Admitting to a hospital for inpatient eating disorder treatment can feel scary and overwhelming. But it’s important to remember that a medical or psychiatric hospital stay may be necessary, and can be a crucial first step toward recovery. As a provider considering hospital admission for a patient (or if you’re concerned that you or a loved one need hospitalization), it’s important to understand not only eating disorder hospitalization criteria, but also the role of a hospital level of care in the recovery process.

“A hospital stay may be needed as a vital first step to your recovery,” says Amy Rapaport, MD, Equip's Medical Director. “A hospital stay can ensure medical and psychiatric stability, improve a patient’s nutritional status, and jumpstart the recovery process." Inpatient eating disorder treatment can also help patients gain weight more quickly, which may be important: some studies indicate that significant weight gain in the first month of treatment leads to a greater chance of sustained recovery.

If you're still hesitant to refer a patient (or loved one) to the hospital, read on. Learning about hospital treatment for eating disorders can help you better understand what it entails, how it can help patients, and what comes after to help support lasting recovery.

What is inpatient eating disorder treatment?

Inpatient eating disorder treatment refers to 24-hour care in a hospital setting, and is usually a relatively short-term step in the treatment process. The patient receives medical and psychiatric care, support, and supervision from a team to help them achieve medical and psychiatric stabilization. Inpatient hospital treatment is most often used when someone is experiencing serious medical complications due to their eating disorder (such as low heart rate or electrolyte imbalances), is at risk of self-harm, or has co-occurring conditions.

Inpatient hospital treatment is the most intensive level of care on the continuum of eating disorder treatments. Therefore, it's typically acute, short-term care, lasting only until a patient is medically and psychiatrically stable to transition to a less intensive level of care. Other levels of care, from most to less intensive, include:

• Residential treatment: Patients in residential care are medically stable but continue to engage in eating disorder behaviors. Similar to inpatient hospital treatment, they are supervised and receive care 24 hours a day; however, they often live in a home-like facility rather than a hospital. While in residential treatment, they often receive psychiatric care, therapy, nutritional counseling, and other support to help them with long-term recovery.
• Partial hospitalization program (PHP): A PHP is a structured treatment program, however it's not 24 hours a day. Instead, patients participate five to seven days a week for anywhere from five to 10 hours a day, but sleep at home each night. This means they eat the majority of their meals and snacks at the treatment center. They also receive individual and group therapy as well as nutrition counseling to help them work on recovery skills and then practice them at home.
• Intensive outpatient program (IOP): Generally for patients who are ready to step down from more intensive levels of care but still need support reducing their eating disorder behaviors or thoughts, IOP programs meet about two to five days a week for about two to three hours at a time. The sessions may be held at hospitals or treatment centers, or virtually. In addition to individual and group therapy and nutrition counseling, IOP may include family therapy and supportive meals. IOPs often meet in the evenings or mornings, allowing patients the flexibility to attend work or school.
• Low-touch outpatient care: The least intensive level of eating disorder care, low-touch outpatient treatment involves meeting with individual providers, rather than providers who are part of a multidisciplinary program. The patient may meet with a therapist and potentially also a psychiatrist, dietitian, and other providers on a weekly basis, usually for an hour each. They may also see their medical provider on a regular basis. This support helps them stay on track for recovery and identify any red flags of a potential relapse early on.

As an adaptable, virtual treatment provider, Equip is an appropriate level of care for all patients who are medically stable, and is an alternative to residential, PHP, IOP, and outpatient care. Our model is built to adapt to the intensity of care each patient needs, and titrates up or down depending on patients’ progress. Many Equip patients discharge to our treatment directly from inpatient hospital care, and 75% of our patient population are considered high acuity.

Refer a patient to EquipFill out a brief form and we’ll get in touch

Begin referral

When should a patient be admitted to the hospital for inpatient treatment?

