December 12, 2011

It Takes a Team to Fight Anorexia

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Joseph V. Madia, MD By:

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Anorexia study provides evidence for a higher calorie initial treatment

(dailyRx News) Weight gain and anorexia naturally find their conflicts, and a current study challenges the effectiveness of current methods.

A study by researchers at University of California in San Francisco provides evidence that eating disorder patients fail to gain weight in their first week in the hospital.

The study's findings will be published in the January issue of the Journal of Adolescent Health alongside an editorial challenging the current conservative treatment of malnutrition.

"Ask doctors about higher-calorie diets for anorexia."

Andrea Garber, Ph.D., R.D., an associate professor of pediatrics at UCSF, led the study alongside senior author Barbara Moscicki, M.D., professor of pediatrics. Dr. Garber tells readers that "studies show that weight gain during hospitalization is crucial for patients' long-term recovery," and Garber believes "we have to make the most out of their short time in the hospital."

The doctors worked with 35 primarily white adolescent women receiving six low-calorie meals each day, given liquid food replacements upon refusal. Vital signs, heart rates, and electrolytes were measured closely.

The study followed current diet recommendations alongside the opinion of the American Psychiatric Association and American Dietetic Association to start around 1,200 calories per day, advancing by 200 calories every other day, varying dependent on size, weight, and personal features.

The suggested "start low and go slow" methodology helps avoid re-feeding syndrome which occurs from rapid electrolyte changes.

Although this methodology successfully avoided refeeding syndrome, it was not until day eight that patients began gaining weight with ninety-four percent of patients starting on fewer than 1,400 calories per day.  With the starting calorie level eerily predictive of time spent in the hospital, these diet levels showed typical weight-loss before weight-gain.  

Dr. Garber explained that "we showed that for every 100 calories higher, the hospital stay was almost one day shorter."  Although these girls initially lost weight on the low-calorie diets,

Dr. Moscicki explains referring syndrome to be "a very real fear" in increasing the initial calorie-count.

On the whole, however, the doctors believe the study to provide a starting point towards incorporating higher-calorie diets, seeing as though no adverse effects were found among patients on the diets. Garber explains, "If we can improve weight gain with higher calories then we're on the right path." 

dailyRx contributing expert Shannon Kolakowski, Psy.D., treats patients with eating disorders.  Dr. Kolakowski explains to dailyRx that anorexia involves significantly more than below average body weight, "85% or less than what is expected for someone of their height and age."  

The people suffering are very afraid of gaining weight, regardless of their size.  People with anorexia hold "a significant disturbance in the perception of their own shape or body size, have trouble objectively viewing their weight, and self- worth is tied to body size, shape and weight," according to Kolakowski.  

She believes that this study "underscores the critical period of initial weight gain, which may require hospitalization to ensure the individual does not starve to death. Due to the nature of the disorder, however, individuals are often very resistant to the idea of gaining weight. This is a serious disorder that often requires extensive treatment to address the cognitive distortions involved."  

These people are in a delicate state and more is necessary than sheer calories.  

"Outpatient treatment of the disorder may include cognitive therapy, education about nutrition, and group therapy, while family-based therapy, particularly for adolescents, has shown the most evidence for effective recovery," Kolakowski tells dailyRx.  

"Additionally, adolescent- focused treatment for eating disorders also shows promising results in randomized control trials.

A treatment team, consisting of a therapist, dietician, psychiatrist, and medical doctor offer an effective support system for individuals with the condition, and is an important aspect of recovery in outpatient, inpatient, and day treatment settings."

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Reviewed by: 
Joseph V. Madia, MD
Review Date: 
December 9, 2011

Last Updated:
July 17, 2012