Does 24/7 care result in better outcomes for adults with eating disorders? A comparison of inpatient/residential care to partial hospitalization/intensive outpatient care for patients at low BMIs.

Background: Higher level of care (HLOC) treatment for eating disorders (EDs) is sometimes necessary, but research is lacking on whether HLOCs are actually more effective than less structured, lower levels of care. The purpose of the current study was to compare outcomes for patients with EDs at low weights who entered 24/7 care (inpatient and residential) to those entering non-24/7 care (partial hospitalization programming and intensive outpatient programming).

Methods: Participants were 1104 adults with body mass indices (BMI) between 14 and 17 receiving treatment for an ED at a large multisite treatment facility offering HLOCs between August 2019 and February 2024. The Eating Disorder Examination-Questionnaire (EDE-Q), assessing ED psychopathology, was completed at admission and discharge. Weight was taken throughout treatment.

Results: In unadjusted analyses, there was a significant difference between those receiving 24/7 care (3.79) versus non-24/7 care (2.17) in BMI increase during treatment. In adjusted analyses controlling for ED diagnosis, length of stay, and admission BMI, results remained the same. Weight gain per week was significantly greater for patients in 24/7 care. Changes in ED psychopathology, as measured by the EDE-Q, were not significantly associated with 24/7 care.

Conclusions: The current study suggests that patients with EDs at low BMIs gain more weight at a faster rate when participating in 24/7 care compared to non-24/7 care. Entering treatment at an appropriate level may result in shorter overall lengths of stay and may increase the chances of a positive long-term outcome.