Hypermetabolism in Anorexia Nervosa

Weight restoration is a crucial component of anorexia nervosa treatment. It is a challenging process for a multitude of reasons. Adding to the complexity and the challenge is the fact that during weight restoration, individuals with anorexia nervosa tend to require increasingly more calories to maintain the same rate of weight gain.

That is, individuals need to continually increase their caloric intake, in steps, sometimes upwards of 100 calories (technically, kilocalories) per kilogram per day, to continue gaining weight. For instance, an individual weighing 45 kg may need to eat 4,500+ calories to continue gaining 1-1.5kg (2.2-3.3lbs) a week. Indeed, studies have found that standard resting energy expenditure (REE) equations tend to overestimate caloric needs at the beginning of refeeding but underestimate them in the later stages (Forman-Hoffmann et al. 2006; Krahn et al., 1993).

After achieving a healthy weight, individuals recovering from anorexia nervosa still typically … Continue reading →

Beyond Simple Solutions: The Need for Complex Ideas in Anorexia Nervosa

I often hesitate to make broad, sweeping claims about the nature, cause, and experience of eating disorders and disordered eating. However, if there is one thing I feel absolutely certain saying about these disorders, it is that they are incredibly complex and multifaceted with no “one-size fits all” solution. So, I was quite excited when I came across a recent article by Michael Strober and Craig Johnson (2012) that explores the complexity of eating disorders and their treatment. Both authors have significant clinical experience treating eating disorders.

This article uses cases studies, literature, and the authors’ collective clinical experience to respond to some of the key controversies surrounding anorexia and its treatment. Among the major controversies that have come to light of late, they focus on two:

  1. Genetic/biological causation (Biologically-based mental illness – BBMI)
  2. Family-based treatment (FBT) as the best form of treatment for adolescents

The authors’ exploration of these … Continue reading →

What Makes a Good Nurse? Perspectives of Anorexia Nervosa Patients

Nurses can play an important role in facilitating recovery from anorexia nervosa, particularly in an inpatient or residential treatment setting. But what makes a good nurse from the patient’s perspective? More specifically, what qualities do adolescents with anorexia nervosa consider important and helpful during recovery?

The answer may seem obvious: understanding, empathetic, supportive, non-judgemental, and the like. But those are sort of general characteristics that apply to good friends, family members, partners, doctors, other healthcare professionals, and even teachers.

Joyce von Ommen and colleagues wanted to dig a little deeper than that. They wanted to find out what components of nursing care helped patients restore normal eating and exercise patterns.

In order to find out, they collected interviews from 12 female adolescent patients (mean age of 15, range from 13-17), who were discharged from a specialized eating disorder treatment centre within three months of the interview. The patients were diagnosed … Continue reading →