In-home medical nutrition support for patients with severe anorexia nervosa: a mixed methods evaluation of a specialized Mobile Nutrition Team

Abstract

Background

Severe anorexia nervosa is associated with complex medical complications, frequent hospitalizations, and fragmented care pathways. To address these challenges, Odense University Hospital established a highly specialized, medically led Mobile Nutrition Team delivering individualized medical monitoring and nutritional support in patients’ homes. This initiative represents the first known model of its kind targeting individuals with severe anorexia nervosa.

Methods

This first-year mixed-methods implementation evaluation examined feasibility, acceptability, and experiences of patients, family members, and healthcare professionals with the Mobile Nutrition Team program. Structured questionnaires and focus group interviews were conducted with patients (n = 15), family members (n = 5), and healthcare professionals (n = 11). Quantitative data were analyzed descriptively, and qualitative data were analyzed using reflexive thematic analysis following Braun and Clarke.

Results

Participants reported high satisfaction with the flexible, home-based care model and improved continuity across treatment settings. Patients described increased involvement in care, a greater sense of safety, and smoother transitions following discharge. Healthcare professionals highlighted strengthened interdisciplinary collaboration and earlier identification of medical concerns. While some participants experienced reduced need for hospitalization, the service was primarily viewed as a complement rather than a replacement for inpatient care. Thematic analyses generated higher-order themes relating to relational safety, flexibility, and coordinated care.

Conclusions

The MNT offers a novel approach that helps bridge gaps between inpatient and community services for individuals with severe anorexia nervosa by providing ongoing medical monitoring and nutritional support at home. The model appears acceptable and feasible and supports continuity of care, though it does not replace inpatient treatment for acute medical instability. Further research should evaluate long-term clinical and organizational outcomes.

Plain language summary

This study reports patient evaluation of a new home-based medical service, the Mobile Nutrition Team (MNT), for people with severe anorexia nervosa. The team provides somatic monitoring, nutritional support, and transitional follow-up directly in patients’ homes. Using questionnaires and focus groups with patients, relatives, and professionals, the study assessed experiences during the first year of implementation.

Participants reported high satisfaction with the model’s flexibility, individual tailoring, and continuity. Patients described greater autonomy, experienced better discharge transitions, and reduced practical strain compared with inpatient care. Familiar staff and consistent follow-up enhanced trust and engagement improving quality of life and short-term outcome. Professionals emphasized improved interdisciplinary collaboration, earlier identification of complications, and more coherent pathways across sectors. Most participants viewed the MNT as a useful supplement that could reduce hospital use, though not a full substitute for inpatient care in complex or acute cases.

Overall, the MNT offers a promising, person-centered, home-based approach that supports harm-reduction principles and bridges gaps between hospital and community treatment.

Background

Placing the Mobile Nutrition Team (MNT) initiative in an international context, existing literature on eating disorder treatment highlights persistent challenges including limited accessibility, fragmented service delivery, and insufficient patient involvement [1]. These findings underline the importance of developing flexible, patient-centered models like the MNT, which aim to close service gaps by providing specialized care in patients’ everyday environments. Similar studies [2, 3], have further shown that intensive, home-based treatment models can reduce hospitalization rates and improve patient satisfaction, supporting the relevance of this approach.

Comparable mobile, home-based initiatives have been more frequently implemented in medical care for older patients. For example, a recent study [4] evaluated a Swedish Mobile Geriatric Acute Team, a cross-sectoral, home-based intervention targeting elderly patients with complex medical needs. This initiative was associated with perceived reductions in hospital admissions, improved continuity of care, and higher patient satisfaction, highlighting the potential of mobile, interdisciplinary healthcare teams. Other internationally recognized multidisciplinary outreach models for severe and enduring mental illnesses include Flexible Assertive Community Treatment (ACT and FACT) and Intensive Home Treatment, which aim to provide integrated, home-based care and, in some cases, reduce reliance on inpatient services [5–7].

Recovery trajectories for individuals with severe and enduring anorexia nervosa (SE-AN) vary widely, with individuals eventually achieving partial or full remission [8]. SE-AN is commonly defined in research as an illness duration of at least 7 years, in line with prior studies employing this threshold to distinguish more chronic and enduring cases, although no universally agreed definition exists. The condition is associated with persistent undernutrition, high medical risk, and significant psychological distress. Patients frequently experience repeated hospitalizations, fragmented care pathways, and substantial functional impairment, highlighting the complexity of this population [8–10].

