Grasping the weight cut‐off for anorexia nervosa in children and adolescents

Abstract

Objective The Diagnostic and Statistical Manual of Mental Disorders 5 suggests the 5th age‐adjusted body mass index (BMI) percentile as the numeric cut‐off for anorexia nervosa (AN) in children and adolescents. We aimed to investigate the degree to which the 5th age‐adjusted percentile as the numeric cut‐off for AN in youths reflects the clinical population of patients accepted for treatment. Method From a specialized eating disorder clinic, 305 patients with AN below 18 years of age were grouped according to age‐adjusted BMI percentiles [below the 5th (low), above the 10th (high), and between the 5th and the 10th (medium)]. The distribution of eating disorder diagnoses and severity measured by the Eating Disorder Examination was compared. Results Full‐syndrome anorexia nervosa (F.50.0) was found in 182 (59.5%) patients and atypical anorexia nervosa (F.50.1) in 123 patients (40.5%). The number of patients in the low, medium, and high BMI percentile groups was 189 (62.0%), 34 (11.1%), and 82 (26.9%), respectively. Patients in the low BMI group differed from patients in the medium BMI group by a lower frequency of vomiting. The high BMI group presented with more weight and shape concern than the lower BMI group. Age was not a confounder of these associations. Discussion We question the applicability of the 5th BMI percentile as a substantiated cut‐off for the weight criterion in anorexia nervosa in youths and argue that the cut‐off should not be ascribed great clinical importance as this may hinder early detection of illness and initiation of treatment.

The validity of the fifth and the 10th Body Mass Index percentile as weight cut‐offs for anorexia nervosa in adolescence: No evidence from quantitative and network investigation of psychopathology

“…In our study, we have observed that adolescents with BMI higher than the fifth percentile had higher drive to thinness, body dissatisfaction, bulimic symptoms, interpersonal insecurity, personal alienation, interpersonal alienation, emotion dysregulation, ascetism and somatization problems. Some methodological differences can explain the discrepancy between our study and Andersen et al (2018). Instead of the ED Examination-Questionnaire employed by those authors to assess ED-related psychopathology, we used the EDI-3 which explores additional ED psychopathological variables, and Abbreviations: ADH, attention problems; AFF, affective problems; AGG, aggressive behaviour; ANX, anxiety; ASC, asceticism; BD, body dissatisfaction; BMI, Body Mass Index; BU, bulimia; DB, delinquent behaviour; DOC, obsessive-compulsive problems; DT, drive for thinness; ED, emotional dysregulation; ID, interoceptive deficits; InA, interpersonal alienation; INS, social insecurity; LSE, low self-esteem; MF, maturity fear; mo, months; P, perfectionism; PeA, personal alienation; PTSD, post-traumatic stress problems; SOM, somatic complaints; YSR, Youth Self Report.…”

“…However, no literature studies have provided support for this value in terms of psychopathology. To the best of our knowledge, only one study (Andersen et al, 2018) has assessed differences in ED symptom severity in accordance with the fifth percentile BMI cut-off in adolescents with AN and did not identify MARIA MONTELEONE ET AL.…”

“…Inconsistent use of different underweight definitions (Golden, Katzman, Sawyer, & Ornstein, 2015) supports the need to investigate the validity of a BMI percentile cut-off as an indicator of psychopathology severity in adolescents with AN. To the best of our knowledge, only one recent study (Andersen, Lindgreen, Rokkedal, & Clausen, 2018) has assessed the utility of the fifth or the 10th BMI percentile weight cut-offs by comparing symptom severity in AN adolescents with a BMI percentile lower or higher than those values. Although the authors have not detected significant differences in symptom severity between the above-threshold and under-threshold groups, they assessed only ED core symptoms without considering other psychopathological variables (i.e., anxious or depressive symptoms), which Highlights � Adolescents with anorexia nervosa (AN) and BMI below the fifth or the 10th percentile weight cut-off have less severe eating disorderrelated symptoms than those with BMI above these cut-offs � Adolescents with AN and BMI below the fifth or the 10th percentile weight cut-off do not differ in general psychopathology from those with BMI above these cut-offs � Neither the fifth or the 10th BMI percentile weight cut-off reflects psychopathology structure in adolescents with AN � Adolescents with atypical AN do not differ in terms of psychopathology from those with AN diagnosis MARIA MONTELEONE ET AL.…”

Factors Associated with Disease-Specific Health Related Quality of Life in Women with Anorexia Nervosa

“…If participants were below 18 years of age, their BMI was converted into BMI-for-age percentiles according to WHO's growth reference [15]. Among adolescents, a BMI-for-age percentile below 10 indicates underweight, while a normal weight range is represented by a BMI-for-age percentile between 10 and 85 [16].…”

Validation of a childhood eating disorder outcome scale

“…However, absolute BMI values are not recommended as a measure for underweight in adolescence, as development-related variations may bias results [16, 17]. In DSM-5, an age- and gender-adjusted BMI percentile of 5 is suggested as a numeric cut-off for low weight criterion in AN in children and adolescents, however, the evidence supporting this cut-off for underweight is lacking [18]. As AN cases with extreme low weight are in a BMI percentile near zero, it is difficult to distinguish their severity of weight loss.…”