The Science of Recovery: How UCSF is Transforming Pediatric Eating Disorder Care
Pediatric hospitalizations for eating disorders have nearly doubled in recent years, but at UCSF, the expertise to meet this moment has been decades in the making.
Through an integrated model that brings together pediatrics, psychiatry, nutrition science and family-based care, the UCSF Division of Adolescent and Young Adult Medicine is redefining what recovery looks like for young people with eating disorders. From rapid medical stabilization to novel brain-based interventions and family empowerment, UCSF is leading a new, evidence-driven standard of care designed for lasting recovery.
The UCSF Eating Disorders Program — a collaboration between the Department of Pediatrics and the Department of Psychiatry and Behavioral Sciences — delivers a seamless continuum of care. By integrating specialized inpatient stabilization with comprehensive outpatient coverage, our patients have access to the latest medical and psychological services.
Creating New Refeeding Standards
For decades, the standard for treating severe malnutrition in anorexia was to "start low and go slow" with food to avoid complications from overfeeding. However, UCSF research showed this cautious refeeding approach led to longer recoveries and hospital stays than needed.
To address this, Andrea Garber, PhD, RD, chief nutritionist for the program, led the NIH-funded StRONG Trial. The study found that patients on a higher-calorie plan safely reached medical stability three days faster, reducing costs by approximately $20,000 per stay.
"Our data showed the traditional approach added unnecessary physical and economic burden," says Garber. "This higher calorie approach has been adopted around the world to get kids home to their families faster."
Garber’s work is now moving beyond calories to precision nutrition approaches, including the gut microbiome. In starvation, the microbiome shifts away from the colon’s preferred fuel (butyrate) toward a “quick fuel” (acetate), which is rapidly absorbed into the bloodstream and can be turned into fat. This shift may help the body endure short-term starvation but may further starve the gut and counteract renourishment efforts. Her team is currently investigating targeted diets to steer the microbiome back to health.
The Next Frontier: Resetting Cognitive Rigidity
While nutrition stabilizes the body, the division is also pioneering treatments for the mind. Many patients struggle with cognitive rigidity — repetitive, obsessive thoughts that make recovery difficult and interfere with therapy.
Amanda Downey, MD, the program’s assistant medical director, and Marissa Raymond-Flesch, MD, MPH, are leading innovative clinical trials to address these brain patterns. Through the SPANYA trial, they are investigating whether psilocybin therapy can increase long-term changes in eating and exercise behaviors, while the KETTLE trial explores ketamine to alleviate the intense distress some patients experience during hospitalization.
“Despite anorexia nervosa having one of the highest mortality rates of any mental health disorder, there are no approved medications for its treatment,” says Downey. “We are investigating if safe and controlled experiences, combined with psychotherapy, can help patients quiet the ‘eating disorder voice’ and engage more fully with recovery.”
Intensive Family Empowerment
Family support is the core of the program’s model. Five-day intensive family treatment sessions prepare families to lead their child’s recovery in a supportive home environment, rather than in a residential facility.
During these sessions, parents learn how to prepare recommended, calorie-dense meals and how to stay calm and supportive when their child becomes distressed or refuses to eat. By empowering parents, UCSF turns the family into a key part of long-term recovery.
Expanding Access to Seamless Care
In 2025, the program opened a new clinic in Los Gatos, led by Jennifer Carlson, MD, who recently joined the UCSF faculty with more than 20 years of experience caring for youth with eating disorders. This expansion completed a network of three specialized satellite clinics that span the North, East, and South Bay. Across the Bay Area, families now have local access to UCSF’s leading eating disorder services.
This expansion is built on UCSF’s greatest strength: the ability to move a patient from the hospital back to daily life without a gap in care. Because our inpatient and outpatient teams are integrated, the same specialists guide every step of the journey.
"The transition from hospital to home is a vulnerable time for any family. Our combined program with psychiatry and behavioral sciences removes gaps in care that can lead to another crisis,” says Sara Buckelew, MD, MPH, chief of the Division of Adolescent and Young Adult Medicine and medical director for the UCSF Eating Disorders Program.
A Unified Path to Recovery
Eating disorders affect more than 5% of young people and are causing more crises than ever. The UCSF Department of Pediatrics is meeting this need through innovations in metabolic science and mental health support.
By bridging the gap between hospital and home, we ensure every child has the full spectrum of support they need to move from crisis to a full, healthy life.
Learn more about how the UCSF Division of Adolescent and Young Adult Medicine is transforming the future of health for young people.