Refeeding Process

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Q & A: Refeeding Process

Q: What are the medical approaches and consequences of the refeeding process?

A: Refeeding refers to providing adequate calories and nourishment to severely underweight anorexia nervosa patients. For those who have moderately-severe anorexia nervosa, staged oral refeeding—sitting at a table and eating a prescribed amount of calories—remains the mainstay of this process.

Reintroducing food to a malnourished person, however, has risks and complications if pursued without expertise. Anorexic patients who begin eating normal foods may encounter adverse side effects such as constipation, bloating, and stomach pain. Findings that indicate the refeeding process is proceeding too quickly are the development of significant swelling in the legs or feet (edema), a steady increase in the pulse rate into the 70–80 per minute range, and the new presence of shortness of breath.

In more severe cases, refeeding syndrome occurs. This refers to the cardiac complications induced by giving too many calories too early in the refeeding process. The resulting problems may include cardiac difficulties ranging from decreased exercise tolerance to major heart abnormalities that can cause fainting and death. Therefore, it is important to involve a dietician, and for the most acute anorectics who are more than 25 percent below their ideal body weight (IBW), an experienced primary care physician.

In general, weight gain should be limited to 1.5–2 pounds per week in an outpatient setting, or 2–3 pounds per week in a closely-monitored inpatient environment. The initial caloric intake is generally in the 800 calories per day range with increases of 300–400 calories every 3–4 days to achieve the targeted weight gain. Blood tests should check levels of sodium, potassium, bicarbonate, magnesium, and phosphorous every few days in the first weeks. Because the body shifts to a protein-building mode with the reintroduction of adequate calories, phosphorous can be quickly depleted within 1–2 days.

As long as the refeeding process is well planned, problems can be averted. Patients will benefit by establishing a target-weight, following a dietary plan that begets a weight gain that does not exceed the recommended ranges, and having frequent blood tests. The patient should pay particular and honest attention to changes in physical status and promptly report any concerns to his or her treatment team.

By Philip S. Mehler, MD
Reprinted with permission from Eating Disorders Recovery Today
Summer 2005 Volume 3, Number 3
©2005 Gürze Books

About the Author

Philip S. Mehler, MD, practices at the Denver Health Medical Center where he was formerly the Chief of Internal Medicine and is now the Associate Medical Director. He is also a Professor of Medicine at the University of Colorado Health Sciences Center.

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