Diagnostic dilemma of avoidant/restrictive food intake disorder after bariatric surgery: A case report and review of literature.

Background: Bariatric surgery is an effective treatment for severe obesity but is associated with an increased risk for development of eating disorders. Indeed, numerous maladaptive eating behaviors and eating disorders have been described following bariatric surgery. However, the differentiation of pathologic eating patterns from expected dietary changes following bariatric surgery can sometimes be difficult to discern.

Preliminary validation of developmental weight suppression in youth with transdiagnostic eating disorders.

Background: Weight suppression (WS), traditionally defined as the difference between highest past and current weights at adult height, is a correlate and predictor of eating disorder (ED) psychopathology. However, for growing adolescents, it may be more appropriate to use a developmentally-adjusted calculation of WS. This study compared how developmental WS, calculated using zBMIs, compared with traditional WS, calculated using weights, as correlate of ED psychopathology in treatment-seeking adolescents with transdiagnostic EDs.

Eating Disorder Severity and Treatment Outcome Across Race/Ethnicity, Sexual Orientation, and Socioeconomic Status: Intersectional Inequities in a Clinical Sample.

Background: Marginalized populations experience increased eating disorder (ED) risk and encounter significant barriers to treatment. Intersectionality provides a framework for understanding how systemic oppression contributes to inequities in EDs; however, intersectional approaches have yet to be applied to a clinical ED sample. The current study examined inequities in ED severity and treatment outcome across the intersections of race/ethnicity, sexual orientation, and socioeconomic status (SES).

Effects of Early Weight Trends on Residential Treatment Outcomes Among Adolescents With Anorexia Nervosa.

Background: Weight variability (WV), or daily-to-weekly fluctuations in weight, associates with increased eating pathology in adults with bulimia nervosa and greater weight gain across the developmental span in healthy controls, but few studies have explored these relations in adolescents with anorexia nervosa (AN). Given the importance of early weight gain during treatment for AN prognosis, WV could impact outcomes via effects on weight trends and related psychopathology. The current study examined whether WV and the slope of weight change predict eating disorder symptoms at the end of treatment (EOT) among adolescents with AN.

Is ketamine safe for individuals in higher level of care treatment for eating disorders? Analysis of safety of subanesthetic ketamine in 104 patients.

Eating disorders are among the most challenging and fatal mental illnesses and, due to the complication of medical instability caused by malnutrition or other disordered eating behaviors, pose unique treatment challenges for patients with co-occurring depression and mood disorders. Randomized control trials have demonstrated "rapid and robust antidepressant effects" of generic ketamine in individuals with treatment-resistant depression and bipolar depression. This paper assesses the medical safety of ketamine as a treatment for co-occurring treatment-resistant depression or bipolar depression in patients in higher levels of care for their eating disorders.

The Eating Disorders Genetics Initiative 2 (EDGI2): study protocol.

Background: The Eating Disorders Genetics Initiative 2 (EDGI2) is designed to explore the role of genes and environment in anorexia nervosa, bulimia nervosa, binge-eating disorder, and avoidant/restrictive food intake disorder (ARFID) with a focus on broad population representation and severe and/or longstanding illness.

Methods: A total of 20,000 new participants (18,700 cases and 1,300 controls) will be ascertained from the United States (US), Mexico (MX), Australia (AU), Aotearoa New Zealand (NZ), Sweden (SE), and Denmark (DK). Comprehensive phenotyping and genotyping will be performed for participants in US, MX, AU, NZ, and SE using the EDGI2 questionnaire battery and participant saliva samples.

Virtual Versus In-Person Intensive Outpatient Treatment for Eating Disorders During the COVID-19 Pandemic in United States-Based Treatment Facilities: Naturalistic Study.

Background: While virtual therapy has proven effective in treating eating disorders (EDs), little work has examined virtual therapy at higher levels of care, which are treatment options providing more support than weekly outpatient therapy including intensive outpatient (IOP) treatment.

Objective: This study aimed to add to the limited research on in-person versus virtual treatment at a higher level of care by comparing treatment outcomes between an in-person IOP and a virtual IOP (VIOP) for patients with EDs. We hypothesized that there would be no differences in improvements between VIOP and in-person IOP groups.

The Medical Complications of Purging Behaviours Associated With Eating Disorders.

Objective: The purpose of this paper is to comprehensively review the medical complications associated with purging behaviours and their recommended treatments.

Methods: A thorough review of the literature through May 2024 was completed.

Results: The medical complications associated with purging behaviours affect every body system.

Zinc levels in severe eating disorders.

Purpose: Severe eating and feeding disorders including Anorexia Nervosa of both restricting (AN-R) and binge-purge (AN-BP) subtypes and Avoidant Restrictive Food Intake Disorder (ARFID) lead to multiple macronutrient and micronutrient deficiencies, including zinc, in the setting of inadequate dietary intake. We investigated whether zinc levels correlated with severe malnutrition, with particular subtypes of eating disorders (EDs), and the effect of the refeeding process.

Methods: This prospective study included 92 adult patients with severe AN or ARFID hospitalized in a medical stabilization unit.

Association of Phosphate Supplements With Refeeding Oedema in Restrictive Eating Disorders.

Objective: Refeeding oedema, believed to result from the effects of insulin on renal sodium retention and subsequent oedema formation, typically occurs during the first 2 weeks after reintroduction of nutrition in individuals with severe malnutrition and can intensify body image distress in patients with eating disorders (EDs). Phosphate supplements have been found to increase insulin sensitivity, and it is hypothesised that they may also contribute to refeeding oedema in patients with EDs.

