Gail Anderson

Higher Caloric Refeeding Is Safe in Hospitalised Adolescent Patients with Restrictive Eating Disorders.

Introduction. This study examines weight gain and assesses complications associated with refeeding hospitalised adolescents with restrictive eating disorders (EDs) prescribed initial calories above current recommendations. Methods. Patients admitted to an adolescent ED structured “rapid refeeding” program for >48 hours and receiving ≥2400 kcal/day were included in a 3-year retrospective chart review. Results. The mean (SD) age of the 162 adolescents was 16.7 years (0.9), admission % median BMI was 80.1% (10.2), and discharge % median BMI was 93.1% (7.0). The mean (SD) starting caloric intake was 2611.7 kcal/day (261.5) equating to 58.4 kcal/kg (10.2). Most patients (92.6%) were treated with nasogastric tube feeding. The mean (SD) length of stay was 3.6 weeks (1.9), and average weekly weight gain was 2.1 kg (0.8). No patients developed cardiac signs of RFS or delirium; complications included 4% peripheral oedema, 1% hypophosphatemia (<0.75 mmol/L), 7% hypomagnesaemia (<0.70 mmol/L), and 2% hypokalaemia (<3.2 mmol/L). Caloric prescription on admission was associated with developing oedema (95% CI 1.001 to 1.047; p = 0.039). No statistical significance was found between electrolytes and calories provided during refeeding. Conclusion. A rapid refeeding protocol with the inclusion of phosphate supplementation can safely achieve rapid weight restoration without increased complications associated with refeeding syndrome.

Understanding affective and cognitive self-evaluations about the body for adolescent girls.

OBJECTIVE The aim of this study was to understand relations between cognitive and affective self-evaluations about the body for adolescent girls in the context of their diverse experiences of the body. METHOD The project involved adolescent girls (N = 141), including underweight to overweight schoolgirls, and hospitalized girls with anorexia nervosa (AN). Materials were brief, reliable inventories of self-concepts about body, movement and appearance, and feelings about the body. RESULTS Measurement models confirmed the related yet discrete self-concepts about the body, movement and appearance, and feeling OK, guilt, worry, disgust, and anger about the body. Self-concepts and feelings were not correlated with body weight, and were sensitive and specific for girls with AN versus low-weight schoolgirls. Relations among self-concepts and feelings about the body vary with the context. In particular, self-concepts and feelings about the body were incongruent for AN girls with acute experiences of making self-evaluations of their bodies. DISCUSSION It is clear that self-evaluations by adolescent girls do not necessarily reflect actual body weight. Findings suggest that associations between thoughts and feelings about the body vary with diverse experiences of the body. Results support brief, reliable, and valid indicators of self-concepts and feelings about the body that are vital in the design of prevention, intervention, and monitoring, and the evaluation of programmes for girls in clinical and educational settings.

Subacute combined degeneration of the spinal cord in an adolescent male with avoidant/restrictive food intake disorder: A clinical case report.

Avoidant/restrictive food intake disorder (ARFID) is a potentially lethal eating disorder. This case example of a male, G, aged 17 years with ARFID illustrates the multiplicity of health problems related to nutritional deficiencies which may develop in an adolescent of normal weight. Of particular concern was the diagnosis of subacute combined degeneration (SCD) of the spinal cord and the real possibility that G may have irreversible damage to his spinal cord. To our knowledge, this is the first reported case of a patient with SCD of the spinal cord due to ARFID. The adolescent was found to be deficient in Vitamin A, E, K, D, B12, and folate. Management required vitamin replacement, initial nasogastric feeding and the slow introduction of a varied diet. This patient will require long term rehabilitation. Medical practitioners need to be attuned to abnormal eating patterns in children and adolescents and refer for specialist care early.Avoidant/restrictive food intake disorder (ARFID) is a potentially lethal eating disorder. This case example of a male, G, aged 17 years with ARFID illustrates the multiplicity of health problems related to nutritional deficiencies which may develop in an adolescent of normal weight. Of particular concern was the diagnosis of subacute combined degeneration (SCD) of the spinal cord and the real possibility that G may have irreversible damage to his spinal cord. To our knowledge, this is the first reported case of a patient with SCD of the spinal cord due to ARFID. The adolescent was found to be deficient in Vitamin A, E, K, D, B12, and folate. Management required vitamin replacement, initial nasogastric feeding and the slow introduction of a varied diet. This patient will require long term rehabilitation. Medical practitioners need to be attuned to abnormal eating patterns in children and adolescents and refer for specialist care early.

