What is Medical Stabilization in Eating Disorder & Malnutrition Treatment?

Eating disorders, like anorexia nervosa, are one of the few psychiatric illnesses regularly accompanied by severe, life-threatening medical complications. Starvation, poor nutrition, overexercise and purging – all of which are associated with eating disorders – cause severe complications of all major organ systems, including refeeding syndrome and potentially death. The same is true for those suffering from non-eating disorder malnutrition, who often experience similar complications.

Medical stabilization is the highest level of care for eating disorders and addresses a variety of severe and complex medical complications. Medical stabilization involves a series of interventions to stabilize vital signs and restore organ function.

When medical stabilization is necessary

In general, medical stabilization is recommended for patients with eating disorders or malnutrition who are severely low weight or have experienced aggressive weight loss, are experiencing serious medical complications, or are at risk of developing refeeding syndrome.

Patients with any of the following criteria may require medical treatment from experienced providers in a medical hospital before entering a treatment program:

  • Weigh less than 70% of ideal body weight (IBW) or have an body mass index (BMI) less than 14.5
  • Unstable vital signs, such as low heart rate or low blood pressure
  • Cardiac symptoms, such as abnormal heart rhythms or heart failure
  • Recurrent fainting due to low blood pressure
  • Acute kidney injury or abnormal liver function tests
  • Frequent purging behaviors, thereby increasing the risk for development of pseudoBartter syndrome
  • Electrolyte abnormalities
  • Hypoglycemia
  • Rapid weight loss

FAQ: Is there a difference between eating disorder medical stabilization & other forms of care?

There are notable differences between medical stabilization and other forms of care for eating disorders. Medical stabilization is inpatient medical care, providing vital sign monitoring, intravenous fluids, daily lab monitoring, nutritional support, and medications that aren’t always available at a lower level of care (e.g., inpatient psychiatric care).

Goals of medical stabilization

Improve vital signs

Improved vital signs are indicators that a patient is becoming stabilized. As patients reach lower weights, their vital signs are impacted and they experience things like bradycardia, hypotension, and low body temperature.

Restore bowel function

The more malnourished an individual, the more severe their gastrointestinal symptoms. Restoring bowel function is a key goal of medical stabilization because impaired bowel function can make refeeding more difficult. Proper bowel function ensures effective digestion and nutrient absorption, helping the body utilize food efficiently and facilitate recovery.

Resolve serum electrolyte and other abnormalities

Electrolyte and other abnormalities are some of the most common complications of eating disorders, putting patients at risk for serious issues like refeeding syndrome or hypoglycemia. Hypoglycemia and refeeding syndrome are both potentially fatal, but with proper medical stabilization and refeeding, these abnormalities can stabilize, putting patients back on track to recovery.

Weight restoration

A major component of medical stabilization is weight restoration. Although not every single complication associated with eating disorders resolves with a restored weight, most of them do, highlighting the importance of nutrition and dietetics in eating disorder care.

Weight restoration is also critical for those with non-eating disorder malnutrition who are ineligible for certain medical treatments, like:

  • Surgery
  • Organ transplant
  • Chemotherapy
  • Radiation therapy

Continued recovery at lower levels of care

Once a patient is medically stable, they can engage in treatment at lower levels of care. Medical stabilization is the first step of many in a patient’s long-lasting recovery. Proper nutrition supports brain function and enhances mood, allowing patients to put their best foot forward as they start their recovery journey.

Delivering medical stabilization

Telemetry

Telemetry is a means to monitor a patient’s cardiac status 24:7, as opposed to intermittent EKGs that only monitor cardiac rhythms for a very brief amount of time, reducing the likelihood of catching cardiac abnormalities. Because vital signs can be unstable in those with eating disorders and malnutrition, vital signs monitoring is necessary to identify serious cardiopulmonary abnormalities and quickly intervene. Vital monitoring allows providers to assess overall health, detect health issues, monitor health conditions and guide treatment decisions.

ACUTE monitors:

  • Heart rate
  • Blood pressure
  • Respiration rate
  • Body temperature
  • Oxygen saturation

Comprehensive nutrition

Medical nutrition therapy (MNT) is vital to treating malnutrition and achieving medical stabilization. Without nutrition interventions, the body’s organs, muscles and tissues cannot heal, perform or replenish, making medical stabilization impossible. Unlike lower levels of care, ACUTE has the capability of providing oral nutrition, enteral nutrition, or even parenteral (IV) nutrition.

Lab Monitoring & Imaging

A very quick turnaround for lab work is necessary when treating patients with eating disorders and severe malnutrition. To monitor a patient’s status, regular and timely lab work is necessary. Daily lab monitoring is particularly important during the initial stages of refeeding to monitor key electrolytes and mitigate the risk of refeeding syndrome.

Physicians can also order imaging, like X-rays , CT scans or MRIs, for diagnostic purposes. These imaging tests can be used for diagnostic purposes or for educational purposes, like helping a patient to better understand their gastrointestinal symptoms.

Staffing

The multidisciplinary team at ACUTE provides all the care that patients need to recover, without the need to transfer between units. With access to specialty consults through Denver Health there is seamless and timely communication that allows for more efficient care.

With around-the-clock nursing coverage and physician oversight, patients receive consistent and immediate care, which is crucial for monitoring changes in their condition and providing timely interventions for any complications that occur during refeeding.

What to expect from medical stabilization

Assessment

On day one, patients meet with a physician who will perform a comprehensive physical assessment to better understand a patient’s current health status, review medical history, identify potential health risks and determine treatment goals. The physical assessment includes:

  • Medical history review
  • Vital signs assessment
  • General physical examination
  • Laboratory tests
  • Additional diagnostic tests as necessary

Alongside the comprehensive physical assessment, patients can expect visits and assessments with other providers, including:

  • Psychiatrists
  • Dieticians
  • Physical therapists
  • Occupational therapists
  • Psychologists
  • Social workers
  • Ancillary staff, such as speech-language pathologists and child-life specialists

Education

Education plays an important role in the medical stabilization process. Most patients are unfamiliar with the medical stabilization and refeeding processes, and as a result have many questions. Physicians answer questions about why medications are recommended, why certain things occur during chronic starvation or the refeeding process, and give insight into what is happening to the body and how it can be treated.

Providers will also review test results and imaging with patients. Physicians may also use imaging as an educational tool to explain anatomy, nutrition or the medical complications that occur alongside eating disorders and malnutrition.

Skilled Interventions

  • Comprehensive treatment planning
  • Dedicated phlebotomist
  • Medical imaging
  • Nursing support to help patients cope with stressors

Who does ACUTE treat?

ACUTE accepts patients who are too medically complex for lower levels of care.

  • 15+ years of age
  • All gender expressions
  • <70% of ideal body weight (IBW)
  • BMI <14.5
  • Severe medical complications associated with anorexia nervosa
View full admissions criteria

Get connected to care

Our admissions specialist can help assess your needs and determine the appropriate level of care.

Even if ACUTE isn’t right for you, our experienced admissions team can connect you with other programs that meet your needs.

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ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

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