Anorexia nervosa (AN) is a serious eating disorder marked by severe restriction of food intake, significantly low body weight, and an intense fear of gaining weight, often accompanied by a distorted perception of body shape or size. AN is a severe mental illness with profound medical and psychological consequences, necessitating comprehensive and specialized treatment. The physical and mental health risks associated with this condition are substantial, often becoming life-threatening without appropriate intervention.
Physical Consequences of Anorexia Nervosa
Prolonged starvation, a hallmark of anorexia nervosa, impacts nearly every organ system. The cardiovascular system is vulnerable, with reduced heart muscle mass, slowed heart rate (bradycardia), and low blood pressure (hypotension). These changes can lead to dizziness, fatigue, and an increased risk of life-threatening arrhythmias.
The gastrointestinal system also suffers, leading to issues such as bloating, constipation, nausea, and delayed gastric emptying. Bone density can significantly decrease, increasing the risk of osteopenia, osteoporosis, and fractures. Hormonal imbalances are widespread, often leading to amenorrhea, the absence of menstrual periods, in females. Brain function can be impaired, resulting in difficulties with concentration, memory, and decision-making, along with mood shifts like irritability and anxiety.
The body breaks down its own muscle and fat for energy, redirecting resources to maintain basic functions. This highlights the need for nutritional intervention to stabilize the patient’s physical condition.
The Initial Dietary Priority: Restoring Weight and Health
The first dietary objective in treating anorexia nervosa is to stop further weight loss, restore the patient to a medically stable weight, and reverse acute malnutrition. This initial phase focuses on physical health and safety, aiming to stabilize vital signs and organ function, thereby reducing immediate medical risks. This foundational step must precede other aspects of treatment, such as addressing body image concerns or disordered eating behaviors.
Achieving a healthy weight is essential for recovery, as sustained starvation leads to cognitive deficits, making psychotherapy challenging. This goal involves restoring adequate caloric intake to promote weight gain and rebuild depleted body tissues. The focus is on providing the necessary energy and nutrients for the body to begin healing from undernourishment. Addressing this physical instability is necessary before deeper psychological work can be undertaken.
Implementing Nutritional Restoration Safely
Nutritional restoration in anorexia nervosa is a carefully managed process requiring medical supervision. It is implemented gradually to prevent dangerous complications. Initial caloric intake typically starts at a lower level (e.g., 600-1600 kcal/day) and is progressively increased. Increments might range from 300-500 kcal every two to four days, depending on the patient’s response and rate of weight gain.
Individualized meal plans are developed, often dividing total calories into three meals and three snacks daily to make consumption manageable and promote normalized eating patterns. A multidisciplinary team, including doctors, registered dietitians, and mental health professionals, collaborates to monitor the patient’s physical signs, symptoms, and laboratory results. In severe cases, tube feeding through a nasogastric tube may be necessary to ensure consistent nutrient delivery, especially in the initial days of hospitalization.
Recognizing and Managing Refeeding Syndrome
Refeeding syndrome is a potentially fatal complication that can arise during the initial stages of nutritional restoration, particularly in severely malnourished individuals. It occurs due to rapid shifts in fluids and electrolytes, such as phosphate, potassium, and magnesium, as the body transitions from a starved state to processing carbohydrates. These shifts are caused by hormonal and metabolic changes, leading to serious consequences affecting the heart, lungs, muscles, and brain.
Common symptoms include muscle weakness, trouble breathing, confusion, seizures, and cardiac arrhythmias. Close monitoring of blood electrolyte levels, especially phosphate, is essential. Medical teams often provide electrolyte supplementation before or alongside refeeding to prevent or treat these imbalances. The risk of refeeding syndrome highlights the need for medical supervision during the initial refeeding process to ensure patient safety.