OBJECTIVE:: Two females with severe anorexia nervosa (BMI of 10) were seen with marked abnormalities in their liver function tests before the initiation of refeeding. These paradoxically resolved with progressive refeeding and weight restoration. METHOD:: Clinical observation during regimented medical stabilization and refeeding of two patients with severe anorexia nervosa with frequent monitoring of liver function tests. RESULTS:: Normalization of liver function tests ensued as caloric intake increased and weight gain progressed. DISCUSSION:: Although classically liver function test elevations occur during refeeding, as a manifestation of excessive calories and fat deposition in the liver, they may also be elevated due to severe malnutrition before refeeding has commenced and improved as refeeding occurs. (c) 2009 by Wiley Periodicals, Inc. Int J Eat Disord 2009.