Anorexia Nervosa, Anxiety and the Clinical Implications of Rapid Refeeding

The current study aimed to examine the temporal relationship between anxiety symptoms and weight gain for adolescents with anorexia nervosa over the course of an inpatient admission targeting weight restoration through rapid refeeding. Participants were 31 females presenting to a specialist inpatient unit. Psychometric assessments using standardized procedures were conducted to assess co-morbid anxiety diagnoses, and eating disorder symptom severity at admission and discharge. Study protocols were completed on a weekly basis over the course of their admission and were compared with weekly BMI change. Multiple mixed-effects linear models with random intercepts were used to assess change in weight status and psychological variables. Results indicated a reduction in anxiety over the course of hospitalization; however, there was no evidence to support a relationship between anxiety change and weight restoration. The clinical implications of these results are discussed and directions for future research recommended.

Adolescent patients’ perspectives on rapid-refeeding: a prospective qualitative study of an inpatient population

ABSTRACT In this study, we aimed to examine the psychological experience over the course of an inpatient treatment implementing rapid-refeeding protocol for adolescent patients with anorexia nervosa (AN). Ten female participants were included in the study and interviews were conducted on a weekly basis over the course of their admissions. Interviews were audio-recorded and analysed according to the principles of thematic analysis. Results revealed a multidimensional process broadly implicating three phases of treatment; reconciling with the ‘AN’ diagnosis, adjustment to treatment, and reflection and integration. Overall, these phases demonstrated a complex and often ambivalent psychological process whereby acceptance for physical and medical interventions was often in conflict with individuals’ affective experiences. Clinical implications of these findings are discussed and avenues for future research highlighted.

Making the most of an admission: the safety and efficacy of higher caloric refeeding in hospitalised adolescents with restrictive eating disorders

Results The mean (SD) age of the 184 adolescents was 16.7 years (0.9). Mean (SD) admission BMI was 16.9kg/m2 (2.3) and discharge BMI was 19.5kg/m2 (1.5). The mean (SD) starting caloric intake was 2523.6kcal/day (383.5) equating to 56kcal/kg (12). Most patients (87.5%) were treated with nasogastric tube feeding. Mean (SD) length of stay was 3.5 weeks (1.9) with a weekly weight gain of 2.1kg (0.9). No patients developed cardiac signs of refeeding syndrome or delirium; complications included peripheral oedema (3.8%), hypophosphatemia (1.1%), hypomagnesaemia (6%), and hypokalaemia (1.6%). Caloric prescription on admission was not associated with developing hypophosphatemia (p=0.15), hypokalaemia (p=0.40) and hypomagnesaemia (p=0.96). Conclusion Results demonstrated the efficacy of treating adolescent inpatients with restrictive EDs safely with higher initial caloric intakes, resulting in rapid weight restoration without major refeeding complications; which challenges current conservative calorie prescriptions advocated in clinical guidelines.

An audit of a high caloric refeeding regimen used for medically unstable adolescent inpatients with severe restrictive eating disorders

Results Median age 16.6 years (range: 14.7 19.9), median BMI 16.2 kg/m2 (12.4 18.5) on admission. Median weight gain in first week 4.0 kg (1.2 – 6.9), median total weight gain 7.8 kg (3.3 18.3). Median BMI on discharge 19.1 kg/m2 (16.4 21.0). Median length of stay 24.4 days (6.0 – 82.3 days). No admissions resulted in refeeding syndrome. Peripheral oedema and/or mild electrolyte abnormality occurred in 20.4% of admissions.