Which refeeding strategies are used in the treatment of anorexia nervosa?

Updated: Jun 10, 2019
  • Author: Bettina E Bernstein, DO; Chief Editor: Caroly Pataki, MD  more...
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Nutrition is an important part of the treatment for the individual with anorexia nervosa. A nutritionist or dietitian should be an integral part of the treatment plan, because the well-recognized refeeding syndrome can occur during the early stages of refeeding the patient with anorexia. This syndrome encompasses cardiovascular collapse, starvation-induced hypophosphatemia, and dangerous fluctuations in potassium, sodium, and magnesium levels.

The process of refeeding must therefore be undertaken slowly, with modest increases in metabolic demands. Assessment of vitamin D and calcium intake is helpful in the design of a successful refeeding plan. [22]

Assessment of linolenic acid, retinol, vitamin A, vitamin D, and pantothenic acid levels can also be helpful, because early in anorexia, levels of vitamin A can be elevated, causing symptoms such as dizziness, cerebral edema, and nausea, as well as bone mineral loss. This tends to exacerbate worsening of the anorexia, thereby worsening the patient’s nutritional and general medical status. [109]

Tube feeding must often be initiated on an inpatient basis when the patient's weight is less than or at 85% of expected weight and/or less than the third percentile for BMI, [110] as outpatient refeeding can be too uncomfortable, and the weight gain can be too rapid for the patient to tolerate, resulting in the patient sabotaging treatment. Tube refeeding does not impair efficacy of any psychological therapies. [111]

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