Intensive Nutritional Interventions for Anorexia Nervosa: A Commentary on Ino et al. (2026)

Nutritional rehabilitation and weight restoration remain key components of the treatment calculus for individuals suffering with anorexia nervosa (AN). While voluntary oral food intake has long been the most frequently used and preferred method to accomplish this, it is not uncommon for these individuals occasionally to require alternative modes of refeeding, such as tube feeding or even intravenous feeding (total parental nutrition; TPN). In addition, there are definite, albeit rare, indications to revert to involuntary feedings and even restraints if the medical condition becomes unstable due to extremely low body weight or hypoglycemia, which are accompanied by impending organ failure or cardiovascular decline. Reversion to compulsory feedings has recently evoked increasing discussion in the eating disorder literature both in favor of and in opposition to them. Individual's right to self-determination is pitted against the physician's obligation to ensure the optimal health outcome for their patient, that is, beneficence. This commentary reflects on the recent epidemiological study by Ino et al. (2026), which characterizes the national United States prevalence and temporal trends in intensive nutritional interventions and physical restraints for individuals with AN. The authors found increasing trends from 2017 to 2022, and expressed concerns about the ethical ramifications of these findings.