When treating anorexia, less isn't more.
The current standard treatment for hospitalized anorexia patients involves placing them on a lower-calorie diet, before gradually increasing the patient's caloric intake. This treatment method, which begins at 1,200 calories per day and advances by 200 calories every other day, is recommended by organizations like the American Psychiatric Association and the Academy of Nutrition and Dietetics.
The slow-and-steady approach follows the same practice employed during WWII to treat prisoners of war for malnutrition. Its aim is to decrease the likelihood of “refeeding syndrome,” a rapid shift in electrolytes that can be deadly.
Challenging Current Treatments
Andrea Garber, an associate professor of pediatrics at the University of California, San Francisco’s Benioff Children’s Hospital, and other experts say that eating disorder treatments need to get with the times and be less conservative.
A study written by Garber and her colleagues in 2011 showed that anorexic adolescents treated with lower-calorie diets experiences more initial weight loss, poorer overall weight gain, and longer hospital stays.
“That study showed that the lower-calorie diets were contributing to the so-called ‘underfeeding syndrome’ and are just too conservative for most of the adolescents that we hospitalize,” Garber said. “Now we’ve compared a higher-calorie approach and found that it dramatically increases the rate of weight gain and shortens hospital stay.”
More Calories = Better Results
Gerber’s latest research appears in the Journal of Adolescent Health. It concludes that patients hospitalized for malnutrition due to anorexia nervosa do better when given high-calorie diets.
The study examined 56 young people hospitalized for low weight due to anorexia. Half were given a low-calorie diet starting at 1,100 calories a day with 100 additional calories per day, while the others started at 1,800 calories and progressed at 200 calories per day. All were give three meals and three snacks a day and were monitored closely.
At the end of regimen, the patients—predominantly white preteen and teenage girls—given the higher calorie diet gained twice as much weight as their peers on lower calorie diets. They also stayed an average of seven fewer days in the hospital, without an increase in the risk of refeeding syndrome.
“This higher calorie approach is a major shift in treatment that looks really promising—not only from a clinical perspective of better weight gain, but from the perspective of these young people who want to get better quickly and get back to their ‘real’ lives,” Garber said.
Treating Anorexia Beyond the Hospital
While Garber’s approach may help treat the physical symptoms of anorexia, the underlying causes must be addressed with additional therapy.
Anorexia nervosa is a mental health condition. One of the biggest hurdles to recovery is getting the affected person to admit he or she is sick. Often, a person with anorexia doesn't feel that he or she needs treatment.
Counseling is often the first step toward helping someone with anorexia. The goals of therapy are to increase self-esteem, increase social activity, and help establish a healthier relationship with food, exercise, and body image.
The Mayo Clinic states that individual therapy, family therapy, or group therapy may be beneficial for eating disorder treatment.