In the short- to medium-term (e.g., within the first year of treatment), full recovery may not be attainable for some patients with extremely low BMI and complex medical and psychosocial needs [9, 11]. The classification of SE-AN has been critiqued for potentially constraining care pathways and shaping expectations in ways that may not align with patient perspectives [11, 12]. In this context, harm-reduction approaches, which prioritize safety, symptom management, and quality of life rather than full weight restoration, have been increasingly discussed as a person-centered alternative. However, they remain a debated strategy within the literature [9]. Home-based, individualized interventions may be well suited to operationalize harm-reduction principles by providing flexible support aligned with patients’ capacities and goals.

Against this background, this paper presents findings from a government-funded project through the Danish ‘satspulje’ scheme, an annually allocated welfare reserve on the state budget. The study investigates self-reported experiences and evaluations from individuals with severe anorexia nervosa who have received highly specialized, in-home care from the MNT. Perspectives from family members and healthcare professionals (HCPs) are also included, offering a multifaceted understanding of the initiative. To our knowledge, the MNT is the first published example of a hospital-based, medically led, mobile team providing complex medical and nutritional care to individuals with severe anorexia nervosa, a patient group traditionally treated within psychiatric inpatient settings. MNT represents an innovative model, expanding existing approaches by offering integrated, home-based care that addresses both physical and psychiatric needs, rather than merely replicating models from other patient populations.

The aim of this study was to conduct a first-year mixed-methods implementation evaluation of the MNT, specifically examining the feasibility, acceptability, and experiences of the service from the perspectives of patients, their family members, HCPs, and key collaborative partners.

Methods

Study design

This study employed a mixed-methods implementation evaluation design, combining structured questionnaires with focus group interviews. Questionnaires captured participants’ experiences and perspectives in a structured format, while focus groups provided the opportunity to explore these perspectives in greater depth. This design allowed for both quantitative trends and qualitative insights, strengthening the evaluation of the MNT initiative.

The questionnaires and focus group interview guide were developed by the project team responsible for the MNT evaluation. The development process was informed by the objectives and success criteria of the initiative and by prior internal evaluation material from the MNT service.

Separate questionnaires were designed for patients, family members, and HCPs/collaborative partners to reflect their different roles and experiences with the service. The questionnaires were developed to explore key domains relevant to the implementation and perceived value of the intervention, including perceived relevance of the service, contribution to treatment and quality of care, perceived impact on hospitalization, patient safety and sense of security, and involvement of family members.

Several questionnaire items addressed themes such as whether the MNT contributed positively to treatment, whether the service was perceived as a relevant intervention, whether it reduced the need for hospitalization, whether it functioned as an alternative to inpatient care, and whether treatment was tailored to the patient’s individual situation.

Similar themes were explored in the focus group interviews to allow deeper discussion of participants’ experiences with the service.

The interview guide was therefore designed to expand on themes identified through the questionnaires and to explore participants’ experiences of the intervention in greater depth.

The MNT was introduced as a pilot implementation study. During the study period, the service was in an early implementation phase and functioned as a supplementary intervention alongside existing treatment pathways rather than as treatment as usual.

Setting

The study was conducted in Odense, Denmark, at Odense University Hospital (OUH) in collaboration with the Psychiatric Hospital Unit. The Mobile Nutrition Team (MNT) operated as a pilot project from 2022 to 2024, providing home-based care for patients with severe anorexia nervosa. Patients remained enrolled in care at the Nutrition Unit, Department of Endocrinology at OUH, while receiving support in their everyday home environments. This setting allowed the team to deliver integrated medical, nutritional, and psychosocial care within patients’ usual contexts.

Organization and daily practice of the MNT

The MNT was established to provide home-based multidisciplinary support for patients with severe anorexia nervosa. The team consists of two full-time somatic nurses and a medical doctor working 12 h per week.

Patients are referred to the MNT by hospital staff and must be enrolled in care at the Nutrition Unit, Department of Endocrinology at OUH. The intervention targets patients with severe anorexia nervosa who experience complex care trajectories, frequent hospitalizations, or fragmented support across services.

The MNT provides individualized care through home visits. During visits, the team conducts clinical assessments, including measurements of weight, blood pressure, and general physical condition using portable medical equipment. The team also provides nutritional guidance, meal support, and monitoring of physical complications related to malnutrition. Psychological support is primarily supportive and motivational.

