title: Treating eating disorders over the internet: a systematic review and future research directions.
abstract: OBJECTIVE
  To review the literature regarding internet-based treatment of eating disorders (ED).
  
  
  METHODS
  Relevant studies were identified by searching electronic databases (including Medline, Embase, PsycInfo, and Web of Science). Eligible studies evaluated an internet-based treatment for ED, or an ED treatment that included at least one internet-based component.
  
  
  RESULTS
  Twenty-one studies were included. Methodological quality varied. Internet-based treatments were superior to waiting lists in reducing ED psychopathology, frequency of binge eating and purging, and in improving (ED-related) quality of life. Internet-based treatment was more effective for individuals with less comorbid psychopathology, binge eating as opposed to restrictive problems, and individuals with binge eating disorder as opposed to bulimia nervosa. Higher levels of compliance were related to more improvements in ED symptoms. Study dropout ranged from 5.3 to 76.8%. Inclusion of face-to-face assessments and therapist support seemed to enhance study compliance. Overall, the internet can be considered an acceptable vehicle for delivering ED treatment.
  
  
  CONCLUSIONS
  Future research should determine the utility of internet-based treatment by comparing them to face-to-face treatment. Research should furthermore focus on unraveling predictors and mediators of treatment outcome, compliance, and dropout, respectively. Studies with good methodological quality are needed with reports according to CONSORT guidelines.
authors.affiliation: Center for Eating Disorders 'Ursula', Leidschendam, The Netherlands.
authors.forename: Jiska J
authors.initials: JJ
authors.lastname: Aardoom
authors.forename: Alexandra E
authors.initials: AE
authors.lastname: Dingemans
authors.forename: Philip
authors.initials: P
authors.lastname: Spinhoven
authors.forename: Eric F
authors.initials: EF
authors.lastname: Van Furth
mesh_terms: D000293:Adolescent; D001068:Feeding and Eating Disorders / Q000523:psychology / Q000628:therapy*; D005260:Female; D006801:Humans; D020407:Internet; D010349:Patient Compliance; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011613:Psychotherapy; D017216:Telemedicine; D016896:Treatment Outcome
keywords: cognitive behavioural therapy; compliance; eating disorders; internet; outcome; predictors; review; treatment