The first step in working toward proper nourishment is a thorough nutrition assessment and the development of an individualized plan of care. During the assessment, the RD discovers the history of the eating disorder, including restricting, exercising, binging and/or purging behaviors. This meeting also allows the RD to learn the patient’s motivation for treatment and recovery.
Re-feeding Syndrome
Particularly in persons who are significantly underweight, electrolytes should be carefully monitored and re-feeding should be introduced gradually and progressively . Individuals with anorexia tend to require increasingly more calories to maintain the same rate of weight gain. This means they need to increase their caloric intake continually in steps. If patients are aggressively fed and rehydrated, hypophosphatemia-induced re-feeding syndrome may occur, which could potentially involve:
- Dysrhythmias
- Respiratory failure
- Seizures
- Coma
- Congestive heart failure
- Weakness
- Hemolysis
- Hypotension
- Ileus
- Metabolic acidosis
- Sudden death
Close medical monitoring is important in the early stages of recovery. Studies have found that standard resting energy expenditure (REE) equations tend to overestimate caloric needs at the beginning of re-feeding but underestimate them in the later stages. High sodium intakes increase risk of fluid overexpansion so limiting sodium intake is prudent. Although weight gain is an eventual goal for anorexia patients, calories should be secondary to protein during initial re-feeding. Regaining lost body composition and repairing internal damage takes a lot of time and energy. Sufficient protein and vitamins are necessary for brain and body recovery.
When the body begins to recover, there is a period of re-starting the metabolism, which was slowed down by the illness. This period is often accompanied by anxiety and overheating, making it difficult to eat enough calories to gain weight. This is a temporary side effect, so again close medical monitoring and advice is very important in order to avoid derailing recovery.
Reaching a Healthy Weight
An important part of establishing a healthy goal weight is the patient’s weight history. This includes the patient’s highest/lowest weight and what behaviors led to those particular weights. When a patient has a significant amount of weight to restore, a goal of 2-3 pounds of weight gain per week is normal. When a patient is at or close to her Ideal Body Weight (IBW) the main focus is managing the eating disorder behaviors and progression toward a normal relationship with food.
At The Meadows Ranch, we provide patient’s maintenance calories by way of three balanced meals per day along with snacks. These meals and snacks teach the patient what her meal plan will look like as she continues to recover and maintains a healthy weight. Weight gain calories are provided through medical nutrition supplements or nasogastric tube feeding if necessary. High calorie, nutrient dense supplements or tube feeding formula provide more nutrients and calories with a smaller volume. After achieving a healthy weight, a patient still typically needs to eat more calories than individuals of the same weight that do not have eating disorders to maintain her new healthy weight. This is due to a hypermetabolic period that tends to last between 3 and 6 months after weight restoration.
The patient may have also used compulsive exercising as a means to lose weight. Because exercise is an important part of a healthy lifestyle, we teach the patients guidelines to help them enjoy physical activity without abusing it.
We Are Here to Help
It takes time for nutritional recovery to have an effect on thoughts and behaviors of semi-starvation. The periods of highest anxiety, distress and body image distortion most often occur at the beginning of re-feeding and again right before the patient reaches a healthy weight. Parents and loved ones must remain patient and maintain optimism during the weight restoration process. Recovery from an eating disorder is possible and is happening every day at The Meadows Ranch. For information about our treatment programs, please call 866-390-5100 or Contact Us for more information on how we can help.