Weight restoration in adolescent anorexia: parents’ goal-directed processes

Parent-led weight restoration is a key intervention of family-based treatment, an empirically supported treatment for adolescent anorexia. Successful outcomes in family-based treatment depend almost entirely on parental action, yet current understandings of this intervention are primarily informed by professional theory and expert perspectives. Comparatively little is known about parents’ goals and actions while implementing the treatment, despite goal-directed action being an explicit framework of family-based treatment. This study seeks to investigate parents’ involvement in weight restoration from the perspective of the goal-directed actions they construct and engage in themselves and with others. This study focuses on the phenomenon of parent-led weight restoration as a project and addresses the following research question: “How do parents participate in the weight restoration of their adolescent as the adolescent recovers from anorexia nervosa?”. This multicase study used the action project method and conceptual framework of contextual action theory to examine four cases of five parents engaged in actions to help their adolescent regain weight and recover from anorexia. Data were collected using multi-part interviews and analyzed according to the action project method and the multicase approach. Parents’ weight restoration projects were identified and grouped based on three common a themes. The primary theme, progressing toward health and well-being, was supported by three key processes: maintaining a holistic focus, trusting, and monitoring progress. Two secondary themes captured actions that were integral to the parents’ projects, but with less prominence. Secondary themes were creating capacity, which was supported by three processes (managing emotions to maintain a helpful focus, personal work, and resourcing time and finances), and coordinating and negotiating partnerships. The socio-cultural valuing of the thin ideal emerged as a unique process salient in one case. This study presents a goal-directed and contextual perspective on how parents translated the principles of family-based treatment into their daily lives. It joins a small but growing body of work concerned with generating new understandings and frameworks for practitioners and researchers to enhance the effectiveness of family-based treatment in community settings. Family-based treatment is one of the leading treatments for helping adolescents recover from anorexia. Parents play an essential role in this treatment, yet little is known about how parents translate the principles of FBT into day-to-day life. We studied four cases of five parents while they were using FBT to help their adolescent recover from anorexia. Overall, we found these parents’ actions were guided by three common and overarching goals. First, parents were focused on progressing toward health and well-being, using processes like keeping a focus on adolescent development, trusting, and monitoring progress. Second, parents were focused on creating psychological, emotional, and financial capacity to be successful in FBT, where many of their actions were shaped and constrained by the resources available to them. Finally, parents were focused on negotiating and coordinating partnerships with their co-parent (primarily), as well as others, to stay united in their efforts.