Researchers at Stanford University were determined to find out if hospitalizations led to long term weight gain in youth with eating disorders. They found that those who were hospitalized had a significantly higher chance of weight gain than those who were treated in outpatient programs.
Eating disorders present a serious health concern for today’s youth, as they can lead to long term physical health complications and even death. Treatment includes a range of inpatient and outpatient programs that include hospitalization, day treatments, residential facilities and counseling. The cost of treating eating disorders is very high and hospitalizations are the largest expense. In fact, in 2008 the cost of inpatient treatment for eating disorders in the United States was approximately $100 million. This leaves service providers wondering; “Do hospitalizations actually lead to long term weight gain? Or would these health care dollars be better spent on additional outpatient resources?”
Researchers at Stanford University set out to answer that question. They examined the health records of 140 patients between the ages of 9yrs to 20yrs with a BMI that was less than 85% of the median and followed these patients for one year. They found that the patients who were hospitalized during this year had a greater chance of achieving a BMI that was 90% or more of the median than patients who were not hospitalized. In fact, the patients who were hospitalized were four times more likely to have significant weigh gain in the year following than patients who were treated in outpatient programs alone.
The patients included qualified for DSM-5 diagnoses of restrictive eating disorders, including anorexia nervosa, atypical anorexia nervosa, and avoidant restrictive food intake disorder (ARFID). Of the patients included, 63 were hospitalized and 77 were received outpatient treatment. No differences in hospitalization rates were observed with respect to age, sex, or race.
It is possible that the very act of hospitalization increases the awareness of the severity of the illness for both the patient and their family. Being hospitalized may act as a motivator for patients who may want to avoid future hospital stays. Hospitalizations also provide a unique opportunity to educate patients and family members about the challenges of treating eating disorders, and can demonstrate in a concrete way the medical improvements that result from improved nutrition. In addition, hospital stays can also help patients and families to understand the serious nature of eating disorders including the possibility of cardiac complications.
Further study is needed to pinpoint the exact reason that hospitalizations lead to improved outcomes. Perhaps these needs could be met outside of the hospital setting, which would lead to lower health care costs and more efficient use of resources. There were a few limitations to this study, including a patient population of only adolescents, and as such this study provides little insight into adult treatment options. The study also only included patients who were hospitalized for the first time, which means that the results may not apply to patients with more chronic, long term eating disorders who may require different care strategies. Additionally, the researchers did not account for differences between inpatient treatment in psychiatric units or emergency department admission for medical stabilization in their analysis.
This study provides important insight into the value of hospitalizations for patients with eating disorders and may lead decision makers to recommend hospitalizations as a first line of defense for treatment.
Written By: Lisa Borsellino