Updated October 2025
Evidence Synthesis
Eating Disorders: Medical Stabilization and Multidisciplinary Care
Medical stabilization focuses on rapid risk stratification, prevention of refeeding syndrome, and correction of acute physiologic derangements. Multidisciplinary care—integrating medical, psychiatric, nutritional, and functional rehabilitation—improves coordination, safety, and continuity across settings. Evidence supports structured inpatient nutritional rehabilitation for unstable patients and team-based outpatient care for medically stable individuals.
Clinical question
What are best practices for medical stabilization and multidisciplinary care in eating disorders across inpatient and outpatient settings?
Eating DisordersAnorexia NervosaAtypical AnorexiaAdolescent MedicineRefeeding SyndromeMultidisciplinary CareNutritional Rehabilitation
Key points
Triage and Indications for Admission
Admit for vital sign instability, electrolyte derangements, acute complications, or failure of outpatient care. Adolescents with AN and atypical AN are at highest risk for inpatient medical stabilization [2], [6].
Prevent Refeeding Syndrome
Initiate structured caloric refeeding with close phosphate, potassium, and magnesium monitoring; refeeding risk is highest in the first 5–7 days of renourishment [1], [2].
Structured Nutritional Rehabilitation
Standardized inpatient protocols improve weight restoration trajectories and reduce electrolyte disturbances when paired with vigilant monitoring [1].
Multidisciplinary Team (MDT) Core
Medical provider, dietitian, and mental health clinician are essential; adding occupational therapy strengthens functional recovery, routine rebuilding, and sensory regulation [3], [4], [5].
Adjunctive Interventions
Mindful eating is an emerging adjunct within MDT models; current evidence base maps growing interest but remains exploratory, warranting integration only as a complement to core treatments [7].
Evidence highlights
Hemodynamic risk, electrolytes, refeeding prevention, caloric titration [1], [2]
Inpatient stabilization focus
Coordinated MDT including medicine, psychiatry, dietetics; add OT for function [3], [4], [5]
Care model
Outpatient psychotherapy feasible if medically stable; inpatient if unstable [2], [6]
Setting selection
Initial Inpatient Approach
Prioritize hemodynamic stabilization, electrolyte correction, and safe refeeding while initiating coordinated psychiatric and nutritional care.
1
Risk Stratify and Admit
Assess for bradycardia, hypotension/orthostasis, hypothermia, dehydration, syncope, QTc prolongation, severe electrolyte abnormalities, or acute complications (e.g., arrhythmia). Adolescents with AN/atypical AN commonly require inpatient stabilization when medically compromised [2], [6].
2
Baseline Diagnostics
Obtain vitals (supine/standing), ECG, CMP with phosphorus and magnesium, CBC, urinalysis, and pregnancy test when applicable. Repeat electrolytes at least daily during early refeeding; more frequent if high risk [1], [2].
3
Initiate Nutritional Rehabilitation
Begin a structured meal plan with caloric targets aligned to refeeding risk and adjust daily. Supplement phosphorus, potassium, and magnesium proactively when indicated; thiamine is often provided in high-risk patients [1], [2].
4
Monitor for Refeeding Syndrome
Watch for edema, tachycardia, respiratory compromise, and drops in phosphorus. The highest-risk window is early in refeeding; escalate labs and telemetry as needed [1], [2].
5
Address Acute Comorbidities
Treat dehydration, hypoglycemia, constipation, and rehydrate carefully to avoid fluid shifts. Consider bowel rest or NG feeding if oral intake fails; consult GI/nutrition support as needed [1], [2].
6
Engage the MDT Early
Coordinate daily with psychiatry/psychology, dietetics, nursing, social work, and OT to align goals, reinforce meal plans, and plan step-down care [3], [4], [5], [8].
Multidisciplinary Care Elements
Core roles and interventions that improve safety, adherence, and functional recovery across settings.
Core Team
Medical lead (pediatrics, internal medicine, or adolescent medicine) [2], [6]
Mental health clinician (CBT-E, FBT, psychopharmacology for comorbidity) [6], [5]
Registered dietitian with ED expertise (meal planning, exposure, education) [4], [5]
Nursing with ED protocols (mealtime supervision, safety) [8]
Social work/case management (family support, transitions of care) [8]
Functional Rehabilitation (OT)
Activities of daily living and routine rebuilding to support return to roles [3]
Graded sensory-exposure and interoceptive awareness strategies [3]
Meal preparation skills and environmental adaptations [3]
Safety and Medical Protocols
Orthostasis and ECG monitoring; QTc review if purging or on QT-prolonging meds [2]
Electrolyte surveillance and proactive supplementation during refeeding [1]
Bone health screening (DXA when indicated) and menstrual/androgen axis review [6]
Nutritional Rehabilitation
Structured meal plans with caloric titration and macronutrient balance [1]
NG supplementation if oral intake inadequate or high medical risk [1]
Micronutrient support (phosphate, thiamine, multivitamin) in early refeeding [1], [2]
Care Transitions
Define medical stability criteria for discharge (vitals, electrolytes, intake) [2], [6]
Warm handoff to outpatient MDT; early scheduling to prevent care gaps [5], [8]
Relapse prevention plan with clear thresholds for re-escalation [6]
Populations Requiring Special Strategies
Severe and enduring AN: shift toward collaborative, harm-reduction goals and QoL focus [9]
Atypical AN: medical risk can equal classic AN despite normal BMI [2], [6]
Co-occurring medical conditions (e.g., diabetes) require tailored protocols [2]
References
Source material
Primary literature that informs this article.
Outcomes of an inpatient medical nutritional rehabilitation ...
link.springer.com
The Inpatient Management of Adolescents with Eating ...
pubmed.ncbi.nlm.nih.gov
The importance of including occupational therapists as part of ...
link.springer.com
Briefing paper
www.nice.org.uk
The multidisciplinary team approach to the outpatient ...
pubmed.ncbi.nlm.nih.gov
Anorexia nervosa: Outpatient treatment and medical ...
pmc.ncbi.nlm.nih.gov
Mindful Eating in the management of eating disorders
www.sciencedirect.com
Multidisciplinary treatment of eating disorders--Part 1
pubmed.ncbi.nlm.nih.gov
Towards collaborative care for severe and enduring Anorexia ...
link.springer.com
A multidisciplinary team treatment for patients with ...
onlinelibrary.wiley.com
7 Multidisciplinary treatment of a patient with anorexia ...
adc.bmj.com