “Our treatment model clearly sets us apart in how we teach families to deal with the feeling of disgust, which is the type of anxiety specific to problems with eating and body image. Disgust is more difficult to manage than other types of anxiety because once you become disgusted by something, your experience doesn’t change that feeling.” The nontraditional approach developed by Dr. Hildebrandt and his team involves teaching a unique set of skills that helps family members manage the disgust response to eating and the impact that eating has on the patient’s self-perception.
The Center of Excellence in Eating and Weight Disorders was established nearly 20 years ago with an emphasis on evidence-based treatment. The Center has grown into a leading multidisciplinary program offering innovative therapies to patients of all ages suffering from a range of feeding, eating, and weight disorders. “We pride ourselves on being a truly integrated clinical-research effort,” said Dr. Hildebrandt, who has led the Center since 2010. “Everyone on our staff has a hand in some aspect of research, as well as direct clinical care.”
Since November 2019, the Center has treated more than 400 individuals, making it the largest nonresidential clinic of its type in New York City. The Intensive Program is equipped to treat about 80 patients a year, nearly two-thirds of them adolescents. Typically, participants spend three to four weeks in the program, after which they are able to effectively manage their disorder by resuming outpatient care with a psychologist.
While clinical studies of the new Intensive Program are ongoing, Dr. Hildebrandt reports extremely positive results to date. “Our trials suggest that our intervention is more effective at getting kids to eat autonomously than having parents or someone else feed them,” he said. “At the same time, children in the program acquire a palpable sense of pride and confidence in their ability to do this on their own.”
Thomas B. Hildebrandt, PsyD
Director of the Center of Excellence in Eating and Weight Disorders