Medical Stabilization for Eating Disorders

Some patients with severe eating disorders may require specialized treatment to address medical complications before admitting to a residential program.

Eating disorders are the only mental illnesses regularly accompanied by severe, life-threatening medical complications. Significant medical instability results from progressive malnutrition, starvation, purging and overexercise, and compromises virtually all of the body’s vital organs and systems.

More than one-third of individuals suffering from eating disorders will require treatment at a higher level of care, ranging from 24-hour inpatient care to comprehensive daytime programming. Most treatment programs offer some degree of minimum internal medicine and/or nursing support to manage medical issues at every stage of recovery. However, some patients may be so medically compromised by their illness that they require specialized medical stabilization prior to entering a residential eating disorder treatment program.

In general, initial medical stabilization is recommended for eating disorder patients who are severely low weight, are seriously medically compromised, or are at risk for complications from refeeding syndrome, a dangerous metabolic disturbance that can occur when nutritional rehabilitation is initiated. Patients with any/all of the following criteria may require medical treatment from experienced providers in a medical hospital before entering a treatment program:

• Weight less than 70 percent of ideal body weight or BMI < 15;
• Unstable vital signs such as low or irregular heart rates or low blood pressure;
• Cardiac disturbances such as abnormal heart rhythms or heart failure;
• Loss of consciousness due to low blood pressure; 
• Acute kidney or liver failure; and/or
• Electrolyte abnormalities such a low potassium or low phosphorous.   

The goal of medical stabilization is to improve and normalize the patient’s vital signs, cardiovascular system and bowel function; to resolve serum electrolyte and chemistry abnormalities; and to restore levels of key electrolytes including phosphorus, potassium, magnesium and calcium. Medical stabilization also involves nutritional rehabilitation to support weight restoration. Most experts agree that careful caloric initiation is vital to medical stability and improved cognitive function, marked by the ability to tolerate and complete the most basic activities of daily living. 

It is important that each of these criteria be met in order for an eating disorder patient to be considered medically stable. Once the patient has achieved medical stability, he or she can continue on the road to recovery by transitioning to 24-hour care facility with the ability to sustain medical progress while incorporating intensive psychotherapy, ongoing weight restoration and other evidence-based interventions.

Seeking treatment for a severe eating disorder can be overwhelming, especially when life-threatening medical complications are present. Understanding which level of care provides adequate medical support to address these complications and restore medical stability is an important first step in the recovery journey.