In the past decade, patients with anorexia nervosa have been subdivided by the presence or absence of binging-and-purging behavior. Psychologic, physiologic, and premorbid weight differences have also been discovered between these subgroups. We now report that nonbulimic anorectics required 30-50% more caloric intake than bulimic anorectics to maintain a stable weight. This difference in caloric intake was independent of phase of illness; it was present at low weight and at intervals after weight restoration. Subjects were closely supervised on an inpatient hospital ward so that they could not binge or purge. Motor activity did not appear to explain these alterations in caloric requirements. Such differences in caloric intake could be trait related or a consequence of many years of starving or binging behavior. These findings are clinically relevant for advising eating disorder patients of caloric requirements necessary to maintain a normal weight.

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In the 2 to 6 weeks after completion of refeeding and termination of a weight restoration program, patients with anorexia nervosa required greater than normal caloric intake to maintain a stable weight and had elevated levels of activity. By contrast, such patients studied 6 months or longer after weight recovery had normal caloric intake and activity levels. The prolonged delay in normalization of caloric intake and activity is mirrored by the slow resolution to normal of the neuroendocrine dysregulation that characterizes this disorder. This suggests that treatment for weight maintenance in anorexia nervosa should be extended aggressively for months after the return of a healthy weight so as to restore normal neuroendocrine function and thereby enhance the likelihood of permanent recovery.