title: Refeeding and weight restoration outcomes in anorexia nervosa: Challenging current guidelines.
abstract: 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.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Graham W
authors.initials: GW
authors.lastname: Redgrave
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Janelle W
authors.initials: JW
authors.lastname: Coughlin
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Colleen C
authors.initials: CC
authors.lastname: Schreyer
authors.affiliation: Department of Psychology, Drexel University, Philadelphia, Pennsylvania.
authors.forename: Lindsay M
authors.initials: LM
authors.lastname: Martin
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Anne K
authors.initials: AK
authors.lastname: Leonpacher
authors.affiliation: Department of Psychiatry, Staten Island University Hospital, New York.
authors.forename: Margaret
authors.initials: M
authors.lastname: Seide
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Antonia M
authors.initials: AM
authors.lastname: Verdi
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Allisyn
authors.initials: A
authors.lastname: Pletch
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Angela S
authors.initials: AS
authors.lastname: Guarda
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000856:Anorexia Nervosa / Q000628:therapy*; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D010351:Patient Discharge; D055677:Refeeding Syndrome / Q000150:complications*; D016896:Treatment Outcome; D015430:Weight Gain; D055815:Young Adult
keywords: anorexia nervosa; hypophophatemia; refeeding syndrome; weight restoration