Nutritional Rehabilitation: Understanding the Process in Long-term Recovery

Contributor: Margaret Geraci, RD, LDN, Director of Nutrition Services, Timberline Knolls

Whether an individual struggles with anorexia, bulimia, binge eating disorder, even orthorexia, all eating disorders share one thing in common: food. When an eating disorder is present, food is used in an unhealthy fashion. Not unlike physical rehabilitation after a severe physical injury, nutritional rehabilitation is necessary as part of eating disorder recovery.

The initial goal of nutritional rehabilitation from anorexia nervosa is weight restoration. Although the diagnostic criteria for this disorder is that the individual is at or below 85 percent of normal body weight, often the person is drastically below what would be considered in the normal and healthy range. A female who would appear healthy and robust at 130 lbs., could easily be 70 lbs. at the point of entering treatment for the disorder.

Weight restoration is in no way as simple as encouraging or even “forcing” an individual to consume food. It is a delicate and complex process. If a woman is in inpatient treatment, the clinicians can utilize a nasogastric feeding tube. In this process, a small tube is threaded through the nose and down into the stomach; it remains in place throughout treatment. Liquid food runs through the tube, providing a steady flow of nutrients.

This is considered a gentle form of refeeding; not only is the nutrition delivered in a slow, consistent fashion, but the patient doesn’t have to fully participate in an extreme act of eating, which is usually perceived of as repugnant. Although she will be consuming normal meals, she does not have to face eating huge quantities of food, which would be the case without the NG tube.

If the person is in residential care where NG tubes are not typically used, refeeding would be addressed in a different way. She would participate in normalized mealtimes, then augment the solid food intake with liquid supplements. The calorie intake would increase by approximately 200 calories a day to avoid refeeding syndrome.

Refeeding Syndrome

Every step in weight restoration is taken carefully due to the risk of refeeding syndrome. When an individual has engaged in anorexic behaviors long enough, her body is literally starving. During starvation mode, the human body breaks down fat to use for energy as opposed to using carbohydrates, which is the norm. When a body undergoes refeeding, it begins to use carbohydrates as energy again. In turn, the pancreas increases insulin excretion in order to utilize glucose effectively. This increases the amount of phosphate, magnesium, potassium and water that the cells can uptake, which then leads to depletion of those specific electrolytes.
This is extremely dangerous.

Refeeding Syndrome can result in fluid and electrolyte, cardiac, hematological and neurological complications; the most serious of these is sudden and unexpected death. To decrease the chances of refeedign syndrome, intake is slowly titrated, blood pressure is carefully monitored as are weight and electrolytes levels.

Improve Eating Behaviors

All the weight restoration in the world will count for little if the individual does not relearn how to view food in a healthy, not harmful, fashion. Normalized food consumption can begin with mechanical eating with an eye toward eventual mindful eating. An exchange system can be utilized to follow normalized eating patterns. The ultimate goal is to embrace intuitive eating; in this, the person eats when hungry and stops when full.

Nutritional rehabilitation is a key component of eating disorder recovery. Once weight is restored and the individual embraces a new, positive relationship with food, it is possible for anyone to recover from an eating disorder, and go on to have a life of health and abundance.

Community Discussion – Share your thoughts here!

What steps have you taken to promote healthy eating and nutritional stabilization in your eating disorder recovery?

About the Author: Margaret Geraci, RD, LDN, is Director of Nutrition Services at Timberline Knolls Residential Treatment Center.

As Director of Nutrition Services, Maggie‘s job entails many duties. She oversees the dietitians and diet technicians, carries a caseload of adolescents, supervises the menu and meal planning stages and develops nutrition-related protocols. She also implements current nutrition recommendations, participates in community outreach and trains dietitians.

Prior to joining Timberline Knolls, Maggie was the Nutrition Manager at Revolution in Chicago. She started with Timberline Knolls as a diet technician and progressed to a Registered Dietitian.

Maggie attended Eastern Illinois University for her undergraduate degree in Dietetics and Nutrition and then completed her dietetic internship at Ingalls Memorial Hospital.

She is a member of the Academy of Nutrition and Dietetics, Behavioral Health DPG and South Suburban Academy of Nutrition and Dietetics.

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 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.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on July 28, 2016
Published on EatingDisorderHope.com