Dimensions within 24 weight history indices and their association with inpatient treatment outcome in adults with anorexia nervosa: analysis of routine data

Abstract

Objective Next to weight suppression (WS), there are a range of less often examined weight history indices, and improvements to the WS construct have been proposed. We aimed to examine redundancy and overlap between 24 weight history indices in order to identify suitable constructs for further investigation. Method Analysis of routine data of 770 female adult inpatients treated for AN. Twenty-four indices based on highest, lowest, and current weight, as well as developmental aspects were calculated and employed in correlational and factor analyses. The indices’ ability to predict core outcomes of inpatient treatment was investigated with regression analyses. Results Five factors emerged: “WS and highest weight”, “weight elevation (i.e., difference between current and lowest weight since puberty)”, “lowest weight”, “age at past highest or lowest weight”, and “years since past highest or lowest weight”. The constructs within these factors showed high correlations. Most indices related to change in weight, ED psychopathology, as well as behavioral aspect of AN. While measures of WE related more to weight gain and general ED Psychopathology, indices including lowest weight were stronger predictors of changes in slimness ideal and inappropriate compensatory behaviors. Conclusion Many proposed weight history indices are closely related and the amount of additional information in complex indices appears questionable. While highest weight seems to dominate indices of WS, WE may rely on current weight. These findings highlight that different aspects of weight history may relate to different aspects of current ED symptoms and their amenability to change under specialized treatment.

Orthorexic tendencies in the general population: association with demographic data, psychiatric symptoms, and utilization of mental health services

“…Together with a high prevalence of ON in anorexia nervosa [14], this finding cannot easily be reconciled with the proposition that restrictive eating in ON is not aimed at weight loss but at healthy eating [1]. However, there was no association between orthorexic tendencies and measures of past and present weight in our sample, unlike to what is known from eating disorders [28,29]. Also, the lack of an association between orthorexic tendencies and symptoms of anorexia nervosa in our sample does not concur with what is reported for clinical and non-clinical samples (see Table 1; [13,14]).…”

Inpatient treatments for adults with anorexia nervosa: a systematic review of literature

“…While not every study provided details on the gender of the patients, 97.55% of the population in 24 studies were female [ 31 , 33 – 50 , 52 – 56 ]. Employment status was reported in five studies [ 30 , 40 , 42 , 44 , 48 ], revealing that about 47.5% were students, 25.67% were employed, and 15.72% were unemployed. The average age of patients in the 26 studies that reported this information was 27.22 years [ 30 – 34 , 36 – 56 ] and the mean length of inpatient stay in 18 studies was 59.35 days [ 30 , 33 , 34 , 37 , 38 , 40 – 42 , 44 – 51 , 54 , 55 ].…”

“…Employment status was reported in five studies [ 30 , 40 , 42 , 44 , 48 ], revealing that about 47.5% were students, 25.67% were employed, and 15.72% were unemployed. The average age of patients in the 26 studies that reported this information was 27.22 years [ 30 – 34 , 36 – 56 ] and the mean length of inpatient stay in 18 studies was 59.35 days [ 30 , 33 , 34 , 37 , 38 , 40 – 42 , 44 – 51 , 54 , 55 ]. Diagnosis subtype was specified in only 20 of the referenced studies [ 30 , 33 , 37 – 50 , 52 – 55 ], with about 57.16% corresponding to the restrictive type of AN, and 40.73% to the binge-purging type.…”

“…In terms of methodology, among the studies that provided details (14 in total) [ 31 – 34 , 36 – 43 , 45 , 55 ] the majority employed Cognitive Behavioral Therapy (CBT) (six studies) [ 32 – 34 , 38 – 40 ], followed by Psychodynamic Therapy (two studies) [ 33 , 41 ]. Additional studies outlined the application of Cognitive Remediation and Emotion Skills Training [ 31 , 32 ], Cognitive Remediation Therapy [ 36 ], Cognitive Analytic Therapy and Schema Therapy [ 32 ], and incorporated components of Interpersonal Psychotherapy [ 34 ].…”

“…Oral nutritional supplements 9 Schlegl et al 2014 [ 38 ] 14.56 n.r BMI ≥ 18 Expected weight gain 700 g per week, monitorized twice a week. In case of failure of weight gain: increase of food intake and monitoring during meal times, administration of high caloric fluids or feeding through nasal tube 10 Andrade et al 2017 [ 39 ] 15.00 n.r n.r 3 meals + 3 snacks, 1700 kcal 11 Hessler et al 2019 [ 40 ] n.r 2.54 n.r Normal portions three times per day, mealtime support, free access to cafeteria/supermarket/lavatories 12 Marzola et al 2019 [ 41 ] 14.16 0.81 n.r Use of NGT, 3 meals + 2 snacks, assisted, in group 13 Chatelet et al 2020 [ 42 ] 14.80 2.30 n.r NGT if goal not achieved in 2 days. Nutrition stepwise approach: 50% of individual basic caloric needs at day 1, 75% at day 3, 100% at day 6.…”