Background: Anorexia nervosa (AN) is a severe psychiatric disorder characterized by food restriction and significantly low body weight. Even after weight restoration, core symptoms such as body dissatisfaction, intense fear of eating, and preoccupation with body shape and weight often persist, contributing to a high risk of relapse.
Methods: This study evaluated the feasibility and safety of a weight-maintaining ketogenic dietary therapy administered over 14 weeks in adults with anorexia nervosa who were either mildly underweight or weight-restored. The study also examined whether ketogenic therapy could reduce eating disorder symptoms. Twenty-two individuals participated, and eighteen (82%) completed the trial.
Results: Repeated-measures MANCOVA (intent-to-treat; comorbidity and medication included in the model) reveals significant overall treatment effects (Wilk's λ = 0.165, F = 2.383, p < 0.001), and symptom score decreases over time on the Eating Disorder Examination Questionnaire (EDE-Q) subscales Restraint, Eating Concern, Shape Concern, and Weight Concern, as well as for depression scores. At study completion, 72% of participants show EDE-Q and depression scores within the normal range. At three-month follow-up, 39% of completers continue ketogenic dietary therapy, of whom 28% show an increase in EDE-Q Global scores, while among those not maintaining ketogenic therapy, 64% present with an elevation in EDE-Q scores. Ketogenic dietary therapy does not precipitate worsening of symptoms or clinically significant weight loss.
Conclusions: The ketogenic dietary therapy is well-tolerated and demonstrates potential efficacy in reducing core symptoms of AN among adults who are mildly underweight or weight-restored. These findings support the further investigation of ketogenic dietary therapy as a potential intervention for this population.
Clinicaltrials: gov ID: NCT06000774; Registration Date August 14, 2023.
Anorexia nervosa is a serious mental health condition marked by food restriction and low body weight. Even after weight restoration, many individuals continue to struggle with intense fears about eating, dissatisfaction with their body, and ongoing worries about weight and shape. This study explored whether a special, fat-based diet could be a safe and effective treatment for adults with anorexia nervosa. Participants tolerated the diet well, with no evidence of worsening of symptoms. Instead, participants showed significant improvements in eating disorder symptoms, including reduced dietary restraint, less concern about food and body shape, and improved mood. By the end of the study, nearly three-quarters of participants had scores within the normal range for both eating disorder and depression symptoms. These findings suggest that a ketogenic diet may be a safe and promising approach to help reduce core symptoms of anorexia nervosa.
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