What is FBT Family based treatment?
Family-Based Treatment (FBT), also known as the Maudsley Approach, is a leading, evidence-based treatment for children and adolescents with eating disorders — especially anorexia nervosa, and increasingly for bulimia nervosa and ARFID.
It’s called “family-based” because it actively involves parents and caregivers as the primary agents of change, rather than placing the responsibility solely on the child or teen.
What Is FBT?
Family-Based Treatment is a structured, three-phase outpatient approach designed to:
Restore the child’s weight and nutritional health
Interrupt disordered eating behaviors
Gradually return age-appropriate control to the child
Support full psychological recovery over time
FBT emphasizes that the eating disorder is separate from the child and that parents are not to blame. Instead, the whole family becomes part of the recovery team.
The 3 Phases of FBT
Phase 1: Weight Restoration & Symptom Interruption
Parents or caregivers take full responsibility for meals, snacks, and eating-related decisions.
The focus is on ensuring adequate nutrition, often with therapist support during meals.
The eating disorder is seen as an external “bully” that the family is working to overcome together.
The child’s psychological insight is not required — weight and nourishment come first.
Phase 2: Returning Control to the Adolescent
Once the child shows improved health and reduced symptoms, the family slowly hands back control of eating decisions.
This process is collaborative and paced based on the child’s progress.
Continued support around food and stress management remains in place.
Phase 3: Establishing Healthy Adolescent Identity
Focus shifts to developmental tasks like autonomy, relationships, and emotional well-being.
The eating disorder is no longer the central focus, as physical and behavioral recovery is mostly complete.
Therapy helps reinforce identity, resilience, and relapse prevention.
Who Is FBT For?
FBT is most effective for:
Children and adolescents under age 18
Those living at home with involved, supportive caregivers
Early intervention cases (better outcomes when treatment begins within 3 years of onset)
It’s particularly effective for anorexia nervosa, but adaptations exist for:
Bulimia nervosa
Avoidant/Restrictive Food Intake Disorder (ARFID)
Older adolescents or emerging adults with caregiver involvement
Key Principles of FBT
Parents are the best resource for recovery — not the problem.
Nutritional restoration comes before insight — the brain needs fuel to think clearly.
Blame is removed — from both the child and parents.
The eating disorder is externalized — it's something to fight together, not part of who the child is.
Therapists guide, but families lead — therapists provide structure and support, but families do the daily work.
Is FBT Effective?
Yes — multiple studies show that FBT leads to faster weight restoration, lower relapse rates, and more sustainable long-term outcomes compared to traditional individual therapy, especially in younger teens.
A landmark randomized controlled trial (Lock et al., 2010) found that FBT was significantly more effective than adolescent-focused individual therapy at one-year follow-up for adolescents with anorexia nervosa.
How to Find FBT Support
Look for clinicians trained in FBT through:
Training programs at Stanford, UCSF, or the Maudsley Centre (UK)
The Training Institute for Child and Adolescent Eating Disorders
Certified FBT providers listed on eating disorder organization websites (like NEDA or FEAST)
Recommended Resources
Books:
Help Your Teenager Beat an Eating Disorder by James Lock & Daniel Le Grange
Brave Girl Eating by Harriet Brown (memoir + family experience with FBT)
Websites:
Final Thought
FBT is not easy — it asks a lot of families — but it offers a structured, evidence-based path toward full recovery. It reminds caregivers that they are not powerless, and it reminds children that they are not alone in the fight against the eating disorder.
With teamwork, persistence, and compassionate guidance, FBT can lay the foundation for both nutritional healing and emotional growth.
