Telehealth eating disorder treatment

In-Person vs. Telehealth Eating Disorder Treatment: A Systematic Review & Meta-Analysis


September 26, 2023 | Reading Time: 3 Minutes

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The acceleration of telehealth as a viable method of healthcare delivery has opened new options for treating behavioral health disorders, including Bulimia Nervosa (BN) and Binge-Eating Disorder (BED). In the wake of the COVID-19 pandemic, the comparative efficacy of traditional in-person interventions vs. telehealth eating disorder treatment has attracted scholarly interest. The study’s author team of Zoi A. Polyzopoulou, Andreas S. Lappas, Nikos Christodoulou, Georgios Papazisis & Michail Chourdakis conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate and contrast remote and in-person interventions for BN and BED (2023). The study was published in the Journal for Technology in Behavioral Science (JTiBS) as an open-source article. Six selected studies encompassing 698 participants were analyzed. While one study significantly favored face-to-face interventions, the aggregated data revealed comparable efficacy between the two delivery methods across various outcome measures. The study represents a significant effort toward illuminating an area that is infrequently discussed at conferences or in broad-based telehealth blogs such as’s.


Bulimia Nervosa (BN) and Binge-Eating Disorder (BED) are prevalent eating disorders that share similarities but are differentiated by specific clinical features (American Psychiatric Association, 2013; Fichter et al., 2008). While various evidence-based treatments are available (Argyrou et al., 2023; Fornaro et al., 2023), barriers such as geographical restrictions, stigma, and socioeconomic disparities often result in suboptimal utilization (Cooper & Kelland, 2015; Kazdin et al., 2017; Liu et al., 2022). Telehealth is a potential mechanism to circumvent these barriers and enhance treatment access (Jacobs et al., 2019; Malik et al., 2023).

The Necessity for Updated Literature

Given the rapid advancements in telehealth technologies and the escalated demand following the onset of the COVID-19 pandemic, it is pivotal to synthesize existing studies in telepsychiatry (Termorshuizen et al., 2020). Prior meta-analyses in depression (Moshe et al., 2021) and obsessive–compulsive disorder (Salazar de Pablo et al., 2023) have not found significant disparities in treatment efficacy between telehealth and face-to-face modalities. Contrarily, empirical evidence yields equivocal results in the domain of BN and BED. Some studies advocate for equal effectiveness of the two approaches (Ljotsson et al., 2007; Mitchell et al., 2008), whereas others express reservations (De Zwaan et al., 2017; Yu et al., 2020; Zerwas et al., 2017).

Methodological Rigor

To ensure a robust, unbiased investigation, the authors adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) statement (Moher et al., 2009).

Synthesis of Findings

The research team’s meta-analysis is groundbreaking in assessing the efficacy and acceptability of telehealth eating disorder treatment and face-to-face interventions for BN and BED. Primary outcome measures included remission rates, binge and purging episode frequency, and treatment responsiveness. Their findings demonstrated the comparable effectiveness of both telehealth and traditional interventions in treating BN and BED across most evaluated metrics. However, the authors observed that one study drove the higher efficacy of face-to-face interventions for remission.

Conclusions & Future Directions for Telehealth Eating Disorder Treatment

The meta-analysis substantiates the applicability of telehealth as a feasible and efficacious platform for delivering treatment for BN and BED. Nevertheless, the authors advocate for additional RCTs and robust real-world effectiveness studies for the findings to be considered conclusive. With advancements in telehealth technology, it is important to consistently revisit and re-evaluate the therapeutic landscape to ensure optimum client and patient outcomes.

Clinical Note

It may also be worth noting that eating disorder telehealth interventions have the strong potential to succeed due to the underlying dynamics involved. The secrecy and shame prevalent in many people struggling with these issues could make them particularly responsive to telehealth from their homes. In-vivo Cognitive Behavior therapy via laptop or smartphone could be used to allow the therapist to “see” the client’s world. By encouraging interactions that take place in a client’s private home, a skillful therapist can work toward helping the client diminish the stimulus value of various trigger spots in the home.

Also, when treating anorexia by means of family therapy, the therapist can literally be given a “seat at the dinner table” with a therapist remotely participating in family dynamics surrounding food at the dinner table. A therapist could see, hear, and interact with family members by means of a laptop strategically located at the dinner table. These and many other strategies can be tried with clients who present with eating disorders.

Technological advancements make it important to consistently revisit and re-evaluate the therapeutic landscape to ensure optimum client and patient outcomes in telehealth eating disorder treatment.

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