Severe Malnutrition in Anorexia Patients and Refeeding Issues

Woman struggling with binge eating disorder

Anorexia nervosa is an eating disorder characterized by an intense fear of gaining weight. This fear of becoming fat leads people to restrict how much food they eat. Someone with anorexia may also use other disordered behaviors to avoid gaining weight, such as compulsive exercise or purging.

Anorexia is one of the deadliest mental illnesses because of the medical complications that can result from disordered eating behaviors. One thing that makes anorexia especially complex is that the desire to lose weight never stops.

Sometimes people in the beginning stages of their eating disorder have a goal weight. For people with anorexia, even after they reach this goal weight or they’re even lower, this isn’t enough. There are a few reasons this happens, but one of the most common reasons is that these individuals often still think they’re in a bigger body.

This not only creates significant emotional distress but also can severely affect someone’s physical health. If you are reading this and you’re struggling with anorexia, this may sound really scary.

Sometimes anorexia tricks people into thinking that their body doesn’t need all the nutrients that other people need. This isn’t true, though. Eating disorders do negatively impact physical health, and your body gives clues that it doesn’t have the nutrients it needs.

These clues may include:

  • Irregular heartbeats
  • Low blood sugar
  • Constant exhaustion and lack of energy
  • Headaches
  • Dehydration
  • Shortness of breath
  • Constipation
  • Bloating
  • Hair loss
  • Stomach pains
  • Lanugo (a fine, baby-like hair covering the body)
  • Loss of menstrual period or irregular periods
  • Insomnia
  • Anemia
  • Electrolyte imbalance
  • Depression
  • Heart problems
  • Organ damage
  • Infertility [1]

All of these symptoms show that malnourishment leads to health problems. Some people may become so malnourished that they have to be hospitalized. At the hospital, the medical staff is going to try to help someone restore enough weight so that their body has at least the minimum amount of nutrients it needs in order to function safely.

Refeeding Concerns

Woman struggling with anorexia and refeedingOne thing that can make it hard for people with anorexia to restore the necessary nutrients are refeeding issues. Refeeding issues can be deadly [2]. Basically, when the body is adjusting to having food again after being in starvation mode, there can be drastic changes in someone’s hormones, electrolytes, and other chemicals. Depending on how the body responds, this can be very dangerous.

This is why it is necessary for someone to begin refeeding under the care of a qualified professional. This process not only involves reintroducing food but also replenishing the body with necessary nutrients that have likely been depleted [2]. A doctor can determine how to help restore a malnourished body in a safe way.

This process can not only be distressing physically but also emotionally. For people with anorexia, the idea of gaining weight leads to severe anxiety. This can serve as a barrier to going through the recovery process.

This is another reason why hospitalization is recommended during this phase. Not only is it medically necessary, but people may also have access to other professionals who can provide the emotional support needed during this time.

If you or a loved one are struggling with anorexia nervosa, get help. This eating disorder can be fatal and causes so much destruction to someone’s emotional, relational, and spiritual well-being. Recovery is possible, and while it might be hard, it will be worth it.


[1] McCallum Place Eating Disorder Center. (2021). Anorexia Health Risks, Medical Complications, and Statistics.

[2] Funayama, M., Memura, Y., Takata, T., Koreki, A., Ogino, S., & Kurose, S. (2021). Body mass index and blood urea nitrogen to creatinine ratio predicts refeeding hypophosphatemia of anorexia nervosa patients with severe malnutrition. Journal of Eating Disorders, 9(1), 1-9.

About the Author:

Samantha Bothwell PhotoSamantha Bothwell, LMFT, is a licensed Marriage and Family Therapist, writer, explorer, and lipstick aficionado. She became a therapist after doing her own healing work so she could become whole after spending many years living with her mind and body disconnected. She has focused her clinical work to support the healing process of survivors of sexual violence and eating disorders. She is passionate about guiding people in their return to their truest Self so they can live their most authentic, peaceful life.

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 February 24, 2021, on
Reviewed & Approved on February 24, 2021, by Jacquelyn Ekern MS, LPC