The service aims to support patients in managing their condition in their home environment and may function both as transitional support following hospital discharge and as an alternative to prolonged inpatient care for patients with severe anorexia nervosa. The team may also assist patients in accessing relevant municipal support services when needed.

Participants

Participants included three main groups: patients, family members, and HCPs/collaboration partners.

All patients who were enrolled in the MNT during the evaluation period were invited to participate in the questionnaire component of the study.

The patient group consisted of individuals with severe anorexia nervosa receiving care from the MNT. Their levels of external support varied, ranging from independent living to municipal assistance or residence in care facilities. Patient characteristics are presented in Table 1.

Table 1.

Patient demographic characteristics

Age (range)	N total = 15
	20–38
Gender, n (%)	Female (100%)
Ethnicity, n (%)	Caucasian (100%)
Neurodivergence, n (%)	2 (13.3%)
Socioeconomic context
- Student, n (%)	4 (26.6%)
- Employed, n (%)	2 (13.3%)
- On disability pension, n (%)	9 (60.0%)
Co-occuring psychiatric condition
- Depression, n (%)	4 (26.6%)
- Anxiety, n (%)	3 (20.0%)
- Post traumatic stress disorder, n (%)	3 (20.05)
- Personality disorder, n (%)	5 (33.3%)
Co-occuring medical condition
- Hypothyroidism, n (%)	1 (6.6%)
- Hypertension, n (%)	1 (6.6%)
- Dissociative conditions (psychogenic nonepileptic seizures), n (%)	1 (6.6%)
- Traumatic brain injury, n (%)	1 (6.6%)

Participation was voluntary, and invitations were distributed through the MNT during regular contact with patients and collaborating professionals.

Family members, primarily parents, were invited due to their central role in care trajectories and recovery processes. HCPs and key collaboration partners comprised staff from the MNT, municipal home care services, social centers, and residential facilities involved in patient pathways. Consideration was given to how interesting factors, including demographics may shape experiences of care [13, 14].

In total, 15 patients, 5 family members, and 11 HCPs/key collaboration partners were invited to complete the questionnaires. For the qualitative component, two focus groups were conducted: one with eight patients who had received care from the MNT, and one with seven HCPs, including two from the MNT and five from relevant municipal services. Table 2 provides an overview of professionals from the second focus group interview.

Table 2.

Overview of participants from the second focus group interview with HCPs and key collaboration partners

Participant number	Participant position
Participant 1	Advisor on the most specialized and complex individual cases within the social services and special education sectors
Participant 2	A dietitian affiliated with a highly specialized social center
Participant 3	A social center leader from a highly specialized social center
Participant 4	A nurse from the MNT
Participant 5	A nurse from the MNT
Participant 6	A representative from a Flex Support program, which is the municipality’s specialized service for adults with severe mental illness and significant functional impairments
Participant 7	A pedagogical staff member from a specialized residential facility, supporting individuals with complex social and psychological needs.

Procedures

Data analysis

Following data collection, quantitative and qualitative data were systematically processed and analyzed to explore participants’ experiences and the impact of the MNT.

Quantitative data from the questionnaires were analyzed using descriptive statistics to summarize participant responses across the key themes. Questionnaires were distributed via Survey Exact. Responses were exported to Excel for cleaning preparation and analysis.

Qualitative data were initially explored using AI-assisted identification of potential themes via ChatGPT, after which the research team collaboratively reviewed, refined, and coded the data to ensure rigor and consensus. No specialized qualitative software was used. The coding and theme development were conducted manually within the team.

Qualitative data from the focus group interviews and open-ended questionnaire responses were analyzed using a reflexive thematic analysis approach following Braun and Clarke [15], allowing for an in-depth understanding of participants’ lived experiences with the MNT [15]. The analysis followed the six phases of reflexive thematic analysis as described by Braun and Clarke, including familiarization with the data, generation of initial codes, searching for themes, reviewing themes, defining and naming themes, and producing the final analysis.

All interviews were transcribed verbatim using electronic transcription software and subsequently verified against the original recordings to ensure accuracy.

The analysis began with repeated readings of the transcripts to obtain an overall sense of the material. An inductive coding process was then carried out, during which key phrases and statements relevant to the study’s aim were identified and systematically coded.

These initial codes were iteratively refined and organized into broader, overarching themes and subthemes to enhance clarity and interpretability. A thematic map illustrating the relationships between themes is presented below [15].

