1. Describe your topic: In December 2012, the American Psychiatric Association published the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) which included significant updates and changes to eating disorder diagnoses. However, no exhaustive systematic review has been conducted on the treatment of eating disorders with the new DSM-5 nosology. Thus, the information obtained from the following set of related questions will serve to update our current understanding of effective treatments and outcomes for DSM-5 eating disorders.

• What is the evidence for the effectiveness of treatments or combination of treatments for DSM-5 diagnosed eating disorders including: anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), avoidant/restrictive food intake disorder (ARFID), and other specified feeding or eating disorder (OSFED)?
• What are the outcomes of DSM-5 diagnosed eating disorders and do outcomes vary based on the level of care provided and/or demographic characteristics?
• What is the available evidence on unique interventions (or culturally-sensitive adaptations of existing interventions) for DSM-5 eating disorders among underserved and unique populations (e.g., racial/ethnic minorities; sexual and gender minorities)? 
  • Identify the population of interest, including details such as age range, gender, coexisting diagnoses, and reasons for therapy.
  • Population of Interest: Children and adults diagnosed with a DSM-5 eating disorder.
  • Identify the interventions (treatments, tests, or strategies) that you want to know more about, and what are the appropriate comparisons.
  • Interventions: All relevant pharmacological, psychological, and combination interventions for individuals meeting criteria for a DSM-5 eating disorder across all available levels of care (e.g., inpatient, residential treatment, partial hospitalization/day treatment, intensive outpatient, and outpatient)
  • Identify the important outcomes (health related benefits and harms) in which you are interested, such as improvements in symptoms or problems with diagnosis.
    • Eating Outcomes
    • Binge-eating episodes
    • Inappropriate compensatory behaviors (e.g., self-induced vomiting, fasting, laxative use, exercise etc.)
    • Psychological features of the eating disorder (e.g., shape and weight concerns, restraint, disinhibition, hunger)
    • Psychological Outcomes
    • Depression
    • Anxiety
    • Substance use
    • Personality
• Biomarkers
  • Weight/BMI
  • Menstrual status
  • Blood pressure, pulse, temperature
  • Medical morbidity (e.g., osteoporosis, infertility, gastrointestinal disorders, etc.)
  • Microbiome
  • Changes in gene expression
• Other
  • Social and occupational functioning
  • Death

==Importance of Suggested Topic==

2. Describe why this topic is important: In 2006, AHRQ conducted a systematic review of eating disorder treatment and outcomes for all diagnoses (AN, BN, BED), but these were according to now outdated nosology (DSM-IV). An update of the treatment literature for DSM-5 AN and BN has not yet been undertaken, and there is no existing review of the treatment literature for the newly defined diagnoses of ARFID and OSFED. (AHRQ did fund a systematic review and meta-analysis for the management and outcomes of BED, but in the 4 years since its publication, several new pharmacological agents have been investigated and additional psychological interventions are emerging). Thus, a rigorous review of the treatment literature for DSM-5 eating disorders is both timely and highly relevant as the prevalence of eating disorders has increased in the past decade, particularly among underserved populations (i.e., males and sexual, racial, and ethnic minorities). Individuals with eating disorders experience significant medical, psychological, interpersonal, and financial consequences. The totality of treatment for an eating disorder can cost well beyond $100,000, putting significant strain on the patient, families, and the healthcare system. An up-to-date synthesis of the current treatments available and their effectiveness is crucial for healthcare consumers and will promote the quality and availability of eating disorder treatment and research among practitioners and aid providers in making decisions regarding the most appropriate treatment and level of care.

3. Tell us why you are suggesting this topic: Eating disorders are pernicious, life-threatening illnesses that are associated with significant medical, psychosocial, and financial burden. Given their impact, healthcare providers, patients, and families are desperate for evidence-based information on which treatments to pursue and at which level of care, but the state of the field has not been updated for over 13 years. The field also needs additional research to develop new treatments and study adapted treatments evolving in clinical settings. The literature is clear that existing treatments do not work for all patients, leaving providers, patients, and families without clear guidance for the 30-50% of whom current treatments are not effective. Existing research varies in depth and conclusiveness regarding the effectiveness of these adapted or new treatments and a thorough review and synthesis of the literature, such as the one proposed here, can help determine research priorities to further our understanding of meeting the needs of the diverse array of patients and their families (particularly those from underrepresented minority groups and those not responding to current evidence based treatments).

Target date: Given the DSM-5 revisions, we believe that answers to our questions are needed as soon as possible. However, we recognize that time will be needed to identify and summarize the evidence. It would be helpful to many in the field to know that a project is underway and when it could be expected to be completed.

==Impact of a New Evidence Report==

4. Describe what you are doing currently and what you are hoping will change because of a new evidence report.: An updated evidence report will provide healthcare providers comprehensive knowledge on the effectiveness of treatments for eating disorders and clarity regarding the direction of future research. As such, this report will promote the use of evidence-based treatments and inform which treatments are recommended according to diagnosis and demographic presentation, and identify gaps in our knowledge bases where this kind of guidance needs additional development. With broad dissemination of the report to both healthcare providers and the public, we hope that treatment delivery will become less varied and more standardized, and will make research priorities clearer, thus minimizing confusion on the part of both groups of stakeholders. Additionally, having an updated, rigorous review of the eating disorders treatment literature may improve the ability for third party payors to make informed decisions about reimbursement for services as well as the kind of outcome data to expect from treatment providers to demonstrate effectiveness of adapted or emerging treatments.

5. How will you or your group use the information from a new evidence report? The mission of the Eating Disorder Coalition is to advance the recognition of eating disorders as a public health priority. We do this through advocacy and information dissemination. For example, we create publicly available educational materials and meet with members of Congress and Federal agencies to promote awareness and improved access to care. We will be able to utilize an updated review of eating disorder treatment and outcomes in all of our work promoting awareness. In particular, such a review will highlight any current gaps that may exist in access to healthcare and treatment outcomes—information we can use in our efforts to improve access to care. We additionally will advocate for and disseminate the results of the review regarding treatment effectiveness and necessary research priorities; advocating for the implementation of the effective evidence-based treatments and support for the necessary research priorities identified within the report. This updated review of eating disorder treatment and outcomes will expand access to evidence-based treatment information by patients, providers, and the general public.

6. How would you or your group plan to disseminate information from the report? Who would you plan to disseminate it to? As noted above, we create publicly available educational materials and meet with members of Congress and Federal agencies to promote awareness and improved access to care. We would use the information provided in this report in all of our advocacy work.

==Other Stakeholders Who Could Use a New Evidence Report==

7. Do you know of organizations that could use an evidence report to change clinical practice? Are you a part of, or have you been in contact with, any organizations that might implement the research findings of an evidence report?

Academy for Eating Disorders

National Association of Anorexia and Associated Disorders

National Center of Excellence for Eating Disorders

National Eating Disorder Association

National Institute of Diabetes and Digestive and Kidney Diseases

National Institute of Mental Health

Eating Disorders Research Society