What is Refeeding? The Minnesota Starvation Experiment.

The Study 

I’m not the first person who’s had to deal with restoring a starving child to a healthy weight. Thankfully, some adult men were willing to undergo this torture, and have the results recorded for posterity.

During WWII, 36 conscientious objectors to the war willingly signed up, for no money, to undergo a starvation & refeeding period, so that scientists and aid workers could know how to best help the people undergoing severe starvation in the European & Asian theaters.

Sadly, the study wasn’t completed when the concentration camps began to be liberated, and the world saw the depth & breadth of the starvation problem.

HOWEVER,

the study is still used to understand the psychological and physical impact of people in famine, or with eating disorders. The methods they use *work*, and some of the advice listed here is used in The Firecracker’s clinic.

These men started with a control period, where they were fed ~3200 calories a day, monitored, and generally lived a healthy lifestyle.

Then, their calories were cut, to just under 1600 per day:

They were required to walk 22 miles per week, which burned 1000 MORE calories per day (on average) than they took in.

The Effects

They were also required to keep a diary.

There were severe psychological and physical stressors during the “semi-starvation” period:

The men were irritable, unmotivated, lethargic, and had extreme mood swings:

Their hostility took a bizarre turn in some cases, like casually discussing eating the staff:

And all of this was BEFORE any treatment started:

 

When Treatment Begins

“Treatment” for eating disorders, and other semi-starved patients, begins and ends with food.

As I mentioned in an older blog post, patients with disordered eating can’t make a decision to change.  By the sixth month of deprivation, men in the Minnesota Starvation Experiment hated walking down the street, because they couldn’t decide which way to go at a corner. One even made an extensive checklist for how he would eat his meal, but kept changing his mind when mealtime arrived.

The study authors explicitly state that attempting any psychological interventions with a starved patient are pointless:

 

This explains so much of The Firecracker’s behavior during the last six months that it’s gut-wrenching.

She’s been lethargic, difficult to talk to, explosive over minor inconveniences, and exhausted. Her favorite things to do including screaming at her sisters to get out of her room.

And yes, it was very, very difficult to untangle “Which one is rebellious teenage behavior, and which one is from the eating disorder?”

We’ve succeeded at refeeding at home before, and I honestly thought we could do it again. However, two noisy, hyperactive, preschool sisters who refuse to get out of her room made it difficult. One quiet, well-adjusted, empathetic third grade sister was slowly descending into depression.

Worse, The Firecracker wasn’t getting any better.

The decision to hospitalize her wasn’t made lightly–it was made after months of trial and failure to balance the needs of all four of my kids, and realizing that the best way to help ALL of them was to let The Firecracker be re-fed by professionals.

Refeeding Makes It Worse. At First.

Our family saw her this past Friday, after four days of re-feeding and brought some gifts from some friends.

As soon as she saw our preschool kids, she said, “Why did you bring the Littles?” and burst into tears.

The Vulcan took the Littles outside, while I stayed  with The Firecracker, & started to show her some of the gifts other people had sent to her. She took one of the books and threw them across the room. “I don’t need any of this bullshit!”

Then she seemed to realize what she’d done. “Oh dear God, I’m so sorry, mom. Will you please tell them thank you for me? But I just don’t need these right now.”

No problem, hon.

We were able to talk reasonably about a few more things, but I still don’t expect her to get better for quite some time. She’s eating over 3000 calories per day. She’s forced to conserve energy by not exercising much–even walking is restricted, to conserve calories. 

Mental illness developed among those who had previously been mentally healthy.

A quote from the study:

 During the refeeding period, emotional disturbance did not vanish immediately but persisted for several weeks, with some men actually becoming more depressed, irritable, argumentative, and negativistic than they had been during semi starvation. After 2 weeks of refeeding, one man reported his extreme reaction in his diary:

I have been more depressed than ever in my life … I thought that there was only one thing that would pull me out of the doldrums, that is release from c.P.S. [the experiment] I decided to get rid of some fingers. Ten days ago, I jacked up my car and let the car fall on these fingers … It was premeditated. (pp. 894-895)

Several days later, this man actually did chop off three fingers of one hand in response to the stress.

The good news is that this is temporary. After about three months, the men in the study were able to regain a great deal of their emotional stability. They always had strange emotional reactions to food at first (and a couple went on to become chefs) but were able to control them, and remember that food was available, and they were safe.

One of the participants was still alive in 2014, and living in Baltimore.

If he, or any of his relatives are reading this, please tell him, “You helped save The Firecracker’s life. I could not have handled the immense stress of refeeding her, plus care for my other three children. The suffering you endured helped me make good decisions for my family, all these decades later. Thank you, from the bottom of my heart, thank you.””

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