Data collection

Data collection was carried out by the MNT. Questionnaires were developed separately for patients, family members, and HCPs/key collaboration partners to reflect their specific roles. Questionnaires were distributed via a secure national digital platform or by email using SurveyXact. Focus group interviews were conducted in neutral settings to encourage open dialogue and reflection.

Questionnaires were sent to participants once the patient was considered stable in their treatment trajectory, either after the first follow-up visit or at the end of a treatment segment, ensuring that respondents had sufficient exposure to the MNT to provide meaningful feedback.

They were administered at three points during the treatment course: (i) after the first follow-up visit, (ii) mid-treatment, and (iii) at the end of the evaluation period, with reminders provided during regular visits. Non-responders were recorded after repeated reminders.

Focus group interviews were facilitated by a nurse involved in the MNT setup but not providing direct home-based care. Reflexive practices, including team discussions on positionality and potential biases, were employed throughout data collection and analysis. No members of the research team had lived experience of severe anorexia nervosa, which may affect interpretation of participants’ accounts; triangulation of perspectives from patients, family members, and HCPs partially mitigated this limitation. Greater lived experience involvement is identified as a priority for future research [12].

Both questionnaires and interview guides addressed a set of predefined topics, including perceived impact of the MNT, tailoring of treatment to individual needs, patient involvement, continuity of care, and perceived safety and trust. These topics informed data collection but did not determine the themes identified in the qualitative analysis. All questionnaires and interview guides were originally developed in Danish and later translated into English for reporting. Responses were provided on a 4-point Likert scale, with an additional ‘Don’t know/Not applicable’ option, and participants could add qualitative comments in open-ended fields. An overview of the questionnaire items and focus group questions is presented in Table 3.

Table 3.

Overview of items from questionnaires and focus group interviews with patients

Items from questionnaires (patients)	Focus group questions (patients)	Prompt questions
The MNT has contributed positively to my treatment	Where are you in your process/treatment journey? (Introductory questions)	- What is your living situation like? - How is your daily life functioning? - What kind of support do you have in your immediate environment?
The MNT is a relevant service for me	The MNT has positively contributed to my treatment?	- How has the MNT specifically helped you? - Where are you currently in your treatment – how long have you been receiving care from MNT? - What do you think the support has meant for you? - Can you notice a difference between the previous treatment and the current intervention?
The MNT has contributed to reducing my hospital admissions	I have felt involved in my treatment with the MNT?	- Expectations - Responsibility
The MNT has supported me during the period immediately following my discharge	I have experienced that the MNT tailored the treatment to my situation?	- Sense of security - Possibly involving/collaborating with other partners (what are your thoughts on network meetings? ) - Opportunity for involving relatives - Flexibility
I have experienced the MNT as an alternative to hospitalization	How do you think the effort/intervention could be improved?	- What would the ideal service look like? (treatment and rehabilitation efforts, e.g., housing support) - Waiting time? Difficult transitions?
I have experienced that the MNT tailored the treatment to my situation	Have any new thoughts or points arisen that you would like to share, with the aim of helping us improve the service?	Closing
I have felt involved in my treatment with the MNT
To what extent do you feel secure in the treatment provided by the MNT?
Have your relatives/close ones been offered the opportunity to be involved in discussions about your illness? If yes, has this involvement been sufficient?

Not all questionnaire items were explored directly in the focus groups. Instead, the interviews focused on broader experiential topics, allowing participants to elaborate on key aspects of the intervention in greater depth. These topics informed data collection but did not determine the themes identified in the qualitative analysis.

Ethics

The study adhered to ethical standards for research involving human participants [16]. The evaluation of the MNT was conducted as part of a larger grant-funded (Danish ‘satspulje’ scheme) initiative supported by the Danish Health Authority (file number 05-0801-602). The project, including this service evaluation, was approved under the institutional governance procedures associated with the grant.

All participants received both oral and written information outlining the study’s purpose, data collection procedures, voluntary nature of participation, and the potential for publication of anonymized findings.

Informed consent was obtained from all participants prior to data collection. Participants were explicitly informed of their right to withdraw from the study at any time without any consequences. Ethical considerations included confidentiality, voluntary participation, and respect for participants’ autonomy throughout the study process. To ensure confidentiality, all data was anonymized, and personal identifiers were removed prior to analysis.

Results

The results from both the questionnaire and the focus group interviews indicate overall satisfaction with the MNT as a supplementary care model for individuals with severe anorexia nervosa. The findings are presented below, structured according to participant groups and themes.

