Refeeding and weight restoration outcomes in anorexia nervosa: Challenging current guidelines

Graham W. Redgrave, Janelle W. Coughlin, Colleen C. Schreyer, Lindsay M. Martin, Anne K. Leonpacher, Margaret Seide, Antonia M. Verdi, Allisyn Pletch, Angela S. Guarda

Research output: Contribution to journalArticlepeer-review

55 Scopus citations


Objective Cohort study from February 2003 through May 2011 to determine weight restoration and refeeding complication outcomes for patients with anorexia nervosa (AN) treated in an integrated inpatient-partial hospital eating disorder program designed to produce rapid weight gain and weight restoration in the majority. Method Consecutive admissions (females and males, adolescents and adults; N-=-361 patients, 461 admissions) at least 1.8 kg below target weight with AN or subthreshold variants were included. Main outcome measures were rates of hypophosphatemia, transfer to medicine, or death; rates of weight gain and percent achieving weight restoration. Results Hypophosphatemia was present in 7.9% of cases at admission and in 18.5% at some point during treatment. Hypophosphatemia was mild to moderate. Lower admission body mass index (BMI), but not rate of weight gain, predicted hypophosphatemia [OR-=-0.65; p-<-.00001 (95% CI 0.57-0.76)]. Five patients (1.1%) were transferred to medicine or surgery, none because of refeeding. There were no deaths. Mean inpatient weight gain was 1.98 kg/week; mean partial hospital weight gain was 1.36 kg/week. By program discharge, 71.8% of adults reached a BMI of 19, 58.5% a BMI of 20. For adolescents, 80.4% came within 2 kg of their target weight; 76.1% came within 1 kg. Discussion Refeeding patients with AN using a hospital-based, behavioral protocol may be accomplished safely and more rapidly than generally recognized, weight restoring most patients by discharge. Helpful elements may include the program's integrated, step-down structure; multidisciplinary team approach emphasizing group therapy to effect behavior change; and close medical monitoring for those with BMI-<-15.

Original languageEnglish (US)
Pages (from-to)866-873
Number of pages8
JournalInternational Journal of Eating Disorders
Issue number7
StatePublished - Nov 2015


  • anorexia nervosa
  • hypophophatemia
  • refeeding syndrome
  • weight restoration

ASJC Scopus subject areas

  • Psychiatry and Mental health


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