Medical Management of Restrictive Eating Disorders in Adolescents and Young Adults

Abstract

The medical provider plays an important role in the management of adolescents and young adults (AYAs) with restrictive eating disorders (EDs), including anorexia nervosa (AN), atypical anorexia nervosa, and avoidant/restrictive food intake disorder. The focus of this article is the medical management of AYAs with restrictive EDs, which can be performed by a number of different medical providers, including pediatricians, family physicians, internists, nurse practitioners, and, in some countries, psychiatrists. This position paper clarifies the role of the medical provider in diagnosing and managing restrictive EDs in AYAs and advocates for consistent standardized terminology for clinical and research purposes when describing the degree of malnutrition and differentiating the degree of malnutrition from treatment goal weight. Boys and men with restrictive EDs are frequently underdiagnosed and may have distinct clinical presentations with important implications for medical management. The medical and psychological complications of AYAs with avoidant/restrictive food intake disorder and atypical anorexia nervosa can be just as severe as those with AN. Scientific evidence supports weight restoration as an important early goal of treatment in AN. Most AYAs with restrictive EDs can be treated as outpatients, and family-based therapy is a first-line outpatient psychological treatment for adolescents with AN. Recent research has demonstrated that inpatient refeeding protocols can start with higher caloric content and advance more rapidly than previously recommended.