It's not hard to think of nasogastric tube feeding as a very simple solution to the problem of anorexia nervosa. The person won't eat? Just give the calories in another way. If only it were that simple! Tube feeding is one component of a long-term recovery plan -- a bridge to weight restoration that can help to restore the possibility of normal eating.
What Is Nasogastric Tube Feeding?
Nasogastric tube feeding is the introduction of liquid calories, via a tube inserted through the nose and running directly to the stomach. In general, tube feeding is a technique used for those who are unable to eat on their own.
When is Nasogastric Tube Feeding for Anorexia Nervosa Appropriate?
Tube feeding may be an option to supplement caloric intake when a person with anorexia has difficulty eating the amount of food necessary to gain weight. Simply putting the appropriate amounts of food in one's mouth can be very troubling for a person with anorexia; it will be far more food than she (or he) has eaten for some time.
Cooperative patients who have difficulty eating enough calories during the day can receive supplemental nasogastric tube feedings overnight. This allows food intake to be spread out over a full 24-hour period. Therefore, the body can adjust more gradually to the bump in calories. At least one study has suggested that this method can result in greater and faster weight gain than oral refeeding alone.
In extreme situations, nasogastric tube feeding may be used as a last resort to keep a patient alive.
Refeeding Syndrome, a Hazard with Tube Feeding
As in any refeeding process, clinical teams must be watchful for refeeding syndrome when employing nasogastric tube feeding. A life-threatening issue, refeeding syndrome occurs when caloric intake rises too quickly for a patient to tolerate. Electrolytes become out of balance, and this increases the possibility of sudden death from heart failure, as well as other problems.
Tube feeding must occur at a measured rate that the patient can handle. Meanwhile, medical staff must carefully watch blood electrolyte levels, heart rate and respiratory rate for signs that the body is not metabolizing calories quickly enough.
What Nasogastric Tube Feeding Is Not
Tube feeding is not a substitute for oral food intake. All patients should be expected to resume eating on their own eventually.
While it can be difficult to convince some patients to give up control of their food intake and rely on calories administered directly by others, the ultimate goal is that they will take control -- healthy control -- of their eating as their symptoms lessen.
How Does Tube Feeding Work with Resistant Patients?
Fearful some patients may disrupt tube feeding by removing their tubes, some treatment providers resort to physically restraining these patients.
Clinicians have raised questions about whether it's ethical to force nutrition on someone who doesn't want it. This issue is complex.
Those with acute anorexia are most likely psychologically impaired: The lack of nutrition affects the capacity for reason. So it's not likely that patients themselves will be competent to make the decision to use tube feeding or not.
Still, a patient cannot be forced to receive tube feeding unless court-ordered guardianship is in place. A treatment team may pursue guardianship when they are unable to come to a consensus with the patient and there are imminent health concerns.
Sources:
American Psychiatric Association. "APA Practice Guidelines: Treatment of Eating Disorders" (3rd ed.). Accessed 19 December 2008.
Hébert PC and Weingarten MA. The ethics of forced feeding in anorexia nervosa. Canadian Medical Association Journal 144 (1991): 141-144.
Robb AS, Silber TJ, Orrell-Valente JK, Valadez-Meltzer A, Ellis N, Dadson MJ, Chatoor I. Supplemental nocturnal nasogastric refeeding for better short-term outcome in hospitalized adolescent girls with anorexia nervosa. American Journal of Psychiatry 159 (2002): 1347-1353.
Zuercher JN, Cumella EJ, Woods BK, Eberly M, Carr JK. Efficacy of voluntary nasogastric tube feeding in female inpatients with anorexia nervosa. Journal of Parenteral and Enteral Nutrition 27 (2003): 268-276.
