Family-Based Treatment Explained: A Parent’s Guide to Healing
What is Family-Based Treatment?
Family-Based Treatment (FBT) is an evidence-based treatment and recommended first line approach for children and adolescents with restrictive eating disorders in the outpatient setting.
With FBT, parents and caregivers become part of the treatment team, taking full responsibility over their child’s meals. The child is viewed as separate from their eating disorder, and all focus goes to renourishing the child, as most children and teens do not possess the insight into the seriousness of their eating disorder, nor the ability to increase their intake on their own.
While going through FBT, parents are strongly encouraged to do so under the care of a trained therapist, and many benefit from also working with an FBT informed dietitian to guide parents on meal planning, replacement protocols, and ensure they are providing enough nutrition to result in weight restoration.
What does FBT look like for parents and caregivers?
FBT is highly structured and requires consistent caregiver involvement. Here’s what it typically involves:
Meal Preparation and Supervision: All meals and snacks are planned, plated, and supervised by caregivers.
School Support: During school hours, arrangements can be made for the child to eat under the supervision of a school nurse, counselor, or trusted teacher.
Monitoring Post-Meals: When possible, parents should remain nearby for at least 30 minutes after eating to monitor for compensatory behaviors (e.g., hiding food, purging).
Regular Eating Schedule: Meals and snacks should be offered every 3-4 hours to establish consistency and reduce anxiety.
Positive Mealtime Atmosphere: Keep conversation light during meals, focusing on neutral or uplifting topics rather than body image or food.
Feedback Outside Mealtimes: Discussions about eating behaviors should happen separately from meals to avoid negotiation or added stress during eating.
Replacement Protocols: If a child refuses or cannot complete a meal, parents should offer a calorie equivalent replacement (e.g., Ensure, Boost, or a homemade smoothie).
For how long do parents or caregivers continue the FBT protocol?
There are three phases of FBT.
Phase 1: Full Parental Control
Parents are fully in charge of meals and snacks. The child’s only role is to eat. This phase continues until the child is nearly weight-restored and no longer engages in compensatory behaviors.
Consistency, calm authority, and compassion are key to success. Caregivers benefit from guidance by a trained FBT therapist who can coach them through challenges.
Phase 2: Gradual Transfer of Responsibility
Once weight is mostly restored and meals are going more smoothly, some control is slowly given back to the child. They may begin selecting their own snacks or eat some meals without supervision.
When regression occurs, caregivers may need to temporarily resume control to maintain progress.
Phase 3: Full Transition to Independence
In this final phase, the adolescent is fully weight-restored and able to make age appropriate food choices without engaging in disordered behaviors. Supervision fades, and the goal is a return to intuitive, flexible eating patterns with long-term stability.
How do you know when FBT is needed or appropriate?
FBT is especially useful when a child or teen lacks the motivation or insight to change their restrictive eating habits. In these cases, parental involvement can drive recovery, even before the child is ready to take ownership of it themselves.
With early intervention, families may be able to avoid hospitalization or residential care. However, FBT may not be suitable for every family. It may not be effective when:
Caregivers lack the time or support to structure and supervise meals consistently.
There are significant family tensions or a parent struggling with their own eating disorder.
The child is medically unstable and requires inpatient care for medical monitoring.
Before starting FBT, children should be evaluated by a pediatrician to assess for medical stabilization in case a higher level of care is needed.
If you’re concerned about your child’s eating habits - whether or not they have been diagnosed with an eating disorder - we welcome you to reach out to our team of Dietitians in St. Louis, MO. We have decades of experience working with disordered eating and Eating Disorders, and would love to help your family meals feel peaceful again.