OBJECTIVE: Cohort study from February 2003 through May 2011 to determine weight restoration and refeeding complication outcomes for patients with anorexia nervosa (AN) treated in an integrated inpatient-partial hospital eating disorder program designed to produce rapid weight gain and weight restoration in the majority. METHOD: Consecutive admissions (females and males, adolescents and adults; N = 361 patients, 461 admissions) at least 1.8 kg below target weight with AN or subthreshold variants were included. Main outcome measures were rates of hypophosphatemia, transfer to medicine, or death; rates of weight gain and percent achieving weight restoration. RESULTS: Hypophosphatemia was present in 7.9% of cases at admission and in 18.5% at some point during treatment. Hypophosphatemia was mild to moderate. Lower admission body mass index (BMI), but not rate of weight gain, predicted hypophosphatemia [OR = 0.65; p < .00001 (95% CI 0.57-0.76)]. Five patients (1.1%) were transferred to medicine or surgery, none because of refeeding. There were no deaths. Mean inpatient weight gain was 1.98 kg/week; mean partial hospital weight gain was 1.36 kg/week. By program discharge, 71.8% of adults reached a BMI of 19, 58.5% a BMI of 20. For adolescents, 80.4% came within 2 kg of their target weight; 76.1% came within 1 kg. DISCUSSION: Refeeding patients with AN using a hospital-based, behavioral protocol may be accomplished safely and more rapidly than generally recognized, weight restoring most patients by discharge. Helpful elements may include the program's integrated, step-down structure; multidisciplinary team approach emphasizing group therapy to effect behavior change; and close medical monitoring for those with BMI < 15.
OBJECTIVE: Cohort study from February 2003 through May 2011 to determine weight restoration and refeeding complication outcomes for patients with anorexia nervosa (AN) treated in an integrated inpatient-partial hospital eating disorder program designed to produce rapid weight gain and weight restoration in the majority. METHOD: Consecutive admissions (females and males, adolescents and adults; N = 361 patients, 461 admissions) at least 1.8 kg below target weight with AN or subthreshold variants were included. Main outcome measures were rates of hypophosphatemia, transfer to medicine, or death; rates of weight gain and percent achieving weight restoration. RESULTS:Hypophosphatemia was present in 7.9% of cases at admission and in 18.5% at some point during treatment. Hypophosphatemia was mild to moderate. Lower admission body mass index (BMI), but not rate of weight gain, predicted hypophosphatemia [OR = 0.65; p < .00001 (95% CI 0.57-0.76)]. Five patients (1.1%) were transferred to medicine or surgery, none because of refeeding. There were no deaths. Mean inpatient weight gain was 1.98 kg/week; mean partial hospital weight gain was 1.36 kg/week. By program discharge, 71.8% of adults reached a BMI of 19, 58.5% a BMI of 20. For adolescents, 80.4% came within 2 kg of their target weight; 76.1% came within 1 kg. DISCUSSION: Refeeding patients with AN using a hospital-based, behavioral protocol may be accomplished safely and more rapidly than generally recognized, weight restoring most patients by discharge. Helpful elements may include the program's integrated, step-down structure; multidisciplinary team approach emphasizing group therapy to effect behavior change; and close medical monitoring for those with BMI < 15.
Authors: Laura K Fischer; Colleen C Schreyer; Allisyn Pletch; Marita Cooper; Irina A Vanzhula; Graham W Redgrave; Angela S Guarda Journal: Eat Weight Disord Date: 2022-08-22 Impact factor: 3.008
Authors: Meredith Kells; Matt Gregas; Barbara E Wolfe; Andrea K Garber; Susan Kelly-Weeder Journal: Nutr Clin Pract Date: 2021-09-08 Impact factor: 3.204
Authors: Sophia Dalenbrook; Silke Naab; Andrea K Garber; Christoph U Correll; Ulrich Voderholzer; Verena Haas Journal: J Clin Med Date: 2022-05-05 Impact factor: 4.964
Authors: Andrea K Garber; Susan M Sawyer; Neville H Golden; Angela S Guarda; Debra K Katzman; Michael R Kohn; Daniel Le Grange; Sloane Madden; Melissa Whitelaw; Graham W Redgrave Journal: Int J Eat Disord Date: 2015-12-12 Impact factor: 4.861
Authors: Katherine Schaumberg; Elisabeth Welch; Lauren Breithaupt; Christopher Hübel; Jessica H Baker; Melissa A Munn-Chernoff; Zeynep Yilmaz; Stefan Ehrlich; Linda Mustelin; Ata Ghaderi; Andrew J Hardaway; Emily C Bulik-Sullivan; Anna M Hedman; Andreas Jangmo; Ida A K Nilsson; Camilla Wiklund; Shuyang Yao; Maria Seidel; Cynthia M Bulik Journal: Eur Eat Disord Rev Date: 2017-10-02