The Impact of Nutrition on Anorexia Nervosa

Contributor: Staff at Timberline Knolls Residential Treatment Center

Anorexia nervosa, which is commonly referred to simply as anorexia, is a complex eating disorder that is characterized by extremely limited food intake, intense fear of gaining weight, distorted body image, and dangerously low body weight.

Untreated anorexia can have a devastating impact on a person’s physical and mental health. Considerable research indicates that anorexia has one of the highest mortality rates of all mental illnesses.

The Nutritional Impact of Anorexia

Anorexia treatment may address a wide range of concerns, including the patient’s medical, psychological, behavioral, and nutritional needs. Because anorexia can cause such significant physical damage, the medical and nutritional components of anorexia treatment may be particularly intensive.

In a November 7, 2013, article that was published by the journal BMC Psychiatry, a team led by Enrica Marzola reported that people who have anorexia have difficulty consuming more than 10-20 kilocalories/kilograms per day [1]. By comparison, the article noted, a healthy young woman will typically consume about 30 or more kilocalories/kilograms per day.

The nutritional impact of anorexia nervosa will, of course, vary from person to person. However, as described by Christina Scribner in her April 29, 2016, Psychiatric Times article [2], anorexia-related malnutrition may lead to:

• Altered brain functioning
• Impairment of the immune system
• Persistent fatigue
• Anemia
• Loss of lean body mass

In her Psychiatric Times article, Scribner also observed that people who have anorexia may also be at elevated risk for developing diabetes, cardiovascular disease, and certain types of cancer.

A December 2010 article by two nutrition and gastroenterology experts reported that malnutrition affects “the function and recovery of every organ system [3],” with consequences that can include:

• Reduced cardiac muscle mass
• Impaired functioning of the kidneys, pancreas, and heart
• Delayed recovery from respiratory tract infections
• Delayed healing of wounds
• Diminished intestinal blood flow

These physical effects, the authors of the December 2010 article wrote, may be accompanied by psychological concerns such as depression, anxiety, and apathy.

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The Nutritional Component of Anorexia Treatment

Given the considerable harm malnutrition can inflict, it is no surprise that treatment for anorexia often focuses on helping patients achieve medical stabilization and increase their body weight. Establishing proper nutritional guidelines and goals is an essential part of this process.

In the November 2013 BMC Psychiatry article referenced in the previous section, lead author Enrica Marzola and co-authors wrote that “nutritional rehabilitation is a core focus of most [anorexia nervosa] programs [4].”

Marzola’s article also included guidance from the National Institute for Clinical Excellence (NICE), which advised a weekly weight increase goal of 0.5-1 kg for patients in an inpatient setting and 0.5 kg for those who are receiving outpatient care. To accomplish this, according to the NICE guidance, patients may need to consume 3,500-7,000 extra calories each week.

The Physician’s Committee for Responsible Medicine (PCRM) advises that electrolyte levels should be carefully monitored in eating disorder patients who are considerably underweight, and that the refeeding process should be conducted “gradually and progressively [5].”

People who have suffered from severe malnutrition or have been drastically restricting their caloric intake can experience adverse reactions if the refeeding process occurs too quickly. As with all aspects of effective comprehensive treatment for anorexia nervosa, it is important for the patient to complete a thorough evaluation prior to the implementation of a refeeding plan.

The PCRM website also emphasizes the need for emotional support services within the nutritional component of anorexia treatment. Effective emotional support services can minimize a patient’s resistance to diet changes and weight gain goals. These services can also identify and address symptoms of anxiety and similar concerns before they become severe enough to cause the patient to refuse further treatment.

Challenges & Potential Solutions

Among the main challenges to implementing an effective nutritional plan as part of a comprehensive anorexia treatment program is the fact that many people who struggle with this disorder are unwilling or unable to admit that they have developed any type of eating disorder, and they have an increased likelihood of refusing to enter treatment or follow the directions of treatment professionals.

In another November 2013 article that was published online by BMC Psychiatry, lead author Giovanni Abbate-Daga and co-authors wrote that “reluctance to recover is sustained by ego-syntonic symptoms that reinforce the illness and relapse is common also because patients often perceive consequences of [anorexia nervosa] as positive and adaptive [6].”

After analyzing the results of 71 studies, Abbate-Daga and co-authors listed denial of the illness, low motivation to change, dysfunctional self-evaluation skills, and inadequate therapeutic relationships as among the many factors that can undermine a person’s willingness to complete treatment for anorexia.

These challenges do not have simple solutions. Abbate-Daga’s team emphasized the value of establishing a positive therapeutic relationship and encouraging patients to express themselves during psychotherapy sessions, with the goal of helping them overcome emotional avoidance and fear of change.

References

1. Marzola, E., Nasser, J. A., Hashim, S. A., Shih, P.-A. B., & Kaye, W. H. (2013, November 7). Nutritional rehabilitation in anorexia nervosa: Review of the literature and implications for treatment. BMC psychiatry. Retrieved September 30, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3829207/.
2. Scribner, C. (2016, April 29). Understanding nutritional needs of patients with eating disorders: Implications for psychiatrists. Psychiatric Times. Retrieved September 30, 2021, from https://www.psychiatrictimes.com/view/understanding-nutritional-needs-patients-eating-disorders-implications-psychiatrists.
3. Saunders, J., & Smith, T. (2013, November 7). Malnutrition: Causes and consequences. Clinical medicine (London, England). Retrieved September 30, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4951875/.
4. Marzola, E., Nasser, J. A., Hashim, S. A., Shih, P.-A. B., & Kaye, W. H. (2013, November 7). Nutritional rehabilitation in anorexia nervosa: Review of the literature and implications for treatment. BMC psychiatry. Retrieved September 30, 2021, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3829207/.
5. Physicians Committee for Responsible Medicine. (2020, December 14). Eating disorders: Nutrition guide for clinicians. Retrieved September 30, 2021, from https://nutritionguide.pcrm.org/nutritionguide/view/Nutrition_Guide_for_Clinicians/1342074/all/Eating_Disorders.
6. Abbate-Daga, G., Amianto, F., Delsedime, N., De-Bacco, C., & Fassino, S. (2013, November 7). Resistance to treatment and change in anorexia nervosa: A clinical overview. BMC Psychiatry. Retrieved September 30, 2021, from https://bmcpsychiatry.biomedcentral.com/articles/10.1186/1471-244X-13-294.

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About Timberline Knolls

At Timberline Knolls Residential Treatment Center, located outside of Chicago, Illinois, we provide specialized care for women and girls who are living with mental health disorders. Our private facility offers female-only treatment programs for eating disorders, addiction, and a range of mental health conditions. We work closely with each person to develop treatment goals to maximize strengths while focusing on individual needs. Our treatment team understands that each woman has unique needs and that she must play a role in her journey to wellness.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on October 12, 2021. Published on EatingDisorderHope.com
Reviewed & Approved on October 12, 2021 by Jacquelyn Ekern, MS, LPC