Epidemiology of Intensive Nutritional Interventions and Restraints in Hospitalizations for Anorexia Nervosa: Annual National Trends of the United States

OBJECTIVE: Despite the clinical relevance of enteral and parenteral tube feeding and restraint use in anorexia nervosa (AN), national-level data on their use have remained limited, particularly for total parenteral nutrition (TPN) and percutaneous endoscopic gastrostomy (PEG). This study systematically characterizes the national prevalence and temporal trends in intensive nutritional interventions, defined as nasogastric tube feeding (NGTF), TPN, and PEG, and physical restraint among hospitalizations for AN in the United States (US). METHOD: We analyzed 66,785 hospitalizations for AN from the 2017 to 2022 National Inpatient Sample using modified Poisson and logistic regression models to estimate prevalence, temporal trends, and associated factors. Subgroup and sensitivity analyses were conducted by age groups, race or ethnicity, and hospital characteristics. RESULTS: Intensive nutritional interventions and restraints of any type were used in 6.8% of hospitalizations. The prevalence was 3.8% for NGTF, 1.7% for physical restraint, 1.1% for TPN, and 0.7% for PEG. The overall rate of any intervention increased from 5.8% in 2017 to 8.1% in 2022, with a significant annual increase of 0.43 percentage points (p = 0.007), primarily driven by NGTF and restraint. Adult patients with AN showed the highest prevalence of any intervention at 7.2%, mainly due to TPN and PEG. Higher intervention rates were observed in urban teaching hospitals. DISCUSSION: This study provides the first national-level evidence that intensive nutritional interventions and restraints, particularly NGTF and restraint, are increasingly used in US hospitalizations for AN. The lower national estimates compared to single-center studies likely reflect referral bias, supported by subgroup analysis. Increased use of intensive nutritional interventions and restraints is controversial and underscores the need to consider less intensive or coercive alternatives and clearer clinical ethics guidelines.