History of Overweight/Obesity as Predictor of Care Received at 1-year Follow-Up in Adolescents With Anorexia Nervosa or Atypical Anorexia Nervosa

Kennedy, Grace A.; Forman, Sara F.; Woods, Elizabeth R.; Hergenroeder, Albert C.; Mammel, Kathleen A.; Fisher, Martin; Ornstein, Rollyn M.; Callahan, S. Todd; Golden, Neville H.; Kapphahn, Cynthia J.; Garber, Andrea K.; Rome, Ellen S.; Richmond, Tracy K.

doi:10.1016/j.jadohealth.2017.01.001

Cited by 62 publications

(50 citation statements)

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“…In adolescents and young adults with restrictive eating disorders, the prevalence of a history of overweight or obesity ranges from 19.3% to 36.7%. [3][4][5] These numbers mirror the national prevalence of overweight or obesity, suggesting that patients with higher weight status are as likely to experience disordered eating as their normal-weight peers. 4 Indeed, overweight adolescents report greater concern about their weight and more body dissatisfaction than their normal-weight peers.…”

Section: ■ Common and Underrecognizedmentioning

confidence: 94%

“…2 Although one study reported that a higher percentage of men with eating disorders had a history of premorbid overweight than women, another found no difference by sex. 3,4 Traditionally, restrictive eating disorders were characterized by low weight or failure to grow appropriately within expected growth curves, maladaptive weight loss strategies, and fear of weight gain. However, these criteria were modifi ed in the fi fth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), demonstrating the evolving clinical understanding of restrictive eating disorders.…”

Section: ■ Common and Underrecognizedmentioning

confidence: 99%

“…Although they present with a higher BMI compared with patients with anorexia nervosa or bulimia nervosa who started out in the normal-weight category, those who started out overweight or obese lose more weight (have greater "weight suppression"), whether the change is measured in kilograms, BMI, or percent body weight. 3,4 The higher weight at presentation results in a more common diagnosis of atypical anorexia nervosa in these patients. 3 The amount of weight suppression is a valuable indication of disease severity as well as a prognostic tool.…”

Section: ■ Greater Weight Suppression In Previously Overweight Patientsmentioning

confidence: 99%

“…3,4 The higher weight at presentation results in a more common diagnosis of atypical anorexia nervosa in these patients. 3 The amount of weight suppression is a valuable indication of disease severity as well as a prognostic tool. 3,4 A greater percent weight loss has been associated with worse psychological and physical symptoms in patients with anorexia nervosa.…”

Section: ■ Greater Weight Suppression In Previously Overweight Patientsmentioning

confidence: 99%

“…3 The amount of weight suppression is a valuable indication of disease severity as well as a prognostic tool. 3,4 A greater percent weight loss has been associated with worse psychological and physical symptoms in patients with anorexia nervosa. 10,11 A position paper from the Society for Adolescent Health and Medicine has advocated for greater recognition of the clinical utility of percent weight loss and emphasizes the dual roles of weight status as well as rate and relative amount of weight loss.…”

Section: ■ Greater Weight Suppression In Previously Overweight Patientsmentioning

confidence: 99%

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Restrictive eating disorders in previously overweight adolescents and young adults

Rastogi

Rome

2020

CCJM

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Eating disorders are common in adolescents and young adults, including those with a history of overweight or obesity, and are associated with numerous systemic sequelae. Understanding the differences in presentation between these patients and those who have a more classic anorexia nervosa phenotype is critical to ensuring timely recognition and treatment. KEY POINTS Patients who are overweight or obese are as likely to experience disordered eating as their normal-weight peers. Patients with a history of premorbid overweight or obesity present differently than their previously healthy weight peers in clinic. Malnutrition resulting from restrictive eating disorders affects many systems in the body and can occur even in the face of obesity or overweight status.

