What If Nasogastric Feeding Were Used to Heal the Brain in Anorexia Nervosa?

A research-informed question about NGT, brain healing, and recovery in eating disorders

Nasogastric tube (NGT) feeding in eating disorders is most often framed as a last resort, a short-term medical intervention used to restore weight until oral intake resumes and the tube can be removed. Alongside this framing sits a persistent concern: that people may become “dependent” on tube feeding, or that it undermines motivation to eat and engage in recovery.

This concern is understandable. But it may also be incomplete.

What if we are asking the wrong question?

Rather than asking whether NGT risks dependence, it may be more clinically useful to ask what starvation does to the brain, and what conditions are required for recovery to become biologically possible.

Starvation is a neurobiological state, not just a behavioural one

There is robust evidence from nutritional neuroscience showing that prolonged energy deficiency alters brain structure and function. These changes affect:

• cognitive flexibility

• emotional regulation

• reward processing

• threat perception

• insight and decision-making

• future-oriented thinking

• 
  

These are not traits, attitudes, or failures of motivation. They are predictable physiological consequences of inadequate energy availability.

In this context, asking someone to demonstrate insight, motivation, or readiness for recovery before reliable nutrition is established may be biologically unrealistic. The brain does not have the metabolic resources required to do that work.

What the research tells us about NGT (and what it doesn’t)

There is a growing body of research showing that nasogastric or enteral feeding:

• can safely improve early weight restoration when oral intake is insufficient,

• can accelerate medical stabilisation,

• may reduce physiological risk and length of hospital stay in some settings,

• and is often better tolerated psychologically than clinicians expect.

What is less well studied, and arguably under-theorised, is the neurobiological and cognitive impact of reliable nutrition, particularly in people whose illness has become entrenched or whose oral intake remains inconsistent despite therapeutic effort.

The literature also highlights gaps:

• limited long-term outcome data,

• little exploration of quality-of-life changes,

• and minimal focus on how nutritional reliability affects cognitive flexibility, emotional regulation, and engagement with life.

  
  

These gaps don’t argue against NGT. They suggest we may not yet be asking the most important questions.

Reframing NGT: from “weight restoration” to neurobiological stabilisation

What if nasogastric feeding were understood not primarily as a weight intervention, but as temporary neurobiological stabilisation?

Clinically, when nutrition becomes consistent and sufficient, many people experience:

• reduced obsessionality and rigidity,

• improved mood and emotional regulation,

• decreased anxiety,

• and greater capacity for reflection, choice, and engagement.

• 
  

These changes do not reliably precede nutrition. They tend to follow it.

From this perspective, NGT is not the opposite of recovery. It may be a precondition for recovery when oral intake alone cannot yet meet the brain’s needs.

The concern about “dependence” deserves closer examination

The fear that people will become reliant on tube feeding is widespread, but largely theoretical.

In practice, most people do not want long-term medical devices. They tolerate NGT because life in a starved brain is profoundly distressing and narrow. As cognition improves and quality of life expands, oral intake often becomes more achievable, not less.

This raises an uncomfortable possibility: that the greater risk is not overusing nutrition support, but withholding adequate nutrition while waiting for psychological readiness that cannot biologically emerge without it.

Quality of life is missing from the conversation

Starvation dramatically constricts life. Social connection falls away. Pleasure disappears. The future feels abstract or irrelevant. Suffering becomes normalised.

If temporary enteral nutrition:

• reduces constant internal struggle,

• stabilises physiology,

• lowers suicide risk,

• and creates cognitive space for reconnection with life,

then the ethical question shifts.

It is no longer simply:

Could this create dependence?

But also:

What is the cost of delaying brain-healing nutrition in the name of avoiding a hypothetical risk?

A system-level tension, not an individual failure

This conversation is difficult because it exposes a broader tension in eating disorder care.

Weight is easy to measure. Brain recovery is not. Services operate under real capacity constraints. Systems tend to reward throughput and short-term metrics rather than long arcs of neurobiological healing.

But starvation physiology does not negotiate with systems.

If recovery is genuinely the goal, including for adults and people with long-standing illness, then nutrition must be treated not as a gatekeeper to care, but as its foundation.

An invitation to think together

This is not an argument for indefinite tube feeding, nor for ignoring psychological, ethical, or relational complexity.

It is a question for the field:

What might change if we intentionally framed nasogastric feeding as a tool for brain recovery and quality of life, rather than solely as a mechanism to reach a weight target and withdraw support?

There is room here for research, nuance, disagreement, and learning.

And perhaps for a more biologically aligned, compassionate use of one of the few tools we have to interrupt starvation’s grip on the brain.

This question sits within a much larger body of work on nutritional neuroscience and eating disorders. If you’re interested in a deeper exploration of how starvation alters brain function, decision-making, threat perception, and recovery capacity, and why nutrition is not an “adjunct” but a core treatment, these ideas are explored in more detail in Food Mad.

The book brings together neuroscience, clinical experience, and lived reality to examine what happens to the brain under prolonged under-nutrition, and what it truly takes to support recovery across the lifespan.