Timing matters. Most eating disorder treatment specialists see patients when they're already pretty ill: it takes a while to be referred to specialty care for all sorts of reasons.
But this fact causes a big bias problem that troubles me. I'm getting really tired of criticism of evidence-based care on the basis of clinicians who are used to so-called "chronic" patients. This is like objecting to early diagnosis and treatment of cancer based on the prognosis for tumors that have spread and caused secondary damage. The point is to prevent those more intractable cases.
If your expertise and experience are based on patients who have been under-treated, whose symptoms have ruined their relationships, who have marinated in the distorted thoughts caused by malnourishment then perhaps you mistake the secondary effects of an eating disorder for the illness itself. All this "doesn't work for everyone" and "don't exist in a vacuum" and "only for a small number of cases" is for me pretty well explained by the fact that we don't support families and primary care providers and front-line professionals with the tools for early detection and intervention.
We can't continue to treat eating disorders as defined by late, underpowered, and failed treatment. We need to define eating disorders as treatable illnesses and DO SO, and save the specialty of complex and intensive treatment for the soon-to-be rare cases that slip through the cracks.
There is a cohort of eating disorder patients that are ABOUT to fall ill. Let's catch them now and treat them properly and fully and keep safety nets in place from then on for them. Let's not let another generation of ED patients become the chronic patients of the future.