Patient perspectives

Quantitative data from the patient questionnaires (n = 15; 60% response rate) indicate overall high satisfaction with the MNT. Most patients reported that the treatment was effectively tailored to their individual needs, with 78% agreeing that the care was adapted to their personal situation. A majority also perceived that the MNT contributed to reducing their need for hospitalization, although some expressed uncertainty about whether the service could fully replace inpatient care in more complex cases. Half of the respondents felt strongly supported during the post-discharge phase, while 70% experienced the MNT visits as flexible and adapted to their daily routines and preferences. Furthermore, 60% of patients felt secure receiving treatment in their home environment, and responses regarding family involvement were mixed, reflecting variation in the degree to which relatives were integrated into treatment discussions. Additional details are provided in Appendix 1.

These quantitative findings align closely with qualitative insights, emphasizing the importance of autonomy, self-management, and continuity of care. Patients highlighted that receiving care in their own home, supported by familiar HCPs, increased their sense of control, safety, and predictability. One patient noted that the MNT enabled them to take responsibility for their own life rather than being subjected to rigid hospital-based treatment approaches, stating:

“It is important and necessary to experience how the team can support patients in developing their own judgment and management, enabling them to take control and responsibility for their own lives, rather than being subjected to the rigid and uncompromising treatment approaches often used in the department.”

Others emphasized the practical and emotional benefits of home visits, remarking:

“It helps me a lot that they come to my home,” and “More projects like this. The mobile team makes my treatment much easier. The days with conversations become more manageable. These are familiar faces you meet, which provides an enormous sense of security.”

Patients particularly valued the smooth transitions from hospital to home, which reduced both logistical and emotional burdens. Continuity of care, including having the same healthcare providers across settings, was consistently highlighted as essential for fostering trust, enhancing communication, and supporting treatment adherence. While most feedback was positive, a minority of patients critiqued certain aspects of the approach as rigid or overly focused on weight, suggesting a need for a more individualized, cause-oriented treatment strategy.

In conclusion, patient questionnaires demonstrate strong satisfaction with the MNT’s home-based, flexible, and individualized approach. These findings are reinforced by qualitative data showing that autonomy, relational support, and continuity of care were central to patients’ positive experiences with the intervention.

Family perspectives

Quantitative data from the family questionnaires (n = 5; 40% response rate) indicate positive experiences with the MNT. All respondents agreed that the MNT contributed positively to their relative’s treatment and regarded the service as highly relevant. Family members reported that the MNT increased their sense of security, with all respondents feeling well-supported and confident in the care provided. They also noted that they felt appropriately involved in treatment decisions, and that communication with the MNT strengthened collaboration across the different services involved in the patient’s care. One respondent highlighted that the team’s professional support helped them structure interventions around the patient’s needs, considering individual challenges such as brain injury, stating:

“ The questionnaire was prepared by staff from Kingstrup, and our assessment is that it has contributed very positively by allowing us to receive professional guidance as much as possible. The patient involved in the project lost weight steadily during the process. However, we were able to identify ‘focus areas’ where we could attempt to provide structure and, based on her brain injury, try to achieve improvements. ”

Qualitative responses supported these quantitative findings. Family members emphasized the comfort of having the same HCPs visiting the home and being available for questions, which created a sense of predictability and security. As one relative noted:

“It is nice to have the same staff and close follow-up. I feel that I know where I can ask questions and seek advice”.

Another highlighted the benefit of avoiding long journeys, stating:

“It is pleasant to receive visits in familiar surroundings and avoid a long commute.”

Family members also appreciated the MNT’s role in coordinating across services, observing that communication with the same consistent team members facilitated collaboration and improved overall care:

“It is nice that communication takes place with the same people, who are incredibly kind.”

While family members generally recognized the MNT as a supportive and relevant service, they acknowledged that the program could not fully replace hospitalization in all cases. Nevertheless, they valued the home-based nature of the service, noting that it reduced logistical burdens and enabled the patient to receive more individualized support. Overall, the quantitative and qualitative data together suggest that the MNT enhances family confidence, engagement, and coordination across care providers, contributing to more consistent and effective treatment experiences for both patients and their relatives.

