Inpatient Treatment of Anorexia Nervosa: Does Inpatient Weight Restoration Prior to Outpatient Family Treatment Improve Outcomes in Adolescent Anorexia Nervosa? A Randomised Controlled Trial

Abstract

Background Anorexia Nervosa (AN) is a serious disorder, with high costs due to hospitalisation and complications due to malnutrition. International treatments vary with prolonged hospitalisations in Europe and shorter hospitalisations in the USA. Uncontrolled studies suggest longer initial hospitalisations that normalise weight produce better outcomes than shorter hospitalisations with lower discharge weights. This study aimed to compare effectiveness of hospitalisation for weight restoration (WR) to medical stabilisation (MS) in adolescent AN. Secondary aims were to assess the safety of a rapid refeeding protocol and to identify early markers in Family Based Treatment (FBT) predicting remission. Methods A randomised controlled trial of 82 adolescents, 12-18 years, with DSM-IV AN and medical instability, admitted to two paediatric units. Participants were randomised to shorter hospitalisation for MS or longer hospitalisation for WR to 90% expected body weight (EBW) for gender, age, and height, both followed by 20 sessions of outpatient FBT. Results Primary outcome was hospital days, following initial admission, at 12-month follow-up. Secondary outcomes were total hospital days used to 12-months, full remission (>95% EBW and global Eating Disorder Examination score within 1 SD of published means), weight gain and medical complications during initial refeeding and early markers of remission. There was no significant difference between groups in hospital days used following initial admission. There were significantly more total hospital days used and post-protocol FBT sessions in the WR group. There were no moderators of primary outcome. All patients gained weight from week one without medical complications. Weight gain of 1.8kg by week 4 of FBT predicted full remission. Conclusions Outcomes are similar with hospitalisations for MS or WR when combined with FBT. Cost savings would result from combining shorter hospitalisation with FBT.