From Across the Desk: Unsung Heroes

These are challenging times for clinicians, patients, and those who support ED patients. A few highlights of this issue include the challenges of caring for adult ED patients, the effects of the COVID pandemic, and choosing current refeeding guidelines or higher-calorie refeeding.

They are the unsung heroes of the battle against eating disorders, supporting ED patients in every way, every day, for years. The heroes include parents, especially parents of adult ED patients. In this issue, Norwegian researchers Jannike Karlstad and colleagues at Nord University found that parents of adult ED patients often had to fill multiple roles to make up for the lack of help from healthcare providers. The most successful parents remained open about their daughter’s or son’s illness, and also set boundaries around their social lives. All wished for more help from healthcare professionals.

And, even as we learn of another strain of the COVID virus, the omicron variant, an article by Otto and colleagues advises that those who care for adolescents with EDs in inpatient settings be prepared to handle the challenges of the pandemic. Admissions for EDs doubled during the last year at their institution, the University of Michigan. In spite of telehealth advantages, vital signs and lab studies and evaluation of signs of medical complications that may call for hospital admission “are essential in the primary care setting,” the authors write. This is essential because as the authors note, demand for treatment, challenged by lack of healthcare providers and facilities, may only increase as the pandemic continues.

Finally, Dr. Neville H. Golden and his colleagues have been proponents of higher-calorie refeeding (HCR) for AN inpatients for some time. Their earlier studies showed that HCR led to faster weight gain and a shortened inpatient stay without the risk of electrolyte disturbances usually seen with the refeeding syndrome. When they tested their theory in a controlled study, there were no differences in clinical remissions, hospitalizations, number of medical readmissions, and number of days medically hospitalized one year after discharge. However, the authors defended use of higher calorie refeeding by pointing to the benefits of earlier release due to HCL, including faster weight gain and earlier release, with lower costs for care.

And on to 2022!


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