There are a great deal of unique factors involved in the treatment of adolescents with Anorexia Nervosa (AN) and other restrictive eating disorders. Individuals that struggle with these disorders restrict their nutrients by severely limiting the food and fluids they take in.
For adolescents, this can cause great harm, as they are experiencing formative mental and physical changes in their growth and development. When individuals restrict their nutrients and fluid intake, it is necessary to include refeeding and weight restoration in the treatment process.
All individual’s bodies work differently and require a unique combination of nutrients to function. For adolescents, the nutrients required to heal their body and improve the bodily functions impacted by their disorder are particularly important due to the formative life stage they are in.
Optimal functioning of these bodily processes is necessary for teens to facilitate appropriate growth. Without considering the unique nutritional requirements of adolescents, treatment providers run the risk of their patient developing Refeeding Syndrome, or the “potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding .”
As one study emphasizes, “these shifts result from hormonal and metabolic changes and may cause serious clinical complications .” Adolescence is a stage in which hormonal and metabolic changes frequently occur rapidly and create extreme change. Therefore, experiencing refeeding is likely for teens.
One study considered the unique physical impact of restrictive eating on teens and took a closer look at how this should be considered in nutritional rehabilitation. The study creators particularly looked at the thiamine levels of adolescent patients in treatment for restrictive eating, as many treatment providers will routinely supplement thiamine in patients prior to initiating nutritional rehabilitation .
This practice is based on “previous research demonstrating thiamine supplementation prior to nutritional rehabilitation may prevent TD and its associated neuropsychiatric conditions,” such as Wernicke’s encephalopathy or Wernicke Korsakoff’s syndrome . However, many of the studies demonstrating this were tested with adults.
When it comes to teens, “neither low thiamine levels nor many of the proposed predisposing factors for low thiamine are typically present for adolescents with mild to moderate malnutrition presenting with restrictive eating disorders .” Study creators posed the question of whether or not thiamine supplementation prior to nutritional rehabilitation was a process that should be done with adolescents in treatment.
Ultimately, the study found that, unlike when refeeding adults, “Adolescents hospitalized with a restrictive eating disorder and commenced on a high caloric prescription did not require additional thiamine supplementation, beyond 10 mg contained within a daily multivitamin, to maintain normal levels of thiamine during nutritional rehabilitation .”
This study demonstrates one of many areas where the treatment of adolescents with eating disorders must be considered different from the treatment of adults. Making changes based on the physical and psychological stages of adolescence can help improve treatment outcomes for teens.
Resources Mehanna, H. M., Moledina, J., Travis, J. (2008). Refeeding syndrome: what it is and how to prevent it and treat it. BMJ; 336:7659.  Parker, E. et al. (2020). An audit of changes in thiamine levels during higher caloric nutritional rehabilitation of adolescent patients hospitalised with a restrictive eating disorder. Journal of Eating Disorders, 8:41.
About the Author:
Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.
As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.
The opinions and views of our guest contributors are shared to provide a broad perspective on 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 November 25, 2020, on EatingDisorderHope.com
Reviewed & Approved on November 25, 2020, by Jacquelyn Ekern MS, LPC