Abstract
Restoration of weight and nutritional status are key elements in the treatment of anorexia nervosa (AN). This review aims to describe issues related to the caloric requirements needed to gain and maintain weight for short and long-term recovery for AN inpatients and outpatients.We reviewed the literature in PubMed pertaining to nutritional restoration in AN between 1960–2012. Based on this search, several themes emerged: 1. AN eating behavior; 2. Weight restoration in AN; 3. Role of exercise and metabolism in resistance to weight gain; 3. Medical consequences of weight restoration; 4. Rate of weight gain; 5. Weight maintenance; and 6. Nutrient intake.A fair amount is known about overall caloric requirements for weight restoration and maintenance for AN. For example, starting at 30–40 kilocalories per kilogram per day (kcal/kg/day) with increases up to 70–100 kcal/kg/day can achieve a weight gain of 1–1.5 kg/week for inpatients. However, little is known about the effects of nutritional deficits on weight gain, or how to meet nutrient requirements for restoration of nutritional status.This review seeks to draw attention to the need for the development of a foundation of basic nutritional knowledge about AN so that future treatment can be evidenced-based.
Highlights
Anorexia nervosa (AN) is a complex and frequently intractable illness of unknown etiology that is often chronic and disabling
It is our clinical experience that the use of reason, insight, and intuition are of limited efficacy in convincing an individual suffering from AN to eat
If this is not true, there is little in the way of rigorously evidence in the literature to support such contentions with current practices of refeeding in AN being highly subjective and having limited backing in scientific research
Summary
Anorexia nervosa (AN) is a complex and frequently intractable illness of unknown etiology that is often chronic and disabling. It is characterized by aberrant feeding behaviors, an extreme pursuit of thinness and emaciation, and body image distortions. Onset tends to occur in females during adolescence and up to 0.7% of this age group may be affected, [1,2], while the current lifetime prevalence estimate of this illness is 0.3% [3]. Two subtypes of eating-related behaviors in AN are typically described. Restricting-type anorexics (R-AN) lose weight purely by dieting and exercising without binge eating or purging. Binge-eating/purging-type anorexics (BP-AN) restrict their food intake and exercise to lose weight, but periodically engage in binge eating and/or purging
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