Trial reportThe International journal of eating disorders2023
Hospital-based higher calorie refeeding and mealtime distress in adolescents and young adults with anorexia nervosa or atypical anorexia nervosa.
Trial report in The International journal of eating disorders, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers.
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The trial behind it
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Who cites it
6 citing papers in PubMed, 12 citations in OpenAlex.
- Short-term outcomes of the study of refeeding to optimize inpatient gains for patients with atypical anorexia nervosa.The International journal of eating disorders · 2024Trial
- High-Caloric Realimentation and Mental and Physical Well-Being in Patients With Extreme Anorexia Nervosa. A Prospective Study.European eating disorders review : the journal of the Eating Disorders Association · 2026Article
- Mealtime Physiological Responses in Individuals With Eating Disorders and Healthy Controls.European eating disorders review : the journal of the Eating Disorders Association · 2026Article
- Evidence of Altered Biobehavioral Threat Processes in Adolescents With Eating Disorders: A Scoping Review.The International journal of eating disorders · 2025Article
- Advancements in Inpatient Medical Management of Malnutrition in Children and Adolescents with Restrictive Eating Disorders.The Journal of pediatrics · 2023Article
- An exploration of the association between premorbid weight status on patient and caregiver factors at pre and post-treatment among youth with anorexia nervosa/atypical anorexia nervosa.Eating behaviors · 2023Article
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Authors and funding
9 authors at 2 institutions in 1 country.
Funding
Abstract
objectiveThe StRONG study demonstrated that higher calorie refeeding (HCR) restored medical stability faster in patients hospitalized with anorexia nervosa (AN) and atypical AN (AAN), with no increased safety events compared with standard-of-care lower calorie refeeding (LCR). However, some clinicians have expressed concern about potential unintended consequences of HCR (e.g., greater mealtime distress). The purpose of this study was to examine patient treatment preference and compare mealtime distress, food refusal, and affective states between treatments.
methodParticipants (N = 111) in this multisite randomized clinical trial were ages 12-24 years, with AN or AAN, admitted to hospital with medical instability who received assigned study treatment (HCR or LCR). Treatment preference was assessed prior to randomization in the full sample. In a subset of participants (n = 45), linear mixed effect models were used to analyze momentary ratings of mealtime distress (pre, during, and post-meals) and daily affective state during the hospitalization.
resultsAbout half (55%) of participants reported a preference for LCR. Treatment assignment was not associated with food refusal, mealtime distress, or affective states in the subsample. Food refusal increased significantly over the course of refeeding (p = .018). Individuals with greater depression experienced more negative affect (p = .033), with worsening negative affect over time for individuals with higher eating disorder psychopathology (p = .023). DISCUSSION: Despite understandable concerns about potential unintended consequences of HCR, we found no evidence that treatment acceptability for HCR differed from LCR for adolescents and young adults with AN and AAN. PUBLIC SIGNIFICANCE: The efficacy and safety of higher calorie refeeding in hospitalized patients with anorexia nervosa has been demonstrated. However, it is not known whether higher calorie refeeding (HCR) increases meal-time distress. This study demonstrated that HCR was not associated with increased mealtime distress, food refusal, or affective states, as compared with lower calorie refeeding. These data support HCR treatment acceptability for adolescents/young adults with anorexia nervosa and atypical anorexia nervosa.
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