Hospital‐based higher calorie refeeding and mealtime distress in adolescents and young adults with anorexia nervosa or atypical anorexia nervosa

Abstract

Objective The StRONG study demonstrated that higher calorie refeeding (HCR) restored medical stability faster in patients hospitalized with anorexia nervosa (AN) and atypical AN (AAN), with no increased safety events compared with standard‐of‐care lower calorie refeeding (LCR). However, some clinicians have expressed concern about potential unintended consequences of HCR (e.g., greater mealtime distress). The purpose of this study was to examine patient treatment preference and compare mealtime distress, food refusal, and affective states between treatments. Method Participants (N = 111) in this multisite randomized clinical trial were ages 12–24 years, with AN or AAN, admitted to hospital with medical instability who received assigned study treatment (HCR or LCR). Treatment preference was assessed prior to randomization in the full sample. In a subset of participants (n = 45), linear mixed effect models were used to analyze momentary ratings of mealtime distress (pre, during, and post‐meals) and daily affective state during the hospitalization. Results About half (55%) of participants reported a preference for LCR. Treatment assignment was not associated with food refusal, mealtime distress, or affective states in the subsample. Food refusal increased significantly over the course of refeeding (p = .018). Individuals with greater depression experienced more negative affect (p = .033), with worsening negative affect over time for individuals with higher eating disorder psychopathology (p = .023). Discussion Despite understandable concerns about potential unintended consequences of HCR, we found no evidence that treatment acceptability for HCR differed from LCR for adolescents and young adults with AN and AAN. Public Significance The efficacy and safety of higher calorie refeeding in hospitalized patients with anorexia nervosa has been demonstrated. However, it is not known whether higher calorie refeeding (HCR) increases meal‐time distress. This study demonstrated that HCR was not associated with increased mealtime distress, food refusal, or affective states, as compared with lower calorie refeeding. These data support HCR treatment acceptability for adolescents/young adults with anorexia nervosa and atypical anorexia nervosa.

Short‐term outcomes of the study of refeeding to optimize inpatient gains for patients with atypical anorexia nervosa

“…However, the safety and efficacy of higher dosages during hospitalizations and outcomes during follow-up must be investigated in patients with atypical AN, including psychological safety. We previously examined the effect of refeeding on mealtime distress and, while we found no difference between LCR and HCR, mealtime distress did significantly increase in relation to caloric dose (Accurso et al, 2023).…”

An exploration of the association between premorbid weight status on patient and caregiver factors at pre and post-treatment among youth with anorexia nervosa/atypical anorexia nervosa

“…The following variables were extracted from electronic health records: age, gender identity, race, ethnicity, medication prescribed (yes/no), psychiatric comorbidity (yes/no and diagnosis), illness duration (months), number of sessions attended, length (in months) of treatment (from first session to discharge), participation in other levels of care, reasons for not continuing in care, highest premorbid BMI percentile and percent of median BMI (%mBMI), baseline BMI percentile and %mBMI. Rate of weight loss was determined by dividing %mBMI loss (%mBMI at highest weight to baseline) by illness duration (months) ( Garber et al, 2019 ) and all %mBMI were based on age-and-sex based norms ( CDC, 2017 ) Weight suppression was calculated by subtracting baseline % mBMI from the highest %mBMI ( Accurso et al, 2023 ; Witt et al, 2014 ). Expected body weight (EBW) and percent of EBW (%EBW) at baseline were determined and entered into health records by dietitians via growth chart review.…”

Estratégias De Nutrição Comportamental No Manejo Da Anorexia Nervosa E Bulimia

“…Todos os descritores foram associados com operadores booleanos AND e OR. possuíam AN 15,[19][20][21] . Segundo Herzog et al 15 é fundamental começarmos tratar de forma precoce e abrangente indivíduos com AN, levando em consideração não apenas o ganho de peso, mas também as comorbidades associadas, podendo melhorar significativamente as chances de recuperação e a qualidade de vida dos pacientes.…”

“…Segundo Herzog et al 15 é fundamental começarmos tratar de forma precoce e abrangente indivíduos com AN, levando em consideração não apenas o ganho de peso, mas também as comorbidades associadas, podendo melhorar significativamente as chances de recuperação e a qualidade de vida dos pacientes. De acordo com Accurso et al 19 , a administração de uma dieta com alto teor calórico a pacientes hospitalizados com AN demonstra eficácia e segurança.…”