Good nutritional management is essential to the treatment of
anorexia nervosa. However, there is relatively little guidance on
nutrition available to professionals treating this serious
disorder. This report was produced by a multidisciplinary group
which included specialists in eating disorders in adults and
children, dietitians and experts in clinical nutrition.
Nutrition should always be considered in its psychological
context. Patients require comprehensive physical, nutritional and
laboratory assessment. Aggressive attempts to drive weight gain
early in treatment are potentially dangerous. The first stage of
treatment includes correction of hypoglycaemia, electrolyte
disturbance and dehydration and stabilization of cardiovascular
function. The second stage is the correction of nutrient
deficiencies and the third is correction of body composition.
Biochemical disturbances are common but measurements of
electrolytes in the blood may mask a significant deficit.
Electrolyte supplementation is often required and micronutient
supplementation is recommended. Iron supplements may be dangerous
during the early stages of treatment.
A weekly weight gain of 0.5 – 1.0 kg is suggested for
in-patients and 0.5 kg for out-patients. The amount of food should
be limited at first, and increased slowly. The early stages of
refeeding are a high-risk period and close medical monitoring is
required. Refeeding can unmask hidden biochemical deficiencies and
hypophosphataemia may develop rapidly.
Enteral feeding has a limited role. The decision to use it
should be considered carefully as it may be very distressing to the
patient. It may be needed as a life-saving measure but should be
used for the minimum length of time. Enteral feeding requires a
clinical team skilled in its use; detailed advice is
provided.
Eating disorders services for children and adolescents should
be staffed by clinicians experienced in work with this group.
Anorexia nervosa can develop without weight loss during a stage of
expected growth. Weight loss may be underestimated if calculated on
the BMI alone and we recommend the use of BMI centiles up to the
age of 20. The management plan should always be presented in an
age-appropriate manner and the patient’s co-operation should gained
if possible. The involvement of parents is vital.
Target audience
- Psychiatrists, nurses and other mental health professionals
involved in the treatment of eating disorders.
- Adult physicians and paediatricians treating patients with
anorexia nervosa.
- Dietitians.
- General practitioners.
- Psychotherapists and counsellors working with eating
disorders.