Restoration of weight and nutritional status are key elements in the treatment of anorexia nervosa (AN). This review aims to describe issues related to the caloric requirements needed to gain and maintain weight for short and long-term recovery for AN inpatients and outpatients.We reviewed the literature in PubMed pertaining to nutritional restoration in AN between 1960–2012. Based on this search, several themes emerged: 1. AN eating behavior; 2. Weight restoration in AN; 3. Role of exercise and metabolism in resistance to weight gain; 3. Medical consequences of weight restoration; 4. Rate of weight gain; 5. Weight maintenance; and 6. Nutrient intake.A fair amount is known about overall caloric requirements for weight restoration and maintenance for AN. For example, starting at 30–40 kilocalories per kilogram per day (kcal/kg/day) with increases up to 70–100 kcal/kg/day can achieve a weight gain of 1–1.5 kg/week for inpatients. However, little is known about the effects of nutritional deficits on weight gain, or how to meet nutrient requirements for restoration of nutritional status.This review seeks to draw attention to the need for the development of a foundation of basic nutritional knowledge about AN so that future treatment can be evidenced-based.

This paper aimed to investigate cognitive rigidity and decision making impairments in patients diagnosed with Anorexia Nervosa Restrictive type (AN-R), assessing also verbal components. Thirty patients with AN-R were compared with thirty age-matched healthy controls (HC). All participants completed a comprehensive neuropsychological battery comprised of the Trail Making Test, Wisconsin Card Sorting Test, Hayling Sentence Completion Task, and the Iowa Gambling Task. The Beck Depression Inventory was administered to evaluate depressive symptomatology. The influence of both illness duration and neuropsychological variables was considered. Body Mass Index (BMI), years of education, and depression severity were considered as covariates in statistical analyses. The AN-R group showed poorer performance on all neuropsychological tests. There was a positive correlation between illness duration and the Hayling Sentence Completion Task Net score, and number of completion answers in part B. There was a partial effect of years of education and BMI on neuropsychological test performance. Response inhibition processes and verbal fluency impairment were not associated with BMI and years of education, but were associated with depression severity. These data provide evidence that patients with AN-R have cognitive rigidity in both verbal and non-verbal domains. The role of the impairment on verbal domains should be considered in treatment. Further research is warranted to better understand the relationship between illness state and cognitive rigidity and impaired decision-making.

The aim of this study is assessing interactions between attachment style and personality in predicting body dissatisfaction (BD). A total of 586 outpatients with eating disorders (EDs) were recruited: 101 with anorexia nervosa, restricting type; 52 with anorexia nervosa, binge-eating/purging type; 184 with bulimia nervosa, purging type; and 249 with an eating disorder not otherwise specified. Participants completed Temperament and Character Inventory, Body Shape Questionnaire, Beck Depression Inventory, and Attachment Style Questionnaire. An insecure attachment was found in all EDs, as well as in eating disorder not otherwise specified. In all diagnostic groups, need for approval, as measured by the Attachment Style Questionnaire and depressive symptomatology, was found to be the best predictor of BD. Personality traits are weaker predictors of BD. This study supports the hypothesis that attachment insecurity is directly correlated with BD, core element in predicting and perpetuating EDs, independently of personality. Implications for treatment are discussed.

Family therapy approaches have generated impressive empirical evidence in the treatment of adolescent eating disorders (EDs). However, the paucity of specialist treatment providers limits treatment uptake; therefore, our group developed the intensive family therapy (IFT)—a 5‐day treatment based on the principles of family‐based therapy for EDs. We retrospectively examined the long‐term efficacy of IFT in both single‐family (S‐IFT) and multi‐family (M‐IFT) settings evaluating 74 eating disordered adolescents who underwent IFT at the University of California, San Diego, between 2006 and 2013. Full remission was defined as normal weight (≥95% of expected for sex, age, and height), Eating Disorder Examination Questionnaire (EDE‐Q) global score within 1 SD of norms, and absence of binge–purging behaviours. Partial remission was defined as weight ≥85% of expected or ≥95% but with elevated EDE‐Q global score and presence of binge–purging symptoms (<1/week). Over a mean follow‐up period of 30 months, 87.8% of participants achieved either full (60.8%) or partial remission (27%), while 12.2% reported a poor outcome, with both S‐IFT and M‐IFT showing comparable outcomes. Short‐term, intensive treatments may be cost‐effective and clinically useful where access to regular specialist treatment is limited. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.