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Section: ■ Common and Underrecognizedmentioning

confidence: 94%

Section: ■ Common and Underrecognizedmentioning

confidence: 99%

Section: ■ Greater Weight Suppression In Previously Overweight Patientsmentioning

confidence: 99%

Section: ■ Greater Weight Suppression In Previously Overweight Patientsmentioning

confidence: 99%

Section: ■ Greater Weight Suppression In Previously Overweight Patientsmentioning

confidence: 99%

See 3 more Smart Citations

Restrictive eating disorders in previously overweight adolescents and young adults

Rastogi

Rome

2020

CCJM

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Teaching How to Avoid Overreliance on BMI in Diagnosing and Caring for Patients With Eating Disorders

2023

AMA Journal of Ethics

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Physicians tend to rely on diagnostic criteria, which can influence patients' access to care by legitimizing need for care, connections to appropriate clinicians, and insurance coverage for indicated interventions. This article considers potential unintended but foreseeable negative consequences, including iatrogenic harm, of using body mass index (BMI) to distinguish typical from atypical anorexia nervosa, despite both illnesses sharing the same behaviors and complications. This article also suggests teaching strategies to help students learn to avoid overreliance on BMI in eating disorders care.

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Short-term Outcomes of the Study of Refeeding to Optimize Inpatient Gains for Patients With Anorexia Nervosa

et al. 2021

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IMPORTANCEThe standard of care for refeeding inpatients with anorexia nervosa, starting with low calories and advancing cautiously, is associated with slow weight gain and protracted hospital stay. Limited data suggest that higher-calorie refeeding improves these outcomes with no increased risk of refeeding syndrome.OBJECTIVE To compare the short-term efficacy, safety, and cost of lower-calorie vs higher-calorie refeeding for malnourished adolescents and young adults with anorexia nervosa. DESIGN, SETTING, AND PARTICIPANTSIn this multicenter randomized clinical trial with prospective follow-up conducted at 2 inpatient eating disorder programs at large tertiary care hospitals, 120 adolescents and young adults aged 12 to 24 years hospitalized with anorexia nervosa or atypical anorexia nervosa and 60% or more of median body mass index were enrolled from February 8, 2016, to March 7, 2019. The primary analysis was a modified intent-to-treat approach. INTERVENTIONS Higher-calorie refeeding, beginning at 2000 kcal/d and increasing by 200 kcal/d vs lower-calorie refeeding, beginning at 1400 k/cal and increasing by 200 kcal every other day.MAIN OUTCOMES AND MEASURES Main outcomes were end-of-treatment outcomes; the primary end point of this trial will be clinical remission over 12 months. Short-term efficacy was defined a priori as time to restore medical stability in the hospital, measured by the following 6 indices: 24-hour heart rate of 45 beats/min or more, systolic blood pressure of 90 mm Hg or more, temperature of 35.6 °C or more, orthostatic increase in heart rate of 35 beats/min or less, orthostatic decrease in systolic blood pressure of 20 mm Hg or less, and 75% or more of median body mass index for age and sex. The prespecified safety outcome was incidence of electrolyte abnormalities; cost efficacy was defined as savings associated with length of stay. RESULTSBecause 9 participants withdrew prior to treatment, the modified intention-to-treat analyses included 111 participants (93%; 101 females [91%]; mean [SD] age, 16.4 [2.5] years). Higher-calorie refeeding restored medical stability significantly earlier than lower-calorie refeeding (hazard ratio, 1.67 [95% CI, 1.10-2.53]; P = .01). Electrolyte abnormalities and other adverse events did not differ by group. Hospital stay was 4.0 days shorter (95% CI, −6.1 to −1.9 days) among the group receiving higher-calorie refeeding, which was associated with a

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History of Overweight/Obesity as Predictor of Care Received at 1-year Follow-Up in Adolescents With Anorexia Nervosa or Atypical Anorexia Nervosa

Abstract: Our findings suggest that, despite greater degree of weight loss and no difference in duration of illness, participants with a history of overweight/obesity are less likely to receive inpatient medical care.

Cited by 62 publications

References 21 publications

Restrictive eating disorders in previously overweight adolescents and young adults

Restrictive eating disorders in previously overweight adolescents and young adults

Teaching How to Avoid Overreliance on BMI in Diagnosing and Caring for Patients With Eating Disorders

Short-term Outcomes of the Study of Refeeding to Optimize Inpatient Gains for Patients With Anorexia Nervosa

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