Hospitalization is generally for patients who need medical and/or psychiatric stabilization. It may be that less intensive treatments haven't helped and a patient’s health has deteriorated, they're at risk of harming themselves or others, or they have a co-occurring condition that is causing significant complications. Whatever the case, inpatient hospital criteria for eating disorders is determined by a patient’s physical and psychiatric symptoms in addition to evaluating medical data.

“Parents may be scared to have their child go into the hospital. They may not understand the urgency of close medical monitoring or the dangers of refeeding their malnourished child at home,” says Rapaport. This can be exacerbated by the fact that many people with eating disorders who appear to be functioning “fine” are actually extremely medically compromised.

That's why it is important to look at blood work and other tests to determine if a patient should be admitted. Low blood pressure, low heart rate, and electrolyte abnormalities in the setting of significant weight loss and/or eating disorder behaviors can place a patient at high medical risk. “There are a lot of things parents can't see only by looking at their child. Rapaport explains.

When to hospitalize for an eating disorder: key medical criteria

Because of all of the factors described above, no single test can indicate that someone should be admitted for inpatient eating disorder treatment. Rather, when deciding when to hospitalize for an eating disorder, many providers consider a list of factors from the American Psychiatric Association Practice Guidelines and the Society for Adolescent Health and Medicine.

These eating disorder hospitalization criteria include:

• Very low weight (<75% of the 50th percentile BMI for age and sex)
• Dehydration
• Electrolyte disturbance (low potassium, sodium, phosphorus)
• Physiological instability
  • Severely low heart rate (<50 beats/minute daytime; <45 beats/minute sleeping)
  • Abnormally low blood pressure
  • Low body temperature (<95 degrees F, <35.6 degrees C)
  • Orthostatic changes in pulse or heart rate
• Failure to thrive/arrested growth and development
• Uncontrollable bingeing and purging
• Medical complications of malnutrition (for example fainting, seizures, heart failure, kidney failure, liver failure, pancreatitis, etc.)
• Concurrent medical or psychiatric conditions that limit appropriate outpatient treatment (like type I diabetes, obsessive compulsive disorder, or a suicide attempt)

Regardless of someone's weight, significant weight loss over a short period of time is a concern. “The refeeding process is a delicate one, and they need to be very closely monitored to avoid refeeding syndrome,” says Sam Cares, PhD, Supervising Psychologist for Rogers Behavioral Health.

What happens during inpatient eating disorder treatment?

Although every hospital’s treatment protocols are unique, the majority include the same basic components, all with the goal of medical and psychiatric stabilization to allow the patient to progress to a lower level of care.

Treatments provided during inpatient care

Regardless of a patient’s diagnosis or specific concerns, inpatient treatment plans tend to include the following.

1. Medical monitoring

Weights, vitals, and blood work help physicians know if, for example, a patient's caloric intake should be adjusted or if their electrolyte levels are improving. This information helps shape a patient's recovery plan and also keeps an eye out for potential health complications like refeeding syndrome.

“Even if you have regular levels of electrolytes and other nutrients on your blood tests upon admission, when your body is malnourished, your cells are not using those nutrients. And as soon as you start to refeed, the cells reactivate—they need these nutrients to metabolize the food they're getting now—and all those nutrients are pulled into the cell, and electrolyte levels in the bloodstream drop. That's what causes refeeding syndrome,” Rapaport explains.

2. Supervised meals

Inpatient eating disorder programs provide three meals and often two to three snacks a day, all tailored to each patient's nutritional needs. In most cases, each patient eats with one person in the room supervising them. This is for a few reasons:

• Nurses or other support staff monitor their patients' intake. If necessary, patients may need supplemental drinks or a feeding tube to ensure they consume all the nutrients they need without raising the risk of refeeding syndrome.
• They help patients work through any distress and other mental and physical challenges that arise before, during, and after eating. They acknowledge their distress and are supportive but firm about the fact that the patient needs their meal, Rapaport says.
• Depending on the patient's symptoms, they may sit with them after the meal to ensure they don't purge and aren't exercising in their room.

