Are Online Consultations as Effective as In-Person Sessions for Eating Disorders?

One of the questions we are often asked is whether online eating disorder treatment is as effective as seeing a clinician in person. It is an understandable question, particularly when deciding where to begin treatment or whether to continue therapy remotely.

Research increasingly supports online treatment as an effective option for many people with eating disorders. However, this does not mean the experience is identical, or that one approach will suit everyone equally.

There are differences in how therapy can feel, how people engage with treatment and how certain aspects of care are delivered. Understanding these can help you decide which approach may work best for you.

What does the research tell us about online eating disorder treatment?

Research comparing online and in-person eating disorder treatment has produced encouraging findings.

A randomised controlled trial by Mitchell and colleagues (2008) compared cognitive behavioural therapy (CBT) delivered remotely and in person for adults with bulimia nervosa. Both groups experienced improvements, with comparable treatment completion rates and broadly similar reductions in binge eating and purging. Although some outcomes favoured in-person therapy, the overall differences were relatively small.

More recently, a 2025 retrospective study of 169 adolescents receiving family-based treatment for restrictive eating disorders found no significant difference between online and in-person treatment in rates of weight restoration or treatment completion. However, adolescents receiving online treatment were less likely to show an early response, suggesting there may be differences in how treatment progresses, even when outcomes are similar.

The evidence is promising, although research remains relatively limited, particularly for some eating disorders, more complex presentations and longer-term recovery.

What we can reasonably conclude is that online therapy can be an effective way of delivering specialist eating disorder treatment. There is not sufficient evidence to say that either format is consistently better, and the most appropriate choice will depend on the individual and their treatment needs.

Does the therapeutic relationship feel different online?

One of the most important aspects of psychological treatment is the therapeutic relationship: feeling understood, trusting your clinician and working together towards shared goals.

This relationship can develop online just as it can in person, but the experience may be different.

For some people, attending from home makes it easier to talk openly. Familiar surroundings may reduce anxiety, particularly when discussing subjects that feel exposing or difficult. Online appointments can also feel less overwhelming for people who find unfamiliar environments or face-to-face interaction challenging.

Others find that being physically present with their therapist helps them feel more connected. Body language, shared silences and the experience of being together in a room can feel particularly important.

A 2024 study examining therapeutic relationships during family-based treatment for adolescent anorexia found that young people and mothers reported a stronger therapeutic connection in person, although this difference was not found across all participants.

This does not suggest that online therapy cannot provide a strong therapeutic relationship. Rather, it reminds us that people experience connection differently and that clinicians need to be thoughtful about developing and maintaining therapeutic relationships in either setting.

Can some aspects of eating disorder therapy work better in person?

Eating disorder treatment often involves more than talking. Depending on the approach, sessions may include reviewing eating patterns, working with difficult emotions, addressing fears around food or body image and practising changes that support recovery.

Much of this work can be undertaken online, but there are situations where being together physically offers advantages.

Some people benefit from leaving their usual environment and attending a dedicated therapeutic space. Others may find it easier to engage in practical food-related work, supported eating or certain exposure exercises with a clinician physically present.

Equally, online treatment has advantages of its own. Working from home may allow someone to practise new skills in the environment where their eating difficulties occur. A clinician can support them in addressing challenges within their everyday routines, rather than discussing these experiences afterwards.

Neither approach is inherently better. The question is whether the format supports the particular therapeutic work that needs to happen.

Does online treatment work for people with more complex eating disorders?

Online treatment is not necessarily limited to people with milder difficulties. Someone with a longstanding or complex eating disorder may benefit considerably from remote therapy, particularly when it provides access to specialist expertise that would otherwise be difficult to obtain.

However, the decision needs to consider more than psychological symptoms alone.

Eating disorders can have significant physical consequences, and some people require regular medical monitoring, including weight, blood pressure, blood tests or ECGs. These assessments cannot be replaced by video appointments.

At The London Centre, physical health monitoring is coordinated with GPs and other medical professionals, whether someone attends therapy online or in person.

Where there are concerns about medical stability, significant psychiatric risk or a need for more intensive support, the team must consider whether outpatient treatment can be delivered safely. This applies to both online and in-person care, although arrangements for responding to concerns may differ.

The important distinction is not simply how severe someone’s eating disorder is, but whether their needs can be appropriately and safely supported within the proposed treatment arrangement.

Which format might suit me best?

There is no single answer, and personal preference is an important part of the decision.

Online treatment offers flexibility around work, education, family responsibilities and travel. For others, attending a clinic provides structure, privacy and a clearer separation between therapy and everyday life.

Home is not always a comfortable or private place to talk. Someone living with family or housemates may worry about being overheard, while others may find it difficult to concentrate or disconnect from responsibilities around them.

There can also be individual considerations around neurodivergence, anxiety, sensory sensitivities or communication preferences. Some people find video appointments less demanding than being in a room with another person, while others experience screen-based interaction as tiring or uncomfortable.

If being visible on camera feels difficult, this is worth discussing with your clinician. Audio-only appointments may sometimes be appropriate, although certain assessments or interventions require visual contact.

What matters is finding a format in which you can engage meaningfully with treatment, feel supported and work towards change.

Can I combine online and in-person eating disorder treatment?

Absolutely. Treatment does not need to follow one format throughout.

Some people attend their initial assessment in person before moving to regular online appointments. Others begin remotely and introduce in-person sessions later.

A hybrid approach may also involve psychological therapy online, occasional clinic appointments and physical health monitoring arranged locally.

At The London Centre, we offer specialist psychological therapy, dietetic support, psychiatry and family interventions through both online and in-person appointments, where clinically appropriate. Our multidisciplinary team works collaboratively so that care remains coordinated regardless of how appointments are delivered.

Choosing the right treatment for you

The research gives us good reason to be confident in the effectiveness of online eating disorder treatment, while recognising that in-person appointments continue to offer important benefits.

Perhaps the most useful question is not whether online therapy is better or worse than in-person therapy, but which arrangement will help you engage with and benefit from the specialist treatment you need.

The therapeutic relationship, the expertise of your clinician, the treatment approach and your ability to attend consistently are all important considerations.

At The London Centre for Eating Disorders and Body Image, we can help you think through these factors when arranging your initial assessment. Whether you attend online, in person or through a combination of both, our focus is on providing specialist, evidence-based treatment that is responsive to your individual needs.

Research references

• Mitchell, J. E., et al. (2008). A randomized trial comparing the efficacy of cognitive-behavioral therapy for bulimia nervosa delivered via telemedicine versus face-to-face. Behaviour Research and Therapy, 46(5), 581–592.
• Cooper, M., et al. (2024). Therapeutic Alliance in Family-Based Treatment of Anorexia Nervosa: In-Person Versus Telehealth. Clinical Psychology & Psychotherapy, 31(3), e3017.
• Drury, C. R., et al. (2025). Comparing Outcomes for Telehealth Versus In-Person Family-Based Treatment: A Retrospective Chart Review. International Journal of Eating Disorders, 58(11), 2090–2104.