What are the criteria for hospital admission of patients with eating disorders?

From the Guidelines

Hospital admission for patients with eating disorders is typically recommended when they exhibit severe medical or psychiatric complications that cannot be managed safely in outpatient settings, as outlined in the American Psychiatric Association practice guideline for the treatment of patients with eating disorders 1. The primary criteria for admission include:

• Severe malnutrition with a body mass index (BMI) below 16 kg/m² or weight less than 75% of ideal body weight
• Rapid weight loss exceeding 1-2 pounds per week
• Physiological instability such as heart rate below 40 beats per minute, blood pressure below 90/60 mmHg, body temperature below 97°F (36.1°C), or orthostatic hypotension with a drop in blood pressure exceeding 20 mmHg
• Electrolyte abnormalities, particularly hypokalemia (potassium <3.0 mEq/L), hyponatremia, or hypophosphatemia
• Psychiatric indications include acute suicidal ideation, severe comorbid psychiatric conditions that impair treatment engagement, or failed outpatient treatment attempts
• For patients with bulimia nervosa, uncontrollable purging behavior or severe medical complications from purging such as hematemesis or syncope may necessitate hospitalization The goal of inpatient treatment is medical stabilization, nutritional rehabilitation with careful refeeding, and initiation of psychiatric treatment, as recommended by the APA 1. Key aspects of the initial evaluation and treatment plan include:
• Weighing the patient and quantifying eating and weight control behaviors 1
• Identifying co-occurring health conditions, including co-occurring psychiatric disorders 1
• Comprehensive review of systems and physical examination, including assessment of vital signs and physical appearance 1
• Laboratory assessment, including complete blood count and comprehensive metabolic panel 1
• Electrocardiogram for patients with restrictive eating disorder, severe purging behavior, or taking medications that prolong QTc intervals 1
• Documented, comprehensive, culturally appropriate, and person-centered treatment plan that incorporates medical, psychiatric, psychological, and nutritional expertise 1

From the Research

Criteria for Hospital Admission of Patients with Eating Disorders

The decision to admit a patient with an eating disorder to the hospital is based on several factors, including:

• Health status, such as acute food refusal, uncontrollable binge eating or purging, co-occurring conditions, suicidality, and test abnormalities 2
• Weight patterns, including severe malnutrition or rapid weight loss 2, 3
• Presence of gastrointestinal symptoms or disorders, such as postprandial fullness, abdominal distention, abdominal pain, gastric distension, and early satiety 4
• Psychosocial factors, including anxiety, depression, and cognitive impairment 5
• Availability of outpatient options and social support 2, 6

Factors Influencing Medical Decisions

Physicians consider several factors when making medical decisions for patients with eating disorders in the acute setting, including:

• Navigating uncertainty and seeking information to guide treatment decisions 6
• Taking a holistic approach that considers both short and longer-term goals 6
• Relying on specialist colleagues, the wider multidisciplinary team, and sometimes family members to guide treatment decisions 6
• Considering the patient's overall well-being and quality of life 6

Guidelines for Admission

According to the existing guidelines, patients with anorexia nervosa or other severe eating disorders may require hospital admission if they:

• Have a low body mass index (BMI) or are at risk of malnutrition 3
• Have severe gastrointestinal symptoms or disorders 4
• Have co-occurring mental health conditions, such as depression or anxiety 5
• Are at risk of suicide or self-harm 2, 6
• Require close monitoring and supervision to ensure their safety and well-being 2, 6