3. Psychiatric and medical care

When appropriate, a psychiatrist or other medical provider may prescribe medications to help treat mental health conditions, such as depression and anxiety, as well as other health conditions that can co-occur with eating disorders. Psychiatrists can also provide psychoeducation about the eating disorder.

4. Enrichment activities

Some hospital programs may include additional therapies, such as support groups, art, or music. “A lot of times when someone struggles with a psychiatric diagnosis, they get away from the valuable, enjoyable activities of daily living. We want to help people reach back into that,” Cares says. This option is more common in hospitals with eating disorder programs, Rapaport notes.

How long do patients stay in inpatient treatment?

The length of inpatient care varies from patient to patient, depending on their current condition and medical history, Cares says. Some may only need two or three days to stabilize their vitals and be able to step down to a lower level of care. Others may need more intensive nutrition rehabilitation and stabilization, which may take up to two weeks or longer, Rapaport says.

Can you have visitors during inpatient treatment?

Yes. Most inpatient treatment programs not only allow for visitors, they encourage it. “The role of support people is paramount to eating disorders treatment,” Cares says. “Studies show the level of support someone has within and outside treatment is correlated to their ability to maintain any gains they make in treatment. For that reason, we have daily visitation time when family, friends, and loved ones can come to an adjacent unit and meet with patients. It helps people still live their lives even though they are very much removed from it at that time.”

However, as a general rule, patients are not permitted to leave the hospital during their care. “The idea behind inpatient treatment is that someone so acutely sick, they need 24/7 monitoring. So they are there until they're discharged,” Cares explains.

What happens after inpatient eating disorder treatment?

Inpatient eating disorder treatment is usually fairly short-term and the first step in acute cases. Once a patient is medically and psychiatrically stabilized, less intensive treatment can begin. “Inpatient doesn't address the underlying issues that are maintaining the eating disorder,” Cares explains. “Other levels of care help address those, so the patient has a better chance of recovery.”

Before a patient leaves the hospital, their inpatient treatment team will generally work with them or their caregivers to identify an appropriate treatment program for them to enter after discharge. “We look at things like how stable their weight, labs, and vitals are; what's ideal versus what's necessary; and their access to resources, including what their insurance will cover,” Cares says. “We also consider, do they need to continue working or go back to school?”

Depending on all of this, the patient may step down to:

• A residential program
• PHP
• IOP
• A virtual program, such as Equip

“We always recommend stepping down to one of these higher levels of care,” Cares says. “You very rarely go from inpatient to outpatient because too much of a drastic shift in support can lead to relapse. We aim to connect people with resources that are going to help them ease back into their life.”

Equip can effectively treat patients who might otherwise seek residential or other higher levels of care after inpatient hospitalization. In fact, 30 percent of Equip patients were previously in higher levels of care, and 75 percent are high acuity (meaning they frequently engage in eating disorder behaviors).

“Once you are medically stable and no longer at risk of refeeding syndrome, it is very important to continue the recovery process,” Rapaport says. This means continuing weight gain if needed, decreasing eating disorder behaviors, and addressing body image concerns.” A team including therapists, dietitians, and medical and psychiatric providers are needed during recovery, all of which are offered at Equip. Additionally, Equip offers many group sessions that patients can attend daily (or more than once a day), peer mentors, and virtual meal support. “At Equip, patients can bring their entire support system to treatment, allowing them to receive all of the individual and group treatments and medical monitoring available in residential treatment while remaining at home,” Rapaport adds.

The Equip takeaway: the role of inpatient treatment in eating disorder recovery

Inpatient eating disorder treatment is necessary when a patient requires medical and/or psychiatric stabilization—but it's just one step along the journey to recovery. Once stable, the patient can step down to a less-intensive level of care. It's essential to work with patients and their loved ones to determine what level of care is best, because lasting recovery requires a multidisciplinary, long-term treatment approach.

If you’re concerned a loved one or patient may need inpatient treatment, schedule a call with Equip. We can guide you through next steps and help connect you with the appropriate resources.