Method: In this retrospective cohort study of 633 patients with severe malnutrition due to anorexia nervosa (AN) or avoidant restrictive food intake disorder (ARFID), the impact of phosphate supplementation on the rate of weight gain was investigated.

Using Bomb Calorimetry to Investigate Intestinal Energy Harvest in Anorexia Nervosa: Preliminary Findings on Stool Calorie Loss.

Objective: Renourishment and weight restoration are critical first steps in anorexia nervosa (AN) treatment. The ability of the gastrointestinal tract to harvest and utilize energy from food is essential for successful weight restoration, but the functional capacity of the intestine after prolonged caloric restriction remains unknown. In an exploratory study, we quantified the stool energy content of individuals with AN before and after renourishment.

Loss of Bone Density in Patients with Anorexia Nervosa Food That Alone Will Not Cure.

Background: Anorexia Nervosa is a highly lethal illness that is also associated with many medical complications. Food restriction and weight loss define this illness. Most of its physical complications are reversible with weight restoration, with the notable exception of the loss of bone density, which is commonly present in anorexia nervosa.

Predictors of treatment outcome in higher levels of care among a large sample of adolescents with heterogeneous eating disorders.

Background: Despite widespread use of higher levels of care in treating eating disorders in adolescents, research supporting the use of these treatments remains limited by small sample sizes and a predominant focus on anorexia nervosa. Further, existing data regarding predictors of outcome have yielded mixed findings. In the current study, we evaluated treatment outcomes and predictors of outcome among a large sample of adolescents with eating disorders presenting to inpatient, residential, partial hospitalization programs, and intensive outpatient programs across the United States.

Evaluation of Mean Plasma Glucose Levels Using HbA1C in Patients With Severe Eating Disorders.

Objective: Hypoglycemia causes significant morbidity and mortality in patients with severe eating disorders. We measured average glycemic levels using hemoglobin A1C (HbA1C) in patients hospitalized for extreme anorexia nervosa (AN) and avoidant restrictive food intake disorder (ARFID).

Methods: This was a prospective, single-center cohort study conducted in an inpatient medical stabilization unit.

Eating disorder virtual intensive outpatient program: patient satisfaction according to age group.

The COVID-19 pandemic has required a shift to telehealth services. However, not all patients are similarly satisfied with this shift, with some studies finding that midlife and older adults are less comfortable with telehealth. The current study examined patient satisfaction with a virtual intensive outpatient program (VIOP) for eating disorders (EDs) among 305 adults (ages 18-25, ages 26-39, and ages 40+), and compared adult satisfaction to satisfaction among children/adolescents ( = 33) receiving VIOP treatment between August 2020 and March 2022 from a large ED treatment facility.

A new conceptual model for anorexia nervosa: A role for connective tissue?

The etiology of anorexia nervosa (AN) remains to be fully elucidated, and current theories also fail to account for the direct effect of starvation on the health of the organs and tissues, specifically the connective tissue present in most organs of the body. Individuals with hereditary disorders of connective tissue manifest with clinical symptoms that overlap with AN, as the abnormal connective tissue also contributes to many of the other extra-articular manifestations of these hereditary disorders. This article hypothesizes that a similar pathophysiology may also contribute to the clinical presentation of AN.

Medical and Psychiatric Characteristics of Patients Hospitalized for Severe Restrictive Eating Disorders: Analysis of 545 Consecutive Patients with Severe Anorexia Nervosa or Avoidant/Restrictive Food Intake Disorder.

Background: People with severe eating and feeding disorders regularly require hospitalization due to complications inherent to their disease, though formal training regarding this care is limited.

Methods: This retrospective study included 545 patients with severe anorexia nervosa (AN) or avoidant restrictive food intake disorder hospitalized in a medical stabilization unit between 2018 and 2021. Biometrics were obtained throughout hospitalization.

Associations between low body weight, weight loss, and medical instability in adults with eating disorders.

Objective: The physical complications of atypical anorexia nervosa remain understudied, with most studies completed in adolescents. This study seeks to examine the impact of various weight measures as predictors of medical instability in a large cohort of adult eating disorder patients.

Methods: In this retrospective cohort study, the impact of admission body mass index (BMI), weight suppression, and recent weight loss (the rate of weight loss within the last 12 months) toward the development of medical complications of malnutrition were examined.

An examination of adults with atypical anorexia nervosa at admission to treatment at higher levels of care: An attempt to increase diagnostic clarity.

Objective: Anorexia nervosa (AN) is a serious illness with a high mortality rate and multiple physiological complications. The vague definition of atypical AN allows for subjective interpretation. This retrospective study aimed to focus future research on the operational definition of atypical AN by examining four factors associated with atypical AN at admission to higher level of care treatment.

Atypical antipsychotic use does not impact weight gain for individuals with extreme anorexia nervosa: a retrospective case-control study.

Background: There are no U.S. Food and Drug Administration (FDA)-approved medications for the treatment of anorexia nervosa (AN).

Can we predict the development of acute gastric dilatation in patients with anorexia nervosa?

Background: Acute gastric dilatation can develop in patients with anorexia nervosa who are being refed to achieve weight restoration. If unrecognized, this condition is associated with significant morbidity and mortality. Patients with acute gastric dilatation usually have abdominal pain, nausea, and vomiting.