What high calorie recipes are suitable for teenagers recovering from anorexia nervosa (AN)?

High-Calorie Nutritional Strategies for Adolescent Anorexia Nervosa Recovery

Core Nutritional Framework

Parents must take full control of all eating decisions and meal planning, serving 3-4 meals plus 1-2 snacks daily (every 90-120 minutes), with emphasis on nutrient-dense foods from all food groups including whole grains, fruits, vegetables, dairy, protein foods, and healthy oils. 1, 2

Initial Caloric Requirements

• Start with approximately 3,200-3,300 kcal/day (74 kcal/kg body weight) during the first week of intensive nutritional rehabilitation, gradually adjusting based on metabolic response 3
• Energy needs are substantially higher than typical adolescent requirements due to metabolic recovery demands and restoration of lean body mass 4, 3
• Most recovering patients require 30-50 kcal/kg/day as treatment progresses, with severely malnourished patients needing careful monitoring to avoid refeeding syndrome 3, 4

Practical High-Calorie Recipe Components

Build meals using the "healthy plate" concept: half filled with vegetables, one-fourth with starch (potatoes, rice, pasta, whole grains), and one-fourth with protein (meat, poultry, fish, eggs, legumes), but increase portion sizes substantially beyond typical adolescent servings. 2

Breakfast Options (Target: 600-800 kcal)

• Whole grain cereals with full-fat dairy, nut butters on whole grain toast, eggs, and fruit 2
• Add high-calorie oral nutritional supplements (200-400 kcal) if solid food intake is insufficient 5

Main Meals (Target: 800-1000 kcal each)

• Emphasize nutrient-dense foods: lean meats, poultry, fish, whole grains, vegetables, and healthy fats 2
• Include 6-11 servings of whole grains and complex carbohydrates daily 2
• Incorporate healthy oils and fats to increase caloric density without excessive volume 2

Snacks (Target: 300-400 kcal, 2-3 times daily)

• Nut butters, full-fat dairy products, whole grain crackers with cheese, trail mix, smoothies with added protein powder 2
• Limit sweetened beverages to 8-12 oz daily for adolescents, focusing instead on nutrient-dense liquid supplements when needed 2

Critical Micronutrient Considerations

Ensure adequate intake of calcium (3+ servings of calcium-rich foods daily), iron, folate, and vitamin D, as 85% of recovering patients have intakes below recommendations for these nutrients. 2, 6

• Iron-rich foods should be prioritized (lean meats, fortified cereals, legumes) as 25% of recovering patients develop subnormal ferritin levels 6
• Vitamin D supplementation may be necessary as 20% have subnormal serum levels despite adequate dietary intake 6

Treatment Strategy and Monitoring

Medical stabilization and nutritional rehabilitation are the most crucial determinants of short- and intermediate-term outcomes, with parents serving as primary agents of change under medical supervision. 1

Combination Approach for Severe Cases

• When oral intake is insufficient, combine natural feeding with oral nutritional supplements; add nasogastric feeding if caloric intake remains below 30% of requirements in the first week 5
• This combination approach significantly reduces hospitalization duration (by approximately 20 days) compared to natural feeding alone 5

Refeeding Syndrome Prevention

In severely malnourished patients, start with slower refeeding (lower initial calories) with careful monitoring of weight, heart rate, cardiac rhythm, and serum electrolytes—especially phosphorus—to prevent potentially fatal refeeding syndrome. 4

• The refeeding syndrome is characterized by fluid, electrolyte, cardiac, hematological, and neurological complications, with sudden death as the most serious risk 4
• Monitor for bradycardia, hypotension, hypothermia, and orthostatic changes 1

Essential Parental Guidance

Parents must separate the child from the illness, avoid all comments about body weight, and focus exclusively on healthful eating behaviors rather than weight or appearance. 1

• Do not wait for laboratory abnormalities to take action—more than half of medically unstable adolescents with eating disorders have normal test results 7
• Return of menstruation depends on adequate energy intake and body fat restoration 6
• Expect initial weight gain to restore lean body mass, followed by adipose tissue restoration as goal weight is approached 4

Common Pitfalls to Avoid

• Never assume the patient will "grow out of it"—mortality rates for eating disorders are among the highest for any psychiatric disorder, with cardiac complications responsible for at least one-third of deaths 1, 7
• Do not restrict fat intake to typical healthy adolescent levels (≤30% of calories); recovering patients need higher fat intake for adequate caloric density 2, 4
• Avoid high-sodium processed foods and added sugars, but do not restrict healthy caloric density 2