Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Restoration of weight and nutritional status are key elements in the treatment of anorexia nervosa (AN). This review aims to describe issues related to the caloric requirements needed to gain and maintain weight for short and long-term recovery for AN inpatients and outpatients.

We reviewed the literature in PubMed pertaining to nutritional restoration in AN between 1960–2012. Based on this search, several themes emerged: 1. AN eating behavior; 2. Weight restoration in AN; 3. Role of exercise and metabolism in resistance to weight gain; 3. Medical consequences of weight restoration; 4. Rate of weight gain; 5. Weight maintenance; and 6. Nutrient intake.

A fair amount is known about overall caloric requirements for weight restoration and maintenance for AN. For example, starting at 30–40 kilocalories per kilogram per day (kcal/kg/day) with increases up to 70–100 kcal/kg/day can achieve a weight gain of 1–1.5 kg/week for inpatients. However, little is known about the effects of nutritional deficits on weight gain, or how to meet nutrient requirements for restoration of nutritional status.

This review seeks to draw attention to the need for the development of a foundation of basic nutritional knowledge about AN so that future treatment can be evidenced-based.

Related collections

Most cited references 82

Record: found
Abstract: found
Article: not found

The outcome of anorexia nervosa in the 20th century.

Hans-Christoph Steinhausen (2002)

The present review addresses the outcome of anorexia nervosa and whether it changed over the second half of the 20th century. A total of 119 study series covering 5,590 patients suffering from anorexia nervosa that were published in the English and German literature were analyzed with regard to mortality, global outcome, and other psychiatric disorders at follow-up. There were large variations in the outcome parameters across studies. Mortality estimated on the basis of both crude and standardized rates was significantly high. Among the surviving patients, less than one-half recovered on average, whereas one-third improved, and 20% remained chronically ill. The normalization of the core symptoms, involving weight, menstruation, and eating behaviors, was slightly better when each symptom was analyzed in isolation. The presence of other psychiatric disorders at follow-up was very common. Longer duration of follow-up and, less strongly, younger age at onset of illness were associated with better outcome. There was no convincing evidence that the outcome of anorexia nervosa improved over the second half of the last century. Several prognostic features were isolated, but there is conflicting evidence. Most clearly, vomiting, bulimia, and purgative abuse, chronicity of illness, and obsessive-compulsive personality symptoms are unfavorable prognostic features. Anorexia nervosa did not lose its relatively poor prognosis in the 20th century. Advances in etiology and treatment may improve the course of patients with anorexia nervosa in the future.

0 comments Cited 204 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight.

Michael Rosenbaum, Jules Hirsch, Dympna A Gallagher … (2008)

After weight loss, total energy expenditure -- in particular, energy expenditure at low levels of physical activity -- is lower than predicted by actual changes in body weight and composition. An important clinical issue is whether this reduction, which predisposes to weight regain, persists over time. We aimed to determine whether this disproportionate reduction in energy expenditure persists in persons who have maintained a body-weight reduction of > or =10% for >1 y. Seven trios of sex- and weight-matched subjects were studied in an in-patient setting while receiving a weight-maintaining liquid formula diet of identical composition. Each trio consisted of a subject at usual weight (Wt(initial)), a subject maintaining a weight reduction of > or =10% after recent (5-8 wk) completion of weight loss (Wt(loss-recent)), and a subject who had maintained a documented reduction in body weight of >10% for >1 y (Wt(loss-sustained)). Twenty-four-hour total energy expenditure (TEE) was assessed by precise titration of fed calories of a liquid formula diet necessary to maintain body weight. Resting energy expenditure (REE) and the thermic effect of feeding (TEF) were measured by indirect calorimetry. Nonresting energy expenditure (NREE) was calculated as NREE = TEE - (REE +TEF). TEE, NREE, and (to a lesser extent) REE were significantly lower in the Wt(loss-sustained) and Wt(loss-recent) groups than in the Wt(initial) group. Differences from the Wt(initial) group in energy expenditure were qualitatively and quantitatively similar after recent and sustained weight loss. Declines in energy expenditure favoring the regain of lost weight persist well beyond the period of dynamic weight loss.

0 comments Cited 118 times – based on 0 reviews      Review now

Bookmark

Record: found
Abstract: found
Article: not found

Enhancing motivation for change in treatment-resistant eating disorders.

Kelly Vitousek, Susan MR Watson, G.Terence Wilson (1998)

Denial and resistance to change are prominent features in most patients with anorexia nervosa. The egosyntonic quality of symptoms can contribute to inaccuracy in self-report, avoidance of treatment, difficulties in establishing a therapeutic relationship, and high rates of attrition and relapse. Individuals with bulimia nervosa are typically more motivated to recover, but often ambivalent about forfeiting the ideal of slenderness and the protective functions of binge-purge behavior. Few attempts have been made to assess denial and resistance in the eating disorders, or to examine alternative strategies for enhancing motivation to change. Review of the clinical literature indicates a striking convergence of recommendations across conceptually distinct treatment approaches. Clinicians are encouraged to acquire a frame of reference that can help them understand the private experience of individuals with eating disorders, empathize with their distress at the prospect of weight gain, and acknowledge the difficulty of change. The Socratic method seems particularly well-suited to work with this population because of its emphasis on collaboration, openness, curiosity, patience, focused and systematic inquiry, and individual discovery. Four themes are crucial in engaging reluctant eating-disordered clients in therapy: the provision of psychoeducational material, an examination of the advantages and disadvantages of symptoms, the explicit use of experimental strategies, and an exploration of personal values.

0 comments Cited 113 times – based on 0 reviews      Review now

Bookmark

All references

Author and article information

Contributors

Enrica Marzola

Jennifer A Nasser

Sami A Hashim

Pei-an Betty Shih

Walter H Kaye

Journal

Journal ID (nlm-ta): BMC Psychiatry

Journal ID (iso-abbrev): BMC Psychiatry

Title: BMC Psychiatry

Publisher: BioMed Central

ISSN (Electronic): 1471-244X

Publication date Collection: 2013

Publication date (Electronic): 7 November 2013

Volume: 13

Page: 290

Affiliations

[1 ]Department of Neuroscience, Section of Psychiatry, University of Turin, Turin, Italy

[2 ]Department of Nutrition Sciences, Drexel University, 19102 Philadelphia, PA, USA

[3 ]Department of Medicine, St. Luke's/Roosevelt Hospital Center, 10025 New York, NY, USA

[4 ]UCSD Department of Psychiatry, University of California, San Diego, 8950 Villa La Jolla Drive, Suite C – 207 La Jolla, 92037 San Diego, CA, USA

Article

Publisher ID: 1471-244X-13-290

DOI: 10.1186/1471-244X-13-290

PMC ID: 3829207

PubMed ID: 24200367

SO-VID: 747ae4d4-339d-4238-9cf5-4434bef56eea

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Nutritional rehabilitation in anorexia nervosa: review of the literature and implications for treatment

Read this article at

Abstract

Related collections

Measurement of Glucocorticoid Receptor Signaling in Major Depression

Most cited references 82

The outcome of anorexia nervosa in the 20th century.

Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight.

Enhancing motivation for change in treatment-resistant eating disorders.

Author and article information

Contributors

Journal

Affiliations

Article

History

Categories

Comments

Comment on this article

Similar content 215

Cited by 54

Most referenced authors 638