When it comes to treating patients hospitalized with anorexia nervosa, clinicians have long thought that a fast weight gain approach would be too traumatic. But a new study led by Johns Hopkins’ Angela Guarda has strengthened the case for promoting rapid weight gain as part of overall efforts for a comprehensive treatment plan.
After analyzing data regarding 149 adult inpatients with anorexia nervosa in the Johns Hopkins Eating Disorders Program, researchers found that a majority of patients not only tolerated the regimen, they also met their weight gain goals in weeks rather than months, they would recommend the program to others, and they would be willing to repeat it if needed.
The findings suggest that inpatient eating disorder programs that focus on rapid weight gain can minimize a patient’s time away from home, work and family; help curb treatment costs by reducing lengths of stay in a hospital or residential treatment program and be rated helpful by most patients, says Guarda, director of the Eating Disorders Program at The Johns Hopkins Hospital.
“Treating anorexia is expensive due to the high cost of inpatient and residential treatment, and the cost of health care is important to both patients and health systems,” she says. “Our findings suggest that a meal-based nutritional approach that emphasizes faster weight gain coupled with different types of behavioral therapy and meal support is well tolerated and achieves weight restoration in a majority of patients.”
The report appears in the International Journal of Eating Disorders.
Earlier work by Guarda and others countered the belief that patients with anorexia need to gain weight slowly to avoid a potentially life-threatening condition called re-feeding syndrome, which is a metabolic imbalance that can occur when severely malnourished people take in too much food or drink. Despite these safety studies, clinicians are still reluctant to implement rapid re-feeding strategies, combined with behavioral treatment approaches, because they fear that patients won’t endure them. With the new study, Guarda and her team sought the patients’ perception of the Johns Hopkins rapid re-feeding program.
“Our program is solely meal-based and does not employ tube feeding,” says Guarda. Occupational therapists and nursing and dietitian staff members assist patients in preparing and portioning meals, and in eating food prepared by others in cafeteria and restaurant settings. “We want to help our patients translate what they’re learning here to a more real-world environment so they can stay healthy once back at home.”
According to Guarda, most patients go to inpatient programs like the one at Johns Hopkins under pressure from family members, employers or a significant other, and they are often anxious about entering treatment. “At the beginning, they often don’t see the need to be here,” she says, “but these results show that for most patients, their overall perception is positive by the end of treatment.”