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. 2025 Dec 25.
doi: 10.1002/erv.70074. Online ahead of print.

High-Caloric Realimentation and Mental and Physical Well-Being in Patients With Extreme Anorexia Nervosa. A Prospective Study

Ulrich Voderholzer  1   2   3 , Juliane Silbernagl  2 , Verena Haas  4 , Ulrich Cuntz  2   5 , Silke Naab  2 , Norbert Quadflieg  1   2
Affiliations

High-Caloric Realimentation and Mental and Physical Well-Being in Patients With Extreme Anorexia Nervosa. A Prospective Study

Ulrich Voderholzer et al. Eur Eat Disord Rev. .

Abstract

Objective: While high caloric realimentation (HCR) is increasingly recommended for quick weight restoration of patients with anorexia nervosa (AN), the development of AN-specific psychopathology and somatic symptoms during HCR have so far insufficiently been studied.

Method: Patients hospitalised for the treatment of AN received oral realimentation starting with 2000 kcal under close medical monitoring and a substitution regimen. Weekly over the initial 6 weeks of treatment, assessments included body weight, drive for thinnesss, body dissatisfaction, depression, and somatic symptoms.

Results: In 46 patients (mean age 27.57 years, 2 males, 44 females), the body mass index increased from 12.6 (SD 1.1) at baseline to 14.4 (SD 1.0) kg/m2 (p < 0.001) at week 6 (d = 2.57). Drive for thinnesss did not change (28.9 [SD 10.2] to 27.7 [SD 10.8]; p = 0.102), while body dissatisfaction increased slightly from 37.3 (SD 7.8) to 39.1 (SD 9.2; p = 0.019; d = 0.41). Depression and somatic symptoms decreased significantly (p < 0.001) with large effect sizes (d = 1.09, d = 0.90, respectively). No case of refeeding syndrome was encountered.

Discussion: HCR was medically safe and associated with a decrease in depressive and somatic symptoms at only slight increase in body dissatisfaction. Fast realimentation brings patients with extreme AN quickly out of a weight range dangerous to their health.

Keywords: anorexia nervosa; eating disorders; high‐caloric realimentation; outcome; psychological symptoms.

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