Are we too cautious when refeeding hospitalised adolescents with anorexia nervosa?

posted 5 Apr 2012, 02:58 by Damian Wood   [ updated 13 Oct 2012, 11:07 ]
Andrea Garber and colleagues report in the Journal of Adolescent Health 2012;50(1):24-29  their findings from a prospective observation of weight gain from oral refeeding of 35 hospitalised adolescents with anorexia nervosa. Their study demonstrates that current feeding regimes, based on a "start low and advance slow" approach of 1200 Kcal advancing by 200 calories every other day, result in initial weight loss for 8 out of 10 young people with no significant increase in %median BMI until around day 8. None of the young people developed re-feeding syndrome but 1 in 5 had a low phosphate level. The authors also noted that higher calories prescribed at baseline were associated with fasterwight gain and shorter hospital stay. This raises the question of whether the standard approach is overly cautious and a UK based multi-centre randomised controlled trial is underway which may help us decide whether we can safely increase the starting calories and rate of increase for young people hospitalised with anorexia nervosa.