Anorexia Treatment: Nutritional, Medical, and Psychiatric

Treatment for Anorexia

Jennifer Huddy, MS, RD, LD

Registered Dietitian and Nutrition Writer

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Anorexia is a high-risk eating disorder that can lead to serious health complications if left untreated. If you or a loved one has been diagnosed with anorexia, finding a treatment option that matches the individual’s current medical, psychological, and nutritional risk is essential.

People with anorexia can be hesitant to change their disordered eating patterns due to an extreme fear of gaining weight. The very first step in treatment is accepting the need to change.

Following this, the primary pillars of anorexia treatment involve restoring weight and addressing the individual’s body image and relationship with food. The patient must be motivated to get better to be successful. Otherwise, they may hold on to the disordered behaviors related to anorexia even once the weight has been restored.

Levels of Care

Different levels of care are available depending on how medically and psychiatrically stable the patient is. A thorough assessment from a medical professional can help determine which level of care an individual with anorexia would most benefit from starting with.

Once matched with the appropriate level of care, the individual generally works through the different levels as their condition improves.

The common thread between these levels of care is the presence of a multidisciplinary team, which may include doctors, dietitians, therapists, psychiatrists, and social workers. The team works together to address all aspects of treatment.

Inpatient

Inpatient treatment takes place in the hospital and is typically utilized when the patient is medically and psychiatrically unstable. Patients with anorexia who meet specific cutoffs for low heart rate, blood pressure, body temperature, and body fat are recommended to seek inpatient care.

Additional criteria for inpatient care include a weight less than 75% of the ideal body weight, refusal to eat, suicidal ideation, and lack of improvement from outpatient care.

There is evidence that utilizing inpatient care for a short time during severe medical or psychiatric complications can lead to a lower mortality risk from anorexia.

Residential

Residential treatment is the next step down from inpatient care. It still involves 24/7 care but is used for medically stable patients. The focus here is on nutritional and psychiatric treatment.

Partial hospitalization (PHP)

Partial hospitalization treatment is utilized when the patient requires daily monitoring and continues engaging in disordered eating behaviors such as intense restriction. Patients attend the program during the day on weekdays and go home at night.

Intensive outpatient (IOP)

Intensive outpatient treatment focuses on patients who are both medically and psychologically stable. They can engage with everyday situations without hindering recovery progress but still need support to stay on track. It typically involves attendance in the program a few days per week for 2-3 hours each time.

Outpatient

Outpatient care is the least intensive level of treatment for anorexia. It usually involves weekly sessions with a therapist and dietitian once the patient has “graduated” from higher levels of care.

Ongoing outpatient care is essential in maintaining progress and attaining recovery. Nourish offers specialized outpatient eating disorder treatment by registered dietitians. All appointments are completed virtually and are covered by insurance, making anorexia treatment easily accessible.

Types of Treatment

Successful anorexia treatment involves nutritional, medical, and psychiatric interventions.

Nutritional treatment

One of the first interventions and primary focus for treating anorexia is refeeding, or bringing the calorie intake back to an ideal level, with the goal of weight restoration and reversing malnutrition. This is a critical priority for adolescents due to the high risk to proper development brought on by low weight and malnutrition.

The long-term goal of refeeding is for the patient to reach at least 90% of their ideal weight, given their height, age, and sex. In adolescents, the target weight will likely need to be changed every few months to reflect normal growth. During this time, it is essential to limit exercise levels.

Refeeding might involve tube feeding at the inpatient level, particularly if food refusal is at play. Inpatient care is recommended for severe cases of malnutrition due to the risk of refeeding syndrome, which occurs when nutritional intake is increased too quickly. It involves dangerous fluid and electrolyte shifts that must be monitored closely during refeeding.

On the outpatient level, refeeding is generally accomplished through a structured meal plan created and monitored by a registered dietitian. The meal plan includes three meals daily plus snacks and is individualized to meet the patient’s estimated calorie and nutrition needs. Vitamin and mineral supplements are often included during this process as well.

Medical treatment

Inpatient care, if indicated, focuses on stabilizing acute medical issues, such as electrolyte imbalances and cardiac abnormalities. Once the patient is considered medically stable, they may be transferred to the next level of care to continue the refeeding and therapy process.

Weight restoration generally leads to an improvement in many of the medical complications of anorexia. For example, amenorrhea, or the loss of the menstrual cycle in females, can often be resolved within a few months of restoring weight. Heart function, immune function, and bone density can also improve upon attaining an appropriate body weight.

Medications

There have been numerous medications studied for the treatment of anorexia. However, the effectiveness of these medications is limited, and therefore they are not routinely utilized.

For example, antidepressants and antipsychotics have been examined as treatment options, but they tend to come with limited benefits for weight gain. In addition, patients who are medically unstable with malnutrition, cardiac issues, or electrolyte abnormalities may suffer more significant side effects from medication treatment.

Though antidepressants aren’t used to treat anorexia directly, they are essential in treating symptoms of depression and suicidal ideation in patients with anorexia.

Psychological treatment

Psychotherapy is an important pillar of anorexia treatment. It is utilized across all levels of care. Therapy in anorexia focuses on improving body image, building a healthy relationship with food, and providing tools for managing social scenarios that may trigger eating disorder behaviors.

While other eating disorders, like bulimia nervosa, can benefit from short-term therapy options such as cognitive behavioral therapy, patients with anorexia tend to have better outcomes from long-term therapy treatment types. These include family-based therapy, interpersonal psychotherapy, cognitive analytic therapy, group therapy, and many others.

Therapy involving the whole family has been studied extensively and is routinely utilized in treating anorexia, particularly in children and adolescents. Also known as the Maudsley method, family-based therapy supports and teaches family members how to help the patient in their recovery process.

Family-based therapy focuses on treating the physical, behavioral, and psychological aspects of anorexia. The focus is not on the individual but on the family as a whole.

Group therapy is also commonly utilized in eating disorder treatment centers. It involves other patients with the same or similar eating disorder diagnoses. Mindfulness strategies such as yoga and meditation are also incorporated with anorexia treatment, particularly in IOP level of care.

Prognosis

On average, recovery from anorexia takes 5-6 years. A person is considered to have recovered from anorexia when weight restoration has been achieved, and psychological and medical components of the eating disorder are well-controlled. The person can maintain their weight and resume normal daily activities.

In general, adolescents tend to have better long-term outcomes of treatment when compared to adults, indicating that early diagnosis and treatment are essential.

If you need an outpatient level of care for anorexia, Nourish can help. Our registered dietitians work with your multidisciplinary team to help you get the best care possible. Get started today.