Objective The aim of this paper is to evaluate the effectiveness of enhanced cognitive behavioral therapy (CBT-E) adapted to be delivered via telehealth in a real-world, clinic treatment setting by a multi-disciplinary team for adults with an eating disorder.

Method A retrospective analysis of treatment outcomes was conducted on adult patients (18+) who received adapted CBT-E, a transdiagnostic treatment approach specifically modified for the treatment of eating disorders. Outcome included weight and eating disorder, depression, and anxiety symptoms. Survival analyses were used to assess length of stay, weight restoration and alleviation of eating disorder, depression, and anxiety symptoms; multilevel models assessed outcome trajectories over treatment time.

Results The patient sample (n = 1,718) was predominantly white (73%), cisgender women (86%), with a mean age of 30 (SD = 12). Diagnoses included anorexia nervosa (AN, 56%), binge-eating disorder (BED, 24%), bulimia nervosa (BN, 7%), and other specified feeding and eating disorder (OSFED, 11%). Approximately 51% of patients with weight restoration targets achieved weight restoration (95% of their target weight) by week 40 of treatment. By week 40 in treatment, 49% of patients reached subclinical levels on the EDE-Q, 58% on the PHQ-8, and 56% on the GAD-7.

Discussion Adapted CBT-E delivered via telehealth by a multi-disciplinary team is effective in improving transdiagnostic eating disorder symptoms, depression, and anxiety in an outpatient setting. Outcomes were consistent across diagnoses, demonstrating the feasibility and effectiveness of virtual CBT-E. However, variability in treatment length makes direct comparison with clinical trial end-of-treatment outcomes challenging.

Public Health Significance This study shows that virtually-delivered CBT-E effectively treats eating disorders by improving symptoms and accessibility to treatment. Expanding virtual treatment can significantly reduce barriers to care, reaching more individuals and lessening the public health impact of these disorders.

All authors are employees at Equip Health and some hold stock options.

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The project was funded by Equip Health, LLC

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The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The evaluation of our patient treatment outcomes was reviewed by the Western Institutional Review Board (WIRB). It was determined evaluation of patient treatment outcomes do not meet the definition of human subjects research and are therefore considered exempt from IRB oversight.

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