The three main aspects on which the participating institutions differ are their definitions of weight objectives, namely when and how contingency contracts are examined, and the choice of consequences. The definition of weight targets and the revision of contingency contracts may reflect the different manuals of the eating disorder centres that they themselves have developed. Half of the experts negotiate weight goals with the patient, taking into account aspects such as the expected length of stay. An additional 40% are based on a BMI that should be achieved (lowly normal). One possible explanation for different BMI goals between 17 and 19 kg/m2 is the ongoing discussion on cutting BMI to be used to indicate non-anoctic weight for anE patients [1.21]. Treatment contracts serve many useful goals for eating disorder patients, their families, and the treatment team. For example, contracts are useful when working with patients or family members who are in disarray or who have not been able to work with members of the treatment team. Contracts can be concluded when treatment has stalled and new therapeutic options need to be clearly put in place. For treatment team members with minimal experience with eating disorders, contracts can serve as a follow-up guide and goals. Contracts can also be useful in transmitting treatment plans to health care organizations and insurance companies. Treatment contracts are particularly useful for young patients and with larger treatment teams, and when family members are more involved in treatment. Finally, the detailed information that has been developed with a treatment contract can be very useful in sending it to managed-care organizations in order to document the severity of an eating disorder.
The consequences were generally dependent on weight loss (90.8%) Weight gain (86.8%). A quarter of the experts also indicated that the consequences of symptoms such as vomiting/rinsing, exercise and eating behaviour may depend. The effects were used regularly after weight control, i.e. after each weigh-in (31.6%) or every second with the weigh-in (47.4%). Experts reported the choices of positive effects themselves (23.7%) or have the positive results selected from a list (17.1%) (26.3%). About a quarter of cases (24.7%) the consequences have already been identified in the emergency contract or negotiated with the patient (13.0%). Regarding the negative consequences, 36.8% of experts said they would decide for themselves the consequences instead of having patients selected from a list (21.1%), or freely (11.8%).