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Randomized Controlled Trial
. 2023 Jun;56(6):1219-1227.
doi: 10.1002/eat.23931. Epub 2023 Mar 15.

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

Erin C Accurso  1 , Jing Cheng  2 , Vanessa I Machen  3 , Sara Buckelew  3 , Anna Kreiter  4 , Sally Adams  3 , Daniel Le Grange  1   5 , Neville H Golden  4 , Andrea K Garber  3
Affiliations
Randomized Controlled Trial

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

Erin C Accurso et al. Int J Eat Disord. 2023 Jun.

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.

Keywords: anorexia nervosa; atypical anorexia nervosa; food refusal; high calorie; mealtime distress; medical stabilization; negative affect; positive affect; refeeding; treatment acceptability.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr. Le Grange receives royalties from Guilford Press and Routledge and is co-director of the Training Institute for Child and Adolescent Eating Disorders, LLC. The other authors have no financial relationships relevant to this article to disclose.

Figures

Figure 1.
Figure 1.
Change in mealtime distress by treatment (n = 40).
Figure 2.
Figure 2.
Change in self-reported negative affect by level of eating disorder psychopathology (n = 40).
Figure 3.
Figure 3.
Change in self-reported positive affect by level of eating disorder psychopathology and duration of illness (n = 40).
See this image and copyright information in PMC

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