From: A review of feeding methods used in the treatment of anorexia nervosa
Food only feeding | |
Benefits | Adverse effects |
• It teaches skills for eating, promotes normal behaviour, and challenges unhelpful coping strategies [39]; | • Less energy is delivered from food when compared with nasogastric feeding [9]. |
• Patients experience the amount of food necessary for weight gain and weight maintenance [40]; | |
• Food makes hospital meal management home-like and realistic, which exposes patients to a situation which is anxiety-provoking, and gives them confidence at managing meals at home [41]. | |
High-energy liquid supplements | |
Benefits | Adverse effects |
• Supplements can meet the high-energy requirements required for weight gain in a smaller volume than food [7, 42]; | • The frequent use of supplements encourages patients away from the experience of food, re-enforces their avoidance of food and can foster dependency on artificial food sources [39]. |
• They are helpful as a “top-up for patients struggling with satiety and the quantities of food required to promote weight gain [39, 40]; | |
• It can be seen as a type of medicine [43]. | |
Nasogastric feeding | |
Benefits | Adverse effects |
• More comfortable for the patient with less pain, physical discomfort and abdominal distension than large amounts of food [33, 34, 38]. | • It interferes with the fragile alliance between the patient and treatment team [44]; |
• The patient may feel disempowered and embittered towards the treatment team, which may have an impact on future personal and professional relationships [45]; | |
• A helpful strategy aiding recovery: | |
o It transfers the responsibility of weight gain from the patient to the treatment team [46]; | • It is invasive, frightening, unpleasant and mirrors the dynamics of trauma [27, 39]; |
o If placed upon admission, it “medicalises” the treatment, and reduces the “power struggle” between the patient and clinicians [34]. | • There is an emotional toll on staff treating involuntary patients [18]; |
• Opinions from patients and carers: | • Not helpful for long term recovery: |
o Nasogastric feeding was seen as necessary by some patients because they believed they lacked the physical or psychological capacity to eat [47]; | o Patients may demonstrate an inability to maintain adequate intake and weight gain once the tube is removed [9, 46]; |
o Parents recognized it as a last resort that was required to keep their child alive [27]; | o Force feeding in low weight patients achieved little in relation to remitting illness or suffering [48]; |
o It reduced the pressure patients perceive is being placed on them to eat and temporarily relieves responsibility for adopting improved eating behaviours [47] | o Patients tamper with the tube by adjusting the control, decanting the feed into other containers when unobserved, biting, and removing the tube [27, 32, 33, 40, 48]. |
• Medical complications i.e. aspiration [49]; nasal bleeding and nasal irritation [9, 18, 33]; reflux and sinusitis [9, 32]; | |
• The tube may not be inserted properly which is more likely when patients have one inserted against their will [40]; | |
• Opinions from patients and carers: | |
o It disguised the consumption of food [47]; | |
o Patients become emotionally attached to and physically reliant on nasogastric feeding, and were anxious about the tube being removed [47] | |
o Used as a form of punishment and seen as a strategy that doctors used to assert their control [47]; | |
o It was easier to avoid nutrition rehabilitation [47]; | |
o “NG feeding becomes enmeshed as an integral and valued sense of patients personal identity or if it becomes entwined with a desire to preserve a public status as an anorexic” which may contribute to the patient valuing AN more highly than recovery. It is a personal and public signifier of AN [47]; | |
o “….my lasting memory of being fed by a tube was that it was very very intrusive” [27]; | |
o Two parents believed that the tube was kept in for too long, which made the reintroduction of solid foods more difficult [27]. | |
Parenteral nutrition | |
Benefits | Adverse effects |
• It requires minimal patient cooperation [31]. | • It may reinforce a tendency to focus only on physical symptoms rather then the psychiatric implications of AN [31]; |
• Sabotage occurs by pouring solutions into the sink and removing the device [8, 31]; | |
• It cannot teach patients anything about eating, food choice or portion size, or to perceive their bodies more accurately [31]. | |
• Medical complications i.e. infections, arterial injury, cardiac arrhythmias (from placement), changes in vascular endothelium, hyper-osmolarity, and hyperglycaemia [44]; hypophosphataemia and hypokalemia [8]; | |