High-Caloric Realimentation and Mental and Physical Well-Being in Patients With Extreme Anorexia Nervosa. A...

While high caloric realimentation (HCR) is increasingly recommended for quick weight restoration of patients with anorexia nervosa (AN), the development of AN-specific psychopathology and somatic symptoms during HCR have so far insufficiently been studied.

Patients hospitalised for the treatment of AN received oral realimentation starting with 2000 kcal under close medical monitoring and a substitution regimen. Weekly over the initial 6 weeks of treatment, assessments included body weight, drive for thinnesss, body dissatisfaction, depression, and somatic symptoms.

In 46 patients (mean age 27.57 years, 2 males, 44 females), the body mass index increased from 12.6 (SD 1.1) at baseline to 14.4 (SD 1.0) kg/m² (p < 0.001) at week 6 (d = 2.57). Drive for thinnesss did not change (28.9 [SD 10.2] to 27.7 [SD 10.8]; p = 0.102), while body dissatisfaction increased slightly from 37.3 (SD 7.8) to 39.1 (SD 9.2; p = 0.019; d = 0.41). Depression and somatic symptoms decreased significantly (p < 0.001) with large effect sizes (d = 1.09, d = 0.90, respectively). No case of refeeding syndrome was encountered.

HCR was medically safe and associated with a decrease in depressive and somatic symptoms at only slight increase in body dissatisfaction. Fast realimentation brings patients with extreme AN quickly out of a weight range dangerous to their health.