Professional perspectives

Quantitative data from professionals’ questionnaires (n = 11; 55% response rate) indicate that the MNT is widely perceived as a relevant and supportive service for patients. Most respondents reported that the MNT contributed positively to patient care, facilitated collaboration across services, and strengthened their own ability to work with patients in a relational and somatic context. Specifically, 86% of respondents felt that the MNT had positively influenced patient treatment, 67% considered the service highly relevant for the patients, and 57% reported that the team’s involvement led to competence enhancement among staff. Furthermore, 50–67% of respondents noted that the MNT improved access to professional guidance and increased patients’ sense of security during treatment.

Qualitative responses complemented these findings, emphasizing the impact of the MNT on both staff and patients. Professionals highlighted that the presence of a consistent mobile team enhanced continuity of care, improved patient engagement, and created a clear bridge between somatic care and relational support. One professional explained:

“It has meant that residents in our facility could engage in collaboration and treatment with Department M in a much more constructive way. This has resulted in a much better course and a cohesive, hands-on approach.”

Another noted the importance of stability and familiarity:

“The mobile team is always the same staff, which creates security for both residents and staff, especially for patients with serious somatic conditions.”

Professionals also reported that the MNT enabled more effective relational work by taking responsibility for the somatic aspects of care, allowing them to focus on psychosocial and developmental goals. As one professional observed:

“The relationship with the patients has remained the same, but it has become significantly easier to build a bridge to treatment together with the patients, as it is much clearer what we are linking to.”

The team’s involvement in planning and delivering care was perceived to enhance interdisciplinary collaboration, provide opportunities for learning and supervision, and create a more coherent and structured approach to patient care.

Overall, both quantitative and qualitative data suggest that the MNT strengthens professional competence, enhances communication across care settings, and improves patient engagement and safety. Professionals consistently emphasized the value of having the mobile team integrated into daily routines, highlighting its role in fostering relational security and supporting holistic treatment for a vulnerable patient population.

To complement the quantitative questionnaire data and provide deeper insight into participants’ experiences, qualitative findings from the focus groups are presented separately below.

Qualitative findings from focus groups

The focus group findings highlight participants lived experiences and provide depth to the quantitative results, illustrating how the MNT was experienced in practice.

Through the qualitative analysis, nine subthemes were identified and organized into three overarching themes: [1] care delivery and flexibility [2], relational and emotional support, and [3] interdisciplinary and preventive care. These themes integrate perspectives from patients, family members, and healthcare professionals/key collaborators, providing a comprehensive understanding of the MNT’s role, its perceived impact, and the broader care environment.

Table 4 summarizes the key findings from these themes, including illustrative quotes.

Table 4.

Key findings from the overarching themes and subthemes identified through focus group interviews

Overarching theme	Subtheme	Key findings	Sample quotes
Care delivery and flexibility	In-homebased Function	MNT facilitated the transition from hospitalization to home care and reduced logistical challenges.	“I think that’s really nice (3), and also the fact that they come out, and you don’t have to think about getting yourself transported.” “So I think, in that way, it has made my course much more stable.”
	Flexibility and Predictability	MNT’s flexible scheduling (evenings/weekends) provided smoother transitions and patient control.	“When you’re discharged on Wednesday, and they come on Friday […], it’s not the same as just being discharged.”
	Transitions	Connection between inpatient care and home treatment was crucial for discharge success.	“So it actually makes it an even easier transition from the unit to the mobile team to home.” “You are actually supported through it, so you don’t feel 100% alone in it.”
Relational and emotional support	Importance of Relationships	Continuity of care strengthened the relationship between patients and staff, enhancing treatment quality.	“They have a better grasp on my course […]. I actually get something out of it […], it’s a help to be attached.” “They also talk to each other […] so it’s not like everything has to go through me […], that’s nice.”
	Security	Patients felt supported and safe in their home environment with MNT’s assistance.	“It’s a meal in my own home […], we practice […] what do I have in my own setting that can work?” “I think it’s really nice that it’s fixed […]. One needs predictability.”
	Meaningfulness	MNT’s individualized approach contributed to a sense of meaningful treatment.	“They also see me in it and ask how I feel, which I haven’t experienced in the same way before.” “It doesn’t feel like I’m starting something completely new […], there’s just some continuity in it all.”
Interdisciplinary and preventive care	Interdisciplinary Collaboration	Strengthened interdisciplinary cooperation improved holistic care for patients.	“They will come out and help us one day with my housing support […], so he can do it with me as well.”
	Early Detection	MNT allowed for earlier interventions, which was particularly helpful for patients with atypical cases.	“It has been fortunate […], especially because my eating disorder is so atypical […], that intervention could have happened earlier.”
	Coping	MNT helped patients integrate treatment into their daily routines, supporting better coping strategies.	“I think it makes a lot of sense that it’s a meal in my own home with my own ingredients.”

