People with severe eating disorders are most at risk of becoming unwell again in the first two months after leaving hospital, but a new evaluation from Oxford Health NHS Foundation Trust shows that virtual intensive treatment delivered at home can provide safe, effective and life‑changing support during this high‑risk period.
The findings, published in the Journal of Eating Disorders, are the first from a prospective study evaluating a fully virtual, multidisciplinary treatment model using enhanced cognitive behavioural therapy. The service, known as Step Care, was developed by the HOPE Provider Collaborative to improve care for adults with severe eating disorders and to address long‑standing challenges with transitions between services.
People leaving inpatient care for an eating disorder face a significant risk of relapse. Traditional services often struggle with fragmented transitions, limited day treatment provision and high readmission rates.
Step Care offers a new solution: intensive, structured therapy delivered entirely online, allowing people to access specialist support while living at home and maintaining everyday routines. The service brings together professionals from psychology, nursing, dietetics, and art therapy.
Support is organised into three tailored pathways:
- Starting Well – helping people at risk of hospital admission avoid inpatient care
- Staying Well – providing consolidation and stability immediately after discharge
- Working Towards Recovery – supporting longer‑term progress once weight restoration has begun
The evaluation found high levels of engagement and completion, even among people who had been unwell for many years.
Participants showed significant improvements in BMI, eating disorder symptoms, psychosocial functioning, and mood.
The majority of people in this pathway were able to avoid hospital admission altogether.
For those leaving inpatient care, the virtual model:
- Helped maintain weight during the highest‑risk period
- Reduced the impact of symptoms
- Led to very low rates of unplanned readmission
- Successfully supported most people to step down into community services
These findings demonstrate that intensive support can be delivered safely outside hospital settings, reducing demand for inpatient beds and enabling smoother transitions between services.
This is the first evidence to show that multidisciplinary CBT‑E delivered entirely online can provide intensive, evidence‑based care at home.
The study highlights the potential of virtual treatment to:
- Reduce repeated hospital admissions
- Prevent relapse after discharge
- Improve patients’ experience of care
- Make specialist support more accessible, regardless of location
- Offer more personalised, flexible care that fits around everyday life
Professional Lead Dietitian within the Step Care service, Lucy Gardner, said:
“Nutrition plays a crucial role in mental health, yet access to the right level of dietetic support is often inconsistent. Our model offers a clear, evidence‑informed way to tailor dietetic input to individual need, delivering CBT‑E virtually as part of a multidisciplinary team. This ensures people receive timely, targeted support and helps us use our specialist dietetic workforce where it has the greatest impact.”
Step Care represents a major innovation in the field of eating disorder treatment. By intervening at the right time, in the right way, the service supports sustainable recovery and bridges gaps between inpatient and community care.
For NHS leaders and commissioners, the findings reinforce the growing evidence that virtual models can deliver safe, high‑quality, cost‑effective alternatives to traditional inpatient pathways - supporting long‑term recovery while easing pressure on acute services.
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