Refeeding and Meal-related Dysfunction

Sensory dysfunction can persist after successful refeeding.

Aggressive refeeding (whether inpatient or outpatient) is the standard approach for treating young patients with restrictive eating disorders. Claire M. Peterson, PhD, and colleagues at Cincinnati Children’s Hospital, Duke University, Durham, NC, and Washington University, St. Louis, have added new data about appetite and meal-related dysfunction after refeeding (Appetite 2016; doi:10.1016/.j appet. 2016.05.037).

The authors found that changes in hunger, taste, and smell that accompany restrictive eating disorders may increase with refeeding. These sensory factors may make it difficult for a patient to eat enough to regain weight. For 14 months, Dr. Peterson and her team compared profiles of hunger, fullness, and sense of smell and taste among 15 adolescent females diagnosed with restrictive EDs on admission to the hospital and 15 healthy, lean adolescent female controls. The patients received inpatient refeeding treatment according to American Psychiatric Association guidelines, and gained an average of .80 kg (1.8 lb) after an average 6 days of treatment. The eating disorders group was on a medical unit; the controls were tested as outpatients in a research center.

Both groups participated in a meal tolerance test in 10 minutes and then were studied with meal-related measures that included ecological momentary assessment intermittently over 150 minutes. The ED group repeated the meal tolerance test on their final full day of hospitalization.

Meal-related sensory disruptions persisted in the ED patients

Perceptions of taste and smell at meals were similar in both test groups. Refed ED participants showed notably lower hunger levels compared to levels at admission and all but two had time test assessments, both close to the time of the meal and up to 150 minutes after the meal. ED participants who had been refed reported greater feelings of fullness compared to their feelings at admission. Over time, the fullness trajectories of the ED patients were very similar.

After a short period of refeeding, the patients had significant changes in meal-rated sensory experiences, all toward more normal responses; however, the authors noted that the patients still had significantly more disrupted meal-related sensory responses compared to the healthy controls.

According to the authors, their findings may demonstrate differences between individuals with eating disorders and their healthy peers. This study’s results may contribute to better understanding of why treatment outcomes may not be as successful as expected, even after aggressive refeeding. The study findings also underscore the importance of considering the inadvertent negative impacts of refeeding, including elevation of distress and ED symptoms.