Across themes, the findings highlighted how MNT’s flexibility and individualized care approach contributed to improved patient outcomes. The ability to receive care in familiar surroundings, supported by known HCPs, enhanced patients’ sense of control, reduced anxiety, and strengthened the therapeutic alliance. The interdisciplinary setup, including municipal services such as housing assistance, enabled a more holistic approach to treatment.

Although some participants remained cautious about MNT’s potential to fully replace hospitalization, particularly in severe or acute cases, the overall feedback strongly supported the initiative’s relevance and impact. These findings, confirmed by both patients and professionals, emphasize the importance of the MNT’s flexible, person-centered approach in addressing the complex needs of patients with severe anorexia nervosa.

Discussion

The one-year evaluation of the MNT initiative demonstrated generally positive experiences among patients, family members, and professionals. The MNT delivers specialized medical and nutritional care in patients’ homes, addressing complex somatic as well as psychological needs, representing a medically anchored addition to existing home-based treatment models. Previous research on intensive home-based and ambulatory care models has demonstrated benefits such as reduced hospitalization, increased patient satisfaction, and improved autonomy [17].

A key strength of the MNT was its ability to tailor care to individual needs, including home visits, flexible scheduling, and support for everyday life with severe anorexia nervosa, reflecting these evidence-based principles [18].

Recent scoping review on intensive community treatment (ICT) and home-based treatment (HBT) for eating disorders highlights that these interventions are generally feasible and acceptable, with reports of improved clinical outcomes, strong patient adherence, and indications of reduced hospital admissions in similar interventions [19]. MNT aligns with this emerging international trend of delivering intensive, community-oriented care to support patients outside of traditional inpatient settings. Although evidence for intensive home- or community-based interventions in adults with severe anorexia nervosa remains limited, the present findings suggest that MNT is a feasible and potentially effective approach, warranting further systematic investigation.

Similarly, stepped-care models based on family- or patient-centered principles show that flexible, home- or community-based interventions can enhance engagement and outcomes in adolescents with anorexia nervosa [20]. Although MNT targets adults, its focus on individualized, home-based care reflects the same evidence-based principles of tailoring treatment to patients’ needs and contexts.

Some participants expressed skepticism that MNT could fully replace hospitalization, reflecting the practical challenges of treating SE-AN [9, 11, 12]. MNT’s home-based, individualized approach enables flexible, patient-centered interventions tailored to daily realities and personal goals, supporting engagement and, according to participants, potentially reducing the risk of repeated hospitalization. Participants reported that its flexible structure reduced missed appointments and logistical barriers. One patient, however, perceived certain elements, such as “reward-punishment dynamics,” as rigid or punitive, highlighting the importance of balancing structured interventions with relational sensitivity [1, 21, 22].

Continuity of care emerged as a central theme. Patients valued working with the same providers before and after discharge, minimizing repetition of their histories and fostering trust. These findings are consistent with previous research showing that sustained patient-provider relationships are crucial for treatment adherence and emotional safety [23]. Integration of trauma-informed approaches in other studies further supports the importance of relational, respectful, and individualized care for individuals with complex histories [24, 25].

This supports the interpretation that MNT may function optimally as a transitional model, bridging hospitalization and long-term outpatient care, and participants perceived that it may reduce hospital dependency, while offering continuity during vulnerable phases. These observations align with previous research showing that outpatient or home-based models can be effective for selected patients when integrated into broader treatment strategies according to individual complexity and risk [26]. Similar principles have been demonstrated in other mobile, home-based care initiatives [27].

Interdisciplinary collaboration was another strength of the MNT, improving coordination across sectors including housing and social services. Participants reported that this facilitated more cohesive care trajectories and holistic treatment, particularly in complex cases. These observations are supported by previous research highlighting how interdisciplinary collaboration can reduce barriers such as stigma and diagnostic delays [28]. Nonetheless, formalizing such collaborations across municipalities and sectors remains challenging, requiring dedicated resources and organizational alignment without compromising MNT’s inherent flexibility.

Finally, the MNT also demonstrated potential for early intervention, as regular home visits enabled staff to identify subtle physical or behavioral changes earlier than in traditional care pathways. However, patients with atypical or fluctuating illness trajectories remain harder to detect systematically, underscoring the need to integrate MNT into broader, cross-sectoral early detection strategies [29].

