Weight suppression and its relation to eating disorder and weight outcomes: a narrative review

Abstract

Weight suppression (WS) refers to the discrepancy between highest adult weight and current weight, and has been examined as a key construct related to both: eating pathology and weight management. However, despite increasing interest in WS, findings regarding the clinical implications of WS are often conflicting. For instance, WS has been associated with both adaptive and maladaptive outcomes across various populations. Moreover, results regarding the predictive utility of WS within clinical samples have been inconsistent. The current paper aims to provide a narrative review of existing investigation related to WS, highlight gaps in the field's understanding of this construct, and outline recommendations for future study.

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

“…The weight history of persons with AN or other eating disorders (EDs), however, only gradually moved into the focus of scientific attention. Most prominently, the concept of weight suppression (WS), which describes the difference between highest adult lifetime weight and current weight, was first examined in bulimia nervosa (BN) and later also in AN [1–3]. The more pronounced WS, the stronger the forces that pull weight back to its previous highest level [2], which is reflected in more rapid weight gain in persons with higher WS in BN [4] and AN [5–8].…”

“…As a consequence, they suggest that more detailed analyses of weight history should be conducted, including, for example, the age at the highest lifetime weight. Gorrell and colleagues pointed to a variability in calculating WS, which might account for some ambiguous findings [3]. For example, when calculating WS with weight only, two persons of different height and weight might show similar values.…”

“…A further important, though seldom considered, problem arises from calculating weight history indices in young adults with EDs, who actually do not have a long weight history [3]. Contemplate, for example, the case of a woman of 19 years with AN, who reached her highest and lowest weights at ages 14 and 17, respectively.…”

The independent and interacting effects of weight suppression and admission body mass index on treatment weight change in patients with anorexia nervosa or bulimia nervosa

“…To the extent that a major goal of treatment is to stabilize weight and eating patterns, failing to understand and acknowledge the differential expected weight trajectories based on current and past weights may run counter to the therapeutic goals. Educating patients on the reality of their expected weight change based on their weight and weight history could help bolster alliance and prepare patients for individualized challenges they may face during treatment (Gorrell, Reilly, Schaumberg, Anderson, & Donahue, ; Juarascio, Lantz, Muratore, & Lowe, ).…”

Weight suppression and weight maintenance following treatment of anorexia nervosa

“…The last decade has witnessed increased interest in understanding the impact of weight suppression (WS: the difference between highest adult weight and current weight) (Bodell, Racine, & Wildes, 2016; Lowe, Piers, & Benson, 2018) on the severity and course of illness of eating disorders. Much of the recent work has focused on bulimia nervosa, and suggests that greater WS is associated with increased psychological symptoms, increased frequencies of binge eating and purging, and increased weight gain during treatment (Gorrell, Reilly, Schaumberg, Anderson, & Donahue, 2019; Lowe et al, 2018).…”