Editorial: Refeeding in Anorexia Nervosa: Quo Vadis?

Abstract

Refeeding is the cornerstone of treatment in anorexia nervosa (AN), a life-threatening eating disorder characterized by severe undernutrition. During refeeding, patients typically gain a large proportion of their body weight within a couple of weeks or months. The aims of this drastic nutritional intervention are mainly somatic stability and the improvement of the mental state of the patient, as a prerequisite for psychotherapy. There has been a recent trend away from the conventional low-calorie "start low, go slow" refeeding approach to higher calorie refeeding with a more rapid weight gain, shorter hospitalization time, and consequently, psychosocial and economic benefits. In favor of higher calorie refeeding, the rate of initial weight gain has been shown to predict weight recovery.¹ Furthermore, recent neuroimaging studies suggest that the widespread reductions of gray matter volume and cortical thickness in acutely underweight AN patients abate rapidly after refeeding.² Although the first studies provided evidence for the relative safety of higher calorie refeeding, particularly in the refeeding syndrome, a rare but possibly fatal complication,^3,4 little is known about less acute side effects. However, relative to its significant clinical importance, the topic is understudied, and guidelines vary considerably across different countries. The clinical review at the focus of this editorial seeks to advance the medical literature by juxtaposing the details of refeeding protocols of 3 well-known specialized eating disorder centers.