This paper describes the issues in the medical care system for eating disorders that have been identified in the “Study on Improvement of Medical Care System for Eating Disorders” funded by the Ministry of Health, Labor and Welfare (MHLW) from 2014 to 2016 and the “MHLW Treatment and Support Center for Eating Disorder Project” started in 2014, and reports on the results of each research group and project. The progress of research to introduce cognitive-behavioral therapy for eating disorders in Japan is also reported. The role of the Japanese Society for Eating Disorders in meeting the unmet needs of eating disorders is discussed.

Eating disorders, namely anorexia nervosa (AN) and bulimia nervosa (BN) Eating disorders, are psychiatric disorders characterized by the presence of disturbed eating behaviors combined with an intense preoccupation with body weight and shape.

AN is one of the most common chronic illnesses among adolescent females and has the highest mortality of any psychiatric illness. Those suffering from eating disorders are often considered to have low motivation to change eating disorder behaviors. The core features of eating disorders are highly valued, causing high ambivalence about change.

The practical guidelines for the treatment of eating disorders, particularly in BN, recommend consideration of psychological treatments, such as guided self-help cognitive behavior therapy (CBT) for adults with BN as the first-line treatment choice. In general, it is recommended that psychological interventions focus on: Establishing therapeutic alliance, and enhancing patient’s motivation to cooperate in the restoration of healthy eating patterns.

The transtheoretical Model (TTM) (Prochaska and DiClemente, 1986) offers an integrative framework for understanding the process of behavior change targeting a particular behavior. The stages of change represent a key component of the TTM and describe a series of changes through which people pass as they change a behavior. Motivational interviewing (MI) (Miller and Rollnick, 1991) have been refined in the fields of addiction into motivation enhanced therapy. This treatment method is aimed at providing the theoretical rationale and techniques of motivational enhancement therapy for BN.

This review explores the recent clinical studies which address improving motivation to change eating disorders behaviors, exploring the clinical interventions.

Nursing care for eating disorder (ED) patients is based on a deep understanding of the individual patient’s symptoms. The main goal is for the patient to independently move toward the desired behavioral changes. The role of the caregiver is to work with the patient in an empathetic and accepting manner. However, difficulties in establishing a therapeutic relationship between patient and nurse are often encountered, which can lead to nurses having negative feelings towards patients and a lack of motivation. In order to address these issues, we have organized seminars and present case studies aimed at understanding the pathogenesis of ED. Nurses and doctors interact as a team with the co-medical staff to ensure a consistent approach to treatment, exchanging detailed information about treatment strategies and day-to-day responses. Orientation forms are given to our patients at the time of admission, and we work to create a positive team atmosphere within the staff. In this paper, we use case studies to show how we actually implement these approaches.

Enhanced Cognitive Behavior Therapy (CBT-E) was developed by Professor Christopher G. Fairburn et al. (2008) in the United Kingdom. CBT-E is an evidence-based therapy applicable for any subtypes of eating disorder (ED) because it is based on the idea that EDs such as anorexia nervosa (AN) and bulimia nervosa (BN) are cognitive disorders wherein patients have a common core psychopathology, that is, the over-evaluation of weight and shape and their control. Currently, a multicenter randomized controlled study on CBT-E for BN patients is being conducted in Japan. In Japan, therapy for BN has been covered by health insurance since 2018.

CBT-E is typically performed for outpatients and requires 20 sessions for non-underweight patients. Most ED patients come to the hospital reluctantly receive the treatment. Therefore, the key is to stimulate the desire to participate in the therapy. To this end, therapists should sympathize with the patients’ anxiety, show an understanding of their current problems, and assure them about CBT-E’s benefits. The therapy begins with the creation of a collaborative case formulation with the patient to clarify the maintenance factors of ED. Parallelly, the patient is guided to establish regular eating habits while self-monitoring his or her daily diet and related feelings at home. On the cognitive front, following the module, the therapist actively deals with the problems caused by over-evaluation of weight and shape and their control. At the final stage, relapse prevention measures are taken and the therapy is terminated.

Fidelity to CBT-E original protocol is important for obtaining successful therapeutic efficacy. Thus, in order to practice CBT-E, therapists must strive to thoroughly learn the structure and techniques of the therapy through various means, for example, by attending workshops and or by being supervised for the therapy.

The current paper outlines the evidence and the actual contents of CBT-E.

Eating disorders have been increasing in recent years, especially among older adults. Their food choices and eating environment, however, are different from those of young patients. Malnutrition in the elderly has been attributed not only to sociological and physiological factors but to physical factors, such as hyposmia, dysgeusia, and anorexia associated with aging. Especially, the loss of gastrointestinal function and muscle mass can affect the nutritional status of older adults. To improve it, peptide-based formula and digestible foods, which are rich in energy and protein, are an effective tool to support disirable protein and energy intake. It is essential to develop personalized nutritional treatment for older adults with eating disorders, taking into considertaion not only pathological conditions but also physical decay and social environment.

First, we introduced the current status of schools as a place of awareness and initial response to eating disorders. Second, “Guidelines for Better Collaboration between Schools and Medical Care for Eating Disorders” was explained from the background to concrete contents. Third, the performed contents（the appropriate method of using the guidelines and the clinical questions in specific stages）at the gatekeeper workshop for school nurses were shown in detail. Moreover, we reported the recent methodology and challenges for early detection and early support of eating disorders such as high school curriculum for health and physical education.