WA study offers hope for adult anorexia


Curtin University research has found an inpatient treatment approach can help adults with eating disorders improve not only their physical health, but also their psychological health.

‘High-energy refeeding’ is often used in EDs to treat malnourished adolescents with anorexia nervosa and involves patients consuming a progressively higher energy intake over a brief period to quickly restore their nutritional health. 

The current guidelines for re-feeding malnourished people with an eating disorder such as anorexia nervosa (AN) recommend starting with a low energy intake and increasing this cautiously.  

However, it has been acknowledged that these guidelines contribute to prolonged starvation and long hospital admissions, and recently, more rapid re-feeding, using higher energy re-feeding protocols, has been shown to be safe and effective for adolescents and young adults with severe malnutrition. 

While the use of high energy re-feeding protocols for nutritional restoration is becoming standard practice for these age groups, it was thought this approach could prove problematic when treating adults with the same condition. 

Researchers from Curtin’s School of Population Health investigated 97 voluntary hospital inpatients at Hollywood Private Hospital (55 adults and 42 adolescents) with eating disorders -predominantly AN – who were treated using a high-energy refeeding protocol. 

The team found both age groups responded well to high-energy refeeding, reporting similar positive weight change and improvements in measurements of their psychological health. 

Masters’ student and study lead, Ms Fiona Salter, said there were concerns that adult patients undergoing high-energy refeeding could be at increased risk of developing ‘refeeding syndrome,’ a potentially fatal condition which can occur when a severely malnourished person starts eating again, causing a sudden shift in fluid and electrolytes. 

“In addition, more frequent mental health issues in adult patients could complicate their medical care,” Ms Salter said. 

“However, only one adult participant in our study did not tolerate the high-energy protocol due to oedema, which is an excess of fluid accumulating in body tissues.” 

Study co-author, Dr Emily Jeffery, a lecturer in Curtin’s Master of Dietetics Program, said the findings indicated that high-energy refeeding in adults who were mildly and moderately malnourished could be safely administered to provide both nutritional and psychological benefits. 

“Utilising our protocol, adolescents, and adults with anorexia nervosa (AN) and avoidant restrictive food intake disorder (ARFID) admitted at a similar BMI had a similar mean rates of weight change of 1.8 and 1.9 kg per week, respectively,” she said. 

“This was likely due to most adolescents and adults in our study adhering to the re-feeding protocol and ongoing individualised measures implemented to support optimal weight change for the duration of their admission.  

“These results are consistent with a study using a similar meal-based high-energy re-feeding protocol to re-feed adults with mixed EDs which found mean rates of weight change of 1.85 kg per week. However, clinicians need to be aware severely malnourished adults may require adjustments to prevent complications.” 

Ms Salter pointed out that the improvements in adult patients’ psychological wellbeing was critically important in using high-energy refeeding in the future. 

“There was some concern feeding too quickly could put them under too much distress, which is why we wanted to measure these psychological scores,” Ms Salter said. 

“We found psychosocial questionnaire scores improved significantly over the hospital admission, but psychological recovery from an eating disorder takes months and years so while it is great we can physically restore someone’s nutritional health quite quickly, the important thing is to keep that going. It needs to be maintained after they leave hospital for their longer-term psychological recovery.” 

Ms Salter explained that the next step was to see how patients with a similar severity of illness responded to high-energy refeeding in a less structured environment, such as an intensive treatment day program.