What is the Refeeding Process?

What is the refeeding process? 

The refeeding process is when caloric intake is increased for a patient after having a very low intake for a prolonged time period.

Why does this process happen?

The goals of the refeeding process are nutritional rehabilitation and weight restoration to help reverse malnutrition. This is necessary for recovery because patients with malnutrition suffer from cognitive deficits that make it difficult to adequately participate in psychotherapy.

 When is the refeeding process necessary?

There are guidelines for when the refeeding process is necessary for a patient. These include having a weight of less than 70% of ideal body weight, slow heart rate, arrhythmias, and unstable vitals.

Refeeding Syndrome

Refeeding syndrome is when there are very low electrolyte levels as a result of refeeding. This is due to the blood sugar increase that happens when the refeeding process begins. This blood sugar increase triggers the release of insulin to lower the blood sugar, but this can also decrease electrolyte levels in the bloodstream. Refeeding syndrome is avoided by carefully monitoring electrolyte levels through labs, as well as careful cardiac monitoring. If there seems to be a risk, electrolyte supplementation is provided.

What is the refeeding process like?

There are no clear guidelines for how the process should be completed, but the general consensus for years has been to gradually increase caloric intake. However, more recent data also suggests that a more aggressive approach to refeeding can also be effective, starting with higher caloric intakes and increasing quickly. Though there may be a shift to this more aggressive approach, the process is still highly individualized and tailored in order to avoid refeeding syndrome.

There are a few different stages that may make up the refeeding process. The first of these is to ensure that enough calories and fluids are consumed in order to meet nutritional needs without worrying about the exact foods that are consumed. When enough food is consumed consistently to meet nutritional needs, there is a shift to focusing on having an appropriate balance of carbohydrates, fat, and protein. Next is a focus on micronutrients—vitamins, minerals, and fiber. 

When there is a good balance of macronutrients and micronutrients, there is a focus on consuming various foods through different meals and snacks. The final stage of this refeeding process might be called “facing fear foods” or “challenging foods”. This is only done when all other requirements of refeeding are met. At this stage, foods that are hard for the person in recovery to consume are introduced in order to decrease the fear and anxiety surrounding those foods.

The refeeding process can seem daunting and scary, but you should and will be surrounded by a supportive team of medical professionals that will help guide you through the process. Refeeding is critical to eating disorder recovery so the psychotherapy that provides cognitive reframing surrounding food can benefit the individual to the greatest extent. 

References

Hopkins, C. (n.d.). What to expect during the refeeding process (J. Walsh, Ed.). Change Creates Change. Retrieved July 25, 2022, from https://changecreateschange.com/what-to-expect-during-the-refeeding-process/

Mascolo, M. (2018, February 8). Refeeding patients with anorexia nervosa: What does research show? Eating Disorder Hope. Retrieved July 25, 2022, from https://www.eatingdisorderhope.com/information/anorexia/refeeding-patients-with-anorexia-nervosa-what-does-research-show

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