A prospective test of the relation between weight change and risk for bulimia nervosa

Abstract

Objective-Prospectively investigate whether weight gain or weight loss increases risk for onset of binge eating and purging in adolescent women.Method-Diagnostic interviews and direct measures of body mass were completed by 496 adolescent women annually for eight years.Results-Substantial weight gain or weight loss during the study produced a 7-fold increase in risk for future onset of threshold or subthreshold bulimia nervosa (BN) relative to weight-stable participants, though the low incidence rate limited statistical power. Those who showed onset of threshold/subthreshold BN experienced greater increases in weight in the two years before onset of their eating disorder relative to healthy comparison participants.Discussion-This is the first prospective study to demonstrate that weight gain and weight loss may both increase risk for future onset of bulimic pathology. Results suggest that young women who have difficulty limiting their dietary intake are at increased risk for BN, an eating disorder characterized by loss of control over eating.Little is known about the relation between relative body weight and the development of BN. Russell 1 , in his classic paper that first formally identified this syndrome, noted that BN was "an ominous variant of anorexia" and that these patients, though typically presenting with "unremarkable" body weights, weighed significantly more prior to the development of their eating disorder. Others 2-4 have presented evidence that individuals with BN are significantly weight-suppressed, that is, their current weight tends to be substantially below their retrospectively reported highest weight ever relative to controls. Because individuals with BN are typically in the normal weight range, this implies that many patients with BN were somewhat overweight at their previous highest weight. Similarly, Fairburn et al. 5 and Yates 6 report that individuals with BN retrospectively reported a higher premorbid body mass than healthy controls and that there was a greater history of overweight in first-degree relatives of BN individuals.On the other hand, the normal weight status of most individuals with BN also conceals a weight history that involved weighing significