Clinical onset and diagnosis of eating disorders in premenarcheal girls is preceded by inadequate weight gain and growth retardation

Abstract

Aim: To study growth and weight changes before the presentation of an eating disorder (ED) with premenarcheal onset. Methods: Growth charts from the school health services were obtained for 45 girls assessed during the period 1990–2000 at Uppsala University Children's Hospital. Measurements of weight and height from the charts and at presentation were recalculated into standard deviation scores (SDS). Results: At their maximal weight the girls were 12.5 ±1.7 (mean ± SE) y old. They were then lighter, shorter and leaner than the general population mean, as evidenced by SDS below zero for weight (‐0.43 ± 1.08; mean ± SD), height (‐0.45 ± 1.01) and body mass index (BMI) (‐0.35 ± 1.07). At presentation approximately 1 y later they had lost 5.8 ± 4.3 kg and were considerably underweight (weight SDS ‐2.27 ± 1.33) and further stunted (height SDS ‐0.76 ± 0.97). The point on the growth curves with the highest SDS for weight was observed at 8.5 ± 1.4 y of age. The girls were then heavier (weight SDS 0.35 ± 0.93) and less lean (BMI SDS 0.42 ± 0.97) than the population average. A tendency to track down through weight and height curves before the onset of weight loss was thus observed. Total weight deficit was as much as 31 ± 10% of expected body weight. Analyses of weight and height deficits indicated that two‐thirds of the weight deficit and 60% of the height deficit was generated before the onset of weight loss. Conclusion: Girls with eating disorders presenting before menarche may have a long history of poor weight gain and growth retardation before the onset of weight loss. This is in contrast to older girls, who commonly start weight loss at an above‐average weight without prior poor weight gain. Since the psychopathology of ED in young girls may be different and less evident compared with older teenagers it is important to be aware that poor weight gain and growth retardation may be associated with early‐onset ED.

Accuracy of reported weight and menstrual status in teenage girls with eating disorders

“…In growing teenagers, this is an important issue because a weight, which at a certain age is average, may later represent underweight due to the absence of expected weight gain. The DSM-IV weight criterion for AN may thus be fulfilled if a teenager maintains constant weight over a period when weight gain is expected as part of normal growth (Swenne & Thurfjell, 2003). Premorbid weight history in teenagers with ED therefore must include not only top weight but also when it was reached.…”

Weight requirements for catch-up growth in girls with eating disorders and onset of weight loss before menarche

“…In a majority of the patients, weight loss starts from a weight above average, and onset of weight loss is reasonably distinct and occurs at an age when only little further growth in stature can be expected (Nielsen, 1985;Swenne, 2001). However, in younger patients who have not yet completed puberty, onset may be insidious and frank weight loss may be preceded by a long period of inadequate weight gain and growth retardation (de Monléon et al, 1998;Jeammet, Hurvy, Rabreau, Piquard-Gauva, & Flavigny, 1984;Modan-Moses et al, 2003;Russel, 1985;Swenne & Thurfjell, 2003). These patients are of an age when considerable further growth should be expected and it is therefore of concern when they present with stunting of growth and delayed development (Abadie, de Tournemire, & Alvin, 2003;Danziger, Mukamel, Zeharia, Dinari, & Mimouni, 1994;de Monléon et al, 1998;Gowers, Crisp, Joughin, & Bhat, 1991;Modan-Moses et al, 2003;Pfeiffer, Lucas, & Ilstrup, 1986;Root & Powers, 1983;Russel, 1985;Swenne & Thurfjell, 2003).…”

Eating Disorders and Menarche: Can Emotions toward the First Period Provide Insight into Future Eating Disorder Development?

“…Results from a 2005 study inquiring about the attitudinal differences in body image between patients with anorexia nervosa and bulimia nervosa showed that individuals with bulimia reported more body image dissatisfaction than those diagnosed with anorexia (Swenne & Thurfjell, 2003). Using this concept, a future study can select participants with an Eating Disorder diagnosis and seek to determine different feelings toward menarche between the diagnoses.…”