Limitations

While the MNT initiative shows promise, several limitations should be noted. The short duration of implementation limits the ability to assess long-term effects and sustainability, particularly given the chronic and complex nature of severe anorexia nervosa. The complexity of the patient group, with frequent comorbidities, also poses challenges in achieving optimal outcomes consistently.

Although many participants reported positive experiences, the model’s ability to fully replace hospitalization, especially in cases of acute risk or high complexity, remains uncertain. Furthermore, response bias may have influenced the results, as participants who chose to engage may have had more positive or engaged experiences with the MNT.

The study also has methodological limitations. The small sample size limits statistical power and generalizability. Additionally, the reliance on self-reported data introduces subjective biases, and the absence of objective outcome measurements reduces the robustness of the findings. Given the study’s specific regional context, the results may not be generalizable to other settings or populations.

Due to the small sample size and pilot nature of the study, we could not assess differences between responders and non-responders, which may affect the findings’ external validity. Intensive, home-based interventions for adults with anorexia nervosa remain under-researched, indicating the need for further studies.

In conclusion, while MNT is promising, it may best be viewed as a supplement to traditional care, rather than a full replacement. Continued research is needed to refine the model and assess its long-term impacts.

Conclusions

This evaluation suggests that the MNT is a valuable addition to treatment options for individuals with severe anorexia nervosa, offering flexibility, home-based care, and individualized support that enhances transitions from inpatient to outpatient care. Its strengths include increased patient autonomy, continuity in therapeutic relationships, and improved interdisciplinary collaboration. However, findings also highlight the need to balance structured protocols with individualized care, especially considering some patients’ experiences of rigidity. The program’s future development should focus on integrating it within an existing treatment system rather than positioning it as a universal alternative to inpatient care.

Implications for clinical practice

The MNT model emphasizes flexibility, individualized care, and integration into daily life, with notable benefits in patient autonomy, continuity of relationships, and interdisciplinary collaboration. Early indications suggest it may help reduce hospitalizations, but these findings must be interpreted cautiously due to the patient population’s complexity.

Future research should evaluate the MNT model more systematically, using larger, more diverse samples, objective outcome measures (e.g., hospitalization rates, psychological health metrics), and longitudinal designs to assess its long-term sustainability. Randomized controlled trials or cohort studies could clarify the intervention’s effectiveness, while mixed-methods designs will continue to capture experiences from patients, families, and professionals. Comparative studies with traditional inpatient or outpatient care could identify which elements of MNT contribute most strongly to positive outcomes.

The MNT model emphasizes early detection, engagement, and cohesive care across sectors, complementing inpatient treatment for some patients while potentially decreasing the need for hospitalization in others. Balancing structured protocols with relational sensitivity is crucial for addressing diverse patient experiences. Trauma-informed principles should be integrated into the model to promote a safe and supportive environment. In conclusion, the MNT’s adaptability and focus on bridging care gaps position as a valuable part of a comprehensive treatment system, though further evidence for adults remains needed.

Abbreviations

MNT

Mobile Nutrition Team

HCPs

Healthcare professionals

OUH

Odense University Hospital (OUH)

SE-AN

severe and enduring anorexia nervosa

Appendix 1 Overview of results from questionnaires

Author contributions

The first author, Tanja Juhl Mikkelsen, was responsible for data collection, processing, and analysis, as well as for drafting the manuscript.René Klinkby Støving and Jeanie Meincke Egedal contributed through critical reading, linguistic and methodological editing, subject-matter expertise regarding the intervention, and support in the further development of the manuscript.Signe Wallin Høj and Maria Pilgaard contributed with proofreading, critical reading, and practice-based insights derived from their daily involvement in the intervention.

Funding

Open access funding provided by University of Southern Denmark. No specific funding was received for the preparation of this manuscript.

Data availability

Data can be made available upon reasonable request and only with approval from the relevant Danish authorities. Access to data is restricted under Danish legislation governing the handling of sensitive personal information and therefore requires explicit permission from the appropriate regulatory bodies.

Declarations

Ethics approval and consent to participate

The project was approved and funded by the Danish state (grant no. 05-0801-602). All participants received written and oral information and provided informed consent. Participation was voluntary, and individuals could withdraw at any time without consequences. The study adhered to the principles outlined in the Declaration of Helsinki.

Consent for publication

All participants provided informed consent for the publication of anonymized research data, in accordance with standard academic practice.

Competing interests

The authors declare no competing interests.