Lighting the Way Through RESEARCH

How leading research is improving the quality of patient care

Providing patients with the highest quality care is the driving force behind both research and clinical practices at Eating Recovery Center and Pathlight Mood & Anxiety Center (ERC Pathlight). Our team of passionate researchers and clinicians simultaneously advances knowledge while using these findings to refine evidence-based treatments.

ERC Pathlight is particularly well positioned to conduct research. With more than 30 centers nationwide, along with Eating Recovery and Pathlight At Home virtual intensive outpatient program, the organization has guided more than 20,000 patients and their families to recovery.

According to Philip S. Mehler, MD, FACP, FAED, CEDS (he/him/his), chief scientific officer at ERC, founder and executive medical director of ACUTE at Denver Health and professor of medicine at University of Colorado Medical School, this large patient population is perfect for conducting large-scale, impactful studies.

ERC Pathlight studies cover both the behavioral and medical sides of eating disorders and have included topics ranging from the effectiveness of treatment modalities to the incidence of eating disorders among transgender youth to drug-prescribing practices among psychiatrists.

Often, however, to determine what research questions to pursue, “We look at our patients,” says Howard Weeks, MD, MBA, DFAPA, DFAACAP (he/him/his), chief medical officer at ERC Pathlight. “Our goal is to look at standard-of-care best practices that are accepted in the field and conduct retrospective analyses to prove that they are effective. These are outcomes-based clinical studies based in the real world; they are not clinical trials. We are striving to improve the quality of care for all patients, including those with co-occurring conditions.”

For example, the team’s 2022 study published in the “International Journal of

Eating Disorders” looked at three behaviors associated with eating disorders (purging, binge eating and restricting) to see if one was a better predictor of suicidal ideation (SI), known to be elevated among this population. The study found that purging was the strongest predictor of SI.1

“This finding can then be applied to clinical care by reinforcing screening for suicidal thoughts and risks for patients with an eating disorder characterized by purging,” says Renee D. Rienecke, PhD, FAED (she/her/hers), director of research at ERC Pathlight. “The research gives us important information that we can use to develop more precise treatment plans for certain patients.”

Clarifying Treatment Choices

Research can also shed light on the reasons behind certain behaviors, information that has the potential to clarify treatment choices. To that end, researchers may ask, “Why do some patients engage in binge eating?” or

“What characteristics lead to readmission to treatment?” Answers to these questions have proven to be enlightening through the following studies.

The role of adverse childhood experiences (ACEs) in eating disorders: In a 2022 ERC Pathlight study, researchers compared adult patients who suffered from ACEs with adults from a national sample. The ERC patients had a higher incidence of ACEs than the national sample, and it was mostly patients with binge eating behaviors who fell into this category. 2 The study points to the importance of including trauma-related work in treatment with these clients.

The relationship between diagnosis and risk of being readmitted to higher levels of care: Patients with binge eating disorder or avoidant restrictive food intake disorder were less likely to be readmitted than those with an eating disorder who also had a major depressive disorder diagnosis or a history of self-harm. 3

A Game-Changing Study

Eating disorders have multifaceted causes and ramifications, and in some cases biology plays an important role and should not be overlooked. “I’ve been watching research evolve over many years and have seen a shift from an extreme focus on sociocultural factors toward a focus on genetics and biology,” says Harry A. Brandt, MD (he/him/his), chief of medical operations at ERC Pathlight. “It is clear that our culture encourages dieting and thinness, but eating disorders have strong biological underpinnings that must be better understood.”

A vivid example of the importance of biology in treating patients with eating disorders was the long-held—though not yet proven—belief that the time it takes for the heart to contract and relax, known as prolongation of the QTc interval, was an intrinsic part of anorexia nervosa. Knowing whether this theory is correct is important as this condition can lead to

Research In Action

cardiac arrest and death.

A team of ERC Pathlight and University of Colorado physicians led by Dr. Mehler set out to address this question. Over 15 years, with a number of publications, the team found that a prolonged QTc interval is not an inherent part of anorexia but is in fact due to secondary causes.

“This finding is significant because instead of automatically ascribing the prolonged QTc interval to the anorexia nervosa and assuming it would get better when the anorexia nervosa improved—an approach that may have led to unnecessary deaths—physicians now have to stop, look for the cause of the abnormal QTc interval and then correct it,” explains Dr. Mehler. “Typically, it is the result of abnormal electrolytes or the medications prescribed. By defining the cause of this abnormality—as proven by research—it then becomes possible to correct it.”4

ERC Pathlight is continuing to build its portfolio of research. “There is a dearth of research on patients in higher levels of care,” notes Dr. Rienecke. “We have to be careful not to act prematurely; over time, we believe that our work will continue to have a significant impact on the quality of patient care.”

1. Joiner, T.E., Robison, M., McClanahan, S., Riddle, M., Manwaring, J., Rienecke, R.D., Le Grange, D., Duffy, A., Mehler, P.S., & Blalock, D.V. (2022). Eating disorder behaviors as predictors of suicidal ideation among people with an eating disorder. International Journal of Eating Disorders, 55(10), 1352-1360

2.Rienecke, R.D., Johnson, C., Le Grange, D., Manwaring, J., Mehler, P.S., Duffy, A., McClanahan, S., & Blalock, D.V. (2022). Adverse childhood experiences among adults with eating disorders: Comparison to a nationally representative sample and identification of trauma profiles. Journal of Eating Disorders, 10 (1), 72

3. Gorrell, S., Le Grange, D., Hutchinson, V., Johnson, M., Duffy, A., Mehler, P.S., Johnson, C., Manwaring, J., McClanahan, S., Blalock, D.V., & Rienecke, R.D. (2022). Care utilization in eating disorders: For whom are multiple episodes of care more likely? Eating and Weight Disorders, 27(8), 3543-3551

4. Krantz, M.J., Blalock, D.V., Tanganyika, K., Farasat, M., McBride, J., & Mehler, P.S. (2020). Is QTcinterval prolongation an inherent feature of eating disorders? A cohort study. American Journal of Medicine, 133(9), 1088-1094

Data show that eating disorder patients in a five-day partial hospitalization program (PHP) lose weight over the weekend. Now, ERC only offers seven-day PHP programming to prevent regression, providing an insurance-backed standard of care. Download your seven-day PHP resource guide.

Research Highlights

Research and patient outcomes data in virtual intensive outpatient programs (IOP): Based on clinical outcomes data and a research study submitted for publication, the data show the efficacy of ERC Pathlight’s virtual IOP, including patient experiences, attendance and outcomes. Study authors: Michel, D.M., O’Melia, A.M., Mathes, W.F., & Tallent, C.N.

In addition to our team’s findings, the eating disorder community published a wide variety of articles in 2022. Below are two notable examples.

What next for eating disorder genetics? Replacing myths with facts to sharpen our understanding: There are many misconceptions about who can develop an eating disorder, which can have a negative impact on genetics research. This study methodically explains the range of people who can develop eating disorders, including all genders, ages and body types. Authors: Huckins, L.M., Signer, R., Johnson, J., Wu, Y.-K., Mitchell, K.S., & Bulik, C.M.

Epidemiology of eating

disorders among US adults: This study provides a look at the sociodemographic characteristics of eating disorder patients, suggesting that LGBTQ+ patients and those with adverse childhood experiences may be at higher risk. Authors: Udo, T., & Grilo, C.M.