Nutrition Approaches for Treatment of Anorexia


Weight gain is a top priority for patients with anorexia nervosa.  Like giving a beta-blocker to someone with high blood pressure, food is used as medicine to treat the physical complications of anorexia nervosa.  Unfortunately the “best approach” to reintroducing food has not been established and is a topic of debate among professionals.  This blog post we explore the current approaches to refeeding patients with anorexia as described by the New York Times article by Roni Caryn Rabin and introduce you to our approach at the Inner Door Center®.

The “Start Low, Go Slow” Approach

For years, practitioners have been using the “start low, go slow” technique for refeeding a patient with anorexia nervosa.  In this approach, patients are started at a low calorie level – typically around 1200 calories – and gradually increased by 200 calories every other day.  This cautious method is used to prevent “refeeding syndrome” – a potentially fatal electrolyte imbalance that sometimes occurs when reintroducing food to a malnourished person.  Unfortunately this method does not typically result in weight gain; in fact, one study showed that patients initially lost weight when beginning treatment and some were unable to gain any weight at all.

A More Aggressive Approach

Newer regimens being introduced in some treatment centers start patients at a higher calorie level – around 1900 calories – and sometimes increase to levels over 3000 calories within a couple of weeks.  This approach not only puts patients at a high risk for refeeding syndrome, but may also cause digestive issues like constipation, diarrhea, vomiting and reflux problems.  This regimen can also be psychologically traumatic for patients – imagine someone with anorexia, whose greatest fear is gaining weight, consuming so many calories and gaining weight so quickly.  Often times when these patients leave treatment they relapse, and it may stall their recovery because of how traumatic the experience is.

Inner Door Center®’s Individualized Approach

At the Inner Door Center®, you will receive individualized care based on your personal needs.  We know and understand that every person’s recovery is unique and requires a different level of structure.  We provide a minimum level of structure centered around eating – for example, in our Partial Hospitalization Program you will eat two snacks and one meal with us on a regular schedule.  Our registered dietitian and interns have worked to create meal plans that focus on healthy portion sizes.  We also work on intuitive eating techniques during our lunch sessions.  It is important to note that while you are in the throes of an eating disorder, it is not possible to work on intuitive eating.  That is why we offer the level of structure that we do to help you in your recovery, and then you can use intuitive eating when you are ready.  During one-on-one sessions with the registered dietitian, you will learn how to create your own meal plan that is not based on calories, but on food groups and portion sizes to get you the energy and nutrients that you need.  You will learn about basic nutrition in our weekly nutrition focus group and how you can apply it to your own life.

What About Calorie Counts?

You might have noticed that we don’t mention certain calorie levels or feeding techniques in our treatment program.  While the registered dietitian will assess a calorie level for you, we don’t feel that it is necessary to share that calorie level with you.  Depending on your course of treatment, your calorie level may change over time.  The meal plan that you will receive that focuses on food groups and portion sizes will provide you with enough calories without stating an actual calorie goal.  We believe that when clients are focused on a number of calories to reach each day that they continue to be disconnected with their hunger and fullness cues.

If you have any questions or thoughts about our program here at Inner Door Center®, please feel free to leave a comment or contact us directly: office@innerdoorcenter.com or (248) 336-2868.  To learn more about the programs offered at Inner Door Center® for eating disorder recovery and substance abuse recovery, please visit our website: www.innerdoorcenter.com.

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