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Anorexia Nervosa

Refeeding Patients with Moderate and Severe Eating Disorders: A Retrospective Cohort Study

International Journal of Nutritional Sciences
By Philip S. Mehler, MD, FACP, FAED, CEDS

Background: Anorexia Nervosa (AN) is a life-threatening mental illness that can cause significant medical complications, including the potentially fatal refeeding syndrome. Registered dietitians (RDs) are a critical part of an eating disorder multidisciplinary team that focuses treatment on safe weight restoration and nutrition rehabilitation.

Method: This study is a description of how the nutrition rehabilitation protocol of 395 adult patients diagnosed with AN and admitted to residential eating disorder treatment is implemented, how the protocol is sustained throughout a patient’s treatment stay to achieve desired weight gain, and how the patients’ biochemical and clinical progress proceeded between admission and discharge, including laboratory results and body mass index (BMI).

Results: One hundred twenty-six patients required phosphorus supplementation for refeeding hypophosphatemia (RH); admission BMI was not significantly different between those with and without RH. The 15% of patients who required enteral nutrition at any point during their admission gained significantly less weight than patients who only received an oral meal plan. 34.4% of patients admitted with starvation induced hepatitis, 28.6% experienced refeeding hepatitis at some point, 21.0% of patients had elevated liver function tests 2 weeks into refeeding and 28.6% at discharge.

Conclusions: This study demonstrated overall effectiveness in achieving weight restoration goals with aggressive kcal increases without a single incidence of refeeding syndrome and infrequent RH. No significant biochemical changes were observed during refeeding. With close medical supervision and concurrent RD oversight, a refeeding approach with consistent calorie increases that is more aggressive than previously recommended appears to be safe.

Keywords: Anorexia Nervosa, Eating Disorders, Refeeding Syndrome, Nutritional Care Plan


Written by

Philip S. Mehler, MD, FACP, FAED, CEDS

Dr. Philip S. Mehler began his career at Denver Health more than 35 years ago and was formerly its Chief of Internal Medicine and then Denver Health’s Chief Medical Officer (CMO) until he was promoted…

ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

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