"When adolescents are hospitalized with anorexia nervosa, feeding their malnourished young bodies is of urgent importance. On the complicated path to recovery, gaining weight is a critical step. But how hospitals approach that first step, called refeeding, has in recent years been subject to rethinking. Now a quartet of studies to be published in the November issue of the Journal of Adolescent Health offers evidence in favor of a new approach - and suggests an emerging shift in the way hospitals approach treating the disorder. Anorexia, an eating disorder typified by relentless pursuit of thinness, affects about 1 percent of adolescent girls in the United States, by some estimates. Weight gain is crucial in reversing medical complications of anorexia, such as confusion, sensitivity to cold and even failing organs, and in enabling the difficult psychological recovery that must accompany a physical one. In refeeding, calories traditionally are doled out with caution, new patients starting with a low number that is then gradually increased. Pushing too much, too quickly could be dangerous, so the old wisdom goes, the sudden surge of nutrients putting a malnourished body at risk for a potentially fatal metabolic imbalance." - Anne Bouey

"The standard is rooted in post-World War II studies of Americans held by the Japanese as prisoners of war and reinforced in clinical guidelines from organizations like the American Psychiatric Association. It is typical for initial calorie intake to begin somewhere around 1,200 calories a day, about half of the recommended daily intake for an average healthy teenager. Then in 2011, researchers at UCSF Benioff Children's Hospital issued a challenge to that long-standing standard, suggesting instead that the "start low, go slow" method was inefficient, unnecessary and out of date. They proposed instead that most patients can start at much higher calorie levels. "Those old guidelines are based on consensus, but they are not based on clinical evidence," said Andrea Garber, lead author of the 2011 study and an associate professor of pediatrics in UCSF's adolescent medicine division. And, now, a new study from UCSF, published online Wednesday, took the initial findings one step further, enrolling a group of adolescents in a higher-calorie diet to compare with the first study's low-calorie diet. The new group gained weight faster and its members were released from the hospital sooner, with no cases of refeeding syndrome." - Anne Bouey