World Journal of Nutrition and Health
ISSN (Print): 2379-7819 ISSN (Online): 2379-7827 Website: Editor-in-chief: Srinivas NAMMI
Open Access
Journal Browser
World Journal of Nutrition and Health. 2015, 3(2), 29-34
DOI: 10.12691/jnh-3-2-1
Open AccessReview Article

Refeeding the Patient with Anorexia Nervosa: Perspectives of the Dietitian, Psychotherapist and Medical Physician

Bobbi Arthur1, Lindsay Strauss1 and Philip S. Mehler1, 2,

1Eating Recovery Center-- 7351 E Lowry Blvd, Suite 200, Denver, CO 80230

2ACUTE at Denver Health– 777 Bannock Street, MC4000, Denver, CO 80204;Department of Medicine, University of Colorado Health Sciences Center

Pub. Date: April 02, 2015

Cite this paper:
Bobbi Arthur, Lindsay Strauss and Philip S. Mehler. Refeeding the Patient with Anorexia Nervosa: Perspectives of the Dietitian, Psychotherapist and Medical Physician. World Journal of Nutrition and Health. 2015; 3(2):29-34. doi: 10.12691/jnh-3-2-1


Anorexia nervosa has the highest mortality of any psychiatric illness. Yet, these patients are often young and have many productive years yet to live. Weight restoration and nutritional rehabilitation, along with psychotherapy, are at the core of a successful treatment plan along with avoiding medical complications during the early periods of refeeding. This article is generated from an extensive literature search including Pubmed and Embase (1990 to 2015), of English-language manuscripts that addressed this topical area. This paper provides multidisciplinary expertise from the vantage points of a dietitian, psychotherapist and internal medicine physician to help with the treatment of a patient with anorexia nervosa in order to effectuate a successful treatment outcome.

anorexia nervosa medical complications refeeding dietician psychotherapist

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  American Psychiatric Association (2013) Diagnosis and statistical manual of mental disorders. (5th edn). American Psychiatric Association, Arlington, VA.
[2]  Mehler PS (2001) Diagnosis and care of patients with anorexia nervosa in primary care settings. Ann Intern Med; 134: 1048-1059.
[3]  Hoang U, Goldacre M, James A (2014) Mortality following hospital discharge with a diagnosis of eating disorder: National record linkage study, England 2001-2009. Int J Eat Disord; 47: 507-515.
[4]  Mehler PS, Winkelman AB, Andersen DM, Gaudiani (2010) Nutritional rehabilitation: practical guidelines for refeeding the anorectic patient. J Nutr Metab; 2010: Epub 2010 Feb 7.
[5]  Reiter CS, Graves L (2010) Nutrition therapy for eating disorders. Nutr Clin Pract; 25: 122-136.
[6]  Mehler PS, Andersen A (2010) Eating disorders: A guide to medical care and complications. (2nd edn). The Johns Hopkins University Press.
[7]  O’Connor G, Nicholls D (2013) Refeeding hypophosphatemia in adolescents with anorexia nervosa. A systematic review. Nutr Clin Pract; 28: 358-364.
[8]  Ozier AD, Henry BW; American Dietetic Association (2011) Position of the American Dietetic Association: nutrition intervention in the treatment of eating disorders. J Am Diet Assoc; 111: 1236-1241.
[9]  Cockfield A, Philpot U (2009) Feeding size 0: the challenges of anorexia nervosa. Managing anorexia from a dietitian’s perspective. Proc Nutr Soc; 68: 281-288.
[10]  Grilo C (2006) Eating and weight disorders. Psychology Press.
[11]  Mittnacht AM, Bulik CM (2015) Best nutrition counseling practices for the treatment of anorexia nervosa: a Delphi study. Int J Eat Disord; 48: 111-122.
[12]  Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, et al. (2005) Medical findings in outpatients with anorexia nervosa. Arch Int Med; 165: 561-566.
[13]  Docx MK, Gewillig M, Simons A, Vandenberghe P, Weyler J, et al. (2010) Pericardial effusions in adolescent girls with anorexia nervosa: Clinical course and risk factors. Eat Disord; 18: 218-225.
[14]  Oflaz S, Yucel B, Oz F, Sahin D, Ozturk N, et al. (2013) Assessment of myocardial damage by cardiac MRI in patients with anorexia nervosa. Int J Eat Disord; 46: 862-866.
[15]  Olivares JL, Vazquez M, Fleta J, Moreno LA, Perez-Gonzalez JM, et al. (2005) Cardiac findings in adolescents with anorexia nervosa at diagnosis and after weight restoration. Eur J Pediatr; 164: 383-388.
[16]  Mehler PS, Krantz MJ (2005) QT dispersion in anorexia nervosa. Am J Cardiol; 96: 1034-1038.
[17]  Miller KK (2013) Endocrine effects of anorexia nervosa. Endocrinol Metab Clin North Am; 42: 515-528.
[18]  Mehler PS, Mackenzie TD (2009) Treatment of osteopenia and osteoporosis in anorexia nervosa: A systematic review. Int J Eat Disord; 42: 195-201.
[19]  Vetergaard P, Emborg C, Stoving RK, Hagen C, Mosekilde L, et al. (2002) Fractures in patients with anorexia nervosa, bulimia nervosa, and other eating disorders – A nationwide register study. Int J Eat Disord; 32: 301-308.
[20]  Faje AT, Fazeli PK, Miller KK, Katzman DK, Ebrahimi S, et al. (2014) Fracture risk areal bone mineral density in adolescent females with anorexia nervosa. Int J Eat Disord; 47: 458-466.
[21]  Gardini GG, Boni E, Todisco P, Manara F, Borghesi A, et al. (2009) Respiratory function in patients with stable anorexia nervosa. Chest; 136: 1356-1363.
[22]  Biffl WL, Narayanan V, Gaudiani JL, Mehler PS (2010) The management of pneumothorax in anorexia nervosa: A case report and review of the literature. Patient Saf Surg; 4: 1-5.
[23]  Sabel AL, Gaudiani JL, Statland B, Mehler PS (2013) Hematological abnormalities in severe anorexia nervosa. Ann Hematol; 92: 605-613.
[24]  Frank GK, Shott ME, Hagman JO, Mittni VA (2013) Alterations in brain structures related to taste reward circuitry in ill and recovered anorexia nervosa and in bulimia nervosa. Am J Psychiatry; 170: 1152-1160.
[25]  Holmes SR, Gudridge TA, Gaudiani JL, Mehler PS (2012) Dysphagia in severe anorexia nervosa and potential therapeutic interventions: A case series. Ann Otol Rhinol Laryngol; 121: 449-456.
[26]  Holmes SR, Gudridge TA, Gaudiani JL, Mehler PS (2012) dysphagia in severe anorexia nervosa: A case report. Int J Eat Disord; 45: 463-466.
[27]  Benini L, Todesco T, Dalle Grave R, Deiorio F, Salandini L, et al. (2004) Gastric emptying in patients with restricting binge/purging subtypes of anorexia nervosa. Am J Gastroenterol; 99: 1448-1454.
[28]  Olffusson EA, Storsrud S, Grundin H, Isaksson M, Attval S, et al. (2014) A small particle sized diet reduces gastrointestinal symptoms in patients with diabetic gastroparesis: A randomized controlled trial. Am J Gastroenterol; 109: 375-385.
[29]  Mascolo M, Dee E, Townsend R, Brinton JT, Mehler PS. (2015) Severe gastric dilation due to superior mesenteric artery syndrome in anorexia nervosa. Int J Eat Disord; [Epub ahead of print].
[30]  Kraeft JJ, Uppot RN, Heffess AM (2013) Imaging findings in eating disorders. AJR Am J Roentgenol; 200: w328-335.
[31]  Mehler PS, Weiner KL (2007) Use of parenteral nutrition in the refeeding of selected patients with severe anorexia nervosa. Int J Eat Disord; 40: 285-287.
[32]  Zipfel S, Sammet I, Rapps N, Herzog W, Herpertz S, et al. (2006) Gastrointestinal disturbances in eating disorders: Clinical and neurobiological aspects. Auton Neurosci; 129: 99-106.
[33]  Smith TW, Korenblum C, thacker K, Bonifacio HJ, Gonska T, et al. (2013) Severely elevated transaminases in an adolescent male with anorexia nervosa. Int J Eat Disord; 46: 751-754.
[34]  Rautou PE, Cazals-Hatem D, Moreau R, Erancoz C, Feldmann G, et al. (2008) Acute liver cell damage in patients with anorexia nervosa. A possible role of starvation-induced hepatocyte autophagy. Gastroenterology; 135: 840-842.
[35]  DeCaprio C, Alfano A, Senatore I, Zarrella L, Dasanisi F, et al. (2006) Severe acute liver damage in anorexia nervosa: two case reports. Nutrition; 22: 572-575.
[36]  Harris RH, Sasson G, Mehler PS (2013) Elevation of liver function tests in severe anorexia nervosa. Int J Eat Diosrd; 46: 369-374.
[37]  Skipper A (2012) Refeeding syndrome or refeeding hypophosphatemia. A systematic review. Nutr Clin Prac; 27: 34-40.
[38]  Golden NH, Keane-Miller C, Sainani KL, Kapphahn CJ (2013) Higher caloric intake in hospitalized adolescents with anorexia nervosa is associated with reduced length of stay and no increased rate of refeeding syndrome. J Adol Health; 53: 573-578.
[39]  Gaudiani JL, Sabel AL, Mascolo M, Mehler PS (2012) Severe anorexia nervosa: Outcomes from a medical stabilization unit. Int J Eat Disord; 45: 85-92.
[40]  National Institute for Health and Care Excellence(NICE) (2006) Nutrition support in adults: Oral nutrition support, enteral tube feeding and parenteral nutrition. Retrieved from
[41]  Cloninger CR, Svrakic DM, Przybeck TR (1993) A psychobiological model of temperament and character. Arch Gen Psychiatry; 50: 975-990.
[42]  Harris R (2008) The Happiness Trap: How to Stop Struggling and Start Living. (2nd edn). Shambala Publications, Boston, MA.
[43]  Sandoz E, Wilson K, Dufrene T (2010) Acceptance and Commitment Therapy for Eating Disorders: A Process-Focused Guide to Treating Anorexia and Bulimia. New Harbinger Publications, Inc., Oakland, CA.