Virtual Eating Disorder Treatment: Pros and Cons of Telepsychiatry

Video conferencing platforms such as Zoom adapt well to eating disorders (ED) treatment needs, but engagement and treatment response may depend on eating disorder subtype.

How Virtual Eating Disorder Treatment Works

During the COVID-19 pandemic, strategies traditionally considered typical of in-person treatment for eating disorders (e.g., group therapy, family involvement, and specialist consultation) were found to be readily adapted to telehealth, even in an inpatient treatment setting.

Researchers at Stanford University examined how a local children’s hospital pivoted the psychiatry/psychology services to remote telehealth, and outlined how the Zoom video conferencing platform can be adapted to meet ED treatment needs:

  • White board & screen share: allows for interactive collaboration and distribution of materials, thus helps with patient engagement.

  • Waiting room feature: allows individual admit of patients and helps with confidentiality.

  • Individual messaging: helps with distribution of group materials where everyone receives a different prompt or cue.

  • Group messaging: allows for communication without disrupting conversation.

  • Attention tracker: identifies screens that have been idle for over 30 seconds thus allows for clinician to ensure appropriate engagement.

  • Gallery view: allows everyone to be seen on the screen for clinician to monitor reactions.

  • Annotate: allows everyone to write on the screenshare and useful in doing group activities together.

Other than adaptability of the Zoom features, researchers say telehealth also brings some unexpected benefits to ED treatment.

Therapeutic groups can be helpful in obtaining peer support and minimize isolation but may also be challenging due to opportunities for social comparisons. Since “Tele-groups” allow only the patient's face to be visible, the intensity of comparisons to others body shape and size is reduced. In addition, clinicians have observed increased participation from group members since shifting to Telegroups.

The mobilization of families and parental empowerment is essential to the recovery process in youth with ED. At times, due to competing obligations and geographical challenges, family members are not able to physically attend family sessions or meals on the unit. Using Zoom increases access for family members integral in renourishment.

Pros and Cons of ED Telepsychiatry

Patients generally report an appreciation for the use of telehealth services to manage mental health, but engagement and treatment response may depend on eating disorder subtype.

In a 2020 research report, researchers say they tried to find out the impact of COVID confinement on the mental health of patients with an eating disorder and of patients with obesity. To do that, they studied a sample of 121 participants (87 ED patients and 34 patients with obesity).

During the lockdown period, 30 (24.8%) participants lived alone, and 32 (26.4%) lived with one or two people at home, 29 (24.0%) lived with three people, and the remaining 30 participants (24.8%) lived with more than three people.

Researchers found that patients with anorexia nervosa (AN) and with obesity endorsed a positive response to remote treatment during confinement, no significant changes were found in bulimia nervosa (BN) patients, whereas “Other Specified Feeding or Eating Disorder” (OSFED) patients endorsed an increase in eating symptomatology and in psychopathology.

Although most patients reported being satisfied with the remote treatment used during the pandemic, AN patients expressed the greatest dissatisfaction and accommodation difficulty with remote therapy.

This finding seems to support the argument that some aspects of ED care (e.g., comprehensive assessment, treatment for those with severe psychopathology) may not always be appropriate in a telehealth platform.


Sources consulted:

Cunningham, Natoshia R., et al. “Addressing pediatric mental health using telehealth during COVID-19 and beyond: A narrative review.” Academic Pediatrics, 2021, article in press: accepted manuscript.

Datta, Nandini, et al. “Telehealth transition in a comprehensive care unit for eating disorders: Challenges and long-term benefits.” International Journal Eating Disorders, 2020, vol. 53, pp. 1774–1779.

Fernandez-Aranda, Fernando, et al. “COVID Isolation Eating Scale (CIES): Analysis of the impact of confinement in eating disorders and obesity—A collaborative international study.” European Eating Disorders Review, 2020, vol. 28, pp. 871–883.