Anorexia Nervosa When First-Line Outpatient Treatment Has Not Achieved Weight Goals
First-line outpatient management is the initial approach for anorexia nervosa. When adequate weight gain is not achieved in that setting, escalation to a higher level of care becomes necessary. This protocol addresses the structured approach taken at that point.
Previous Line — Failure Condition
Prior therapy: First-line outpatient treatment, combining nutritional rehabilitation and psychological intervention.
Target not reached: Weight gain of 0.2–0.5 kg per week in the outpatient setting.
Failure to meet this weekly weight target — or the presence of high risk for medical complications — triggers escalation to the protocol below.
Next-Step Approach (partial)
The next step involves a hospital-based level of care — either day-hospital or full inpatient admission — centred on nutritional rehabilitation. The approach specifies a preferred route for nutritional support, with more intensive nutritional measures reserved only as a last resort. Provisions exist for patients who do not consent to treatment.
The complete regimen, decision criteria, and full sequencing are available in the structured protocol.
Inpatient target: 0.5–1.5 kg weight gain per week
References
DOI: 10.1097/YCO.0000000000000360
- Overall, hospitalization should be considered for patients who have failed at outpatient care, or who are at high risk for medical complications as determined using patient's weight status (e.g., extremely low body mass index), behavioral factors (e.g., decline in oral intake), vital signs (e.g., heart rate < 40 bpm), psychiatric comorbidity (e.g., suicide risk), or environmental aspects (e.g., family support).
- Although the extent to which information on artificial feeding was given differed among guidelines (e.g., concerning refeeding practice, duration, or indication), guidelines consistently favored oral enteral nutrition over parenteral nutrition which should only be used as a last option.
- For very malnourished patients who do not consent to treatment, most guidelines provided some information on compulsory treatment.
- Weight gain per week in inpatient and outpatient settings, mostly ranging between 0.5–1.5 and 0.2–0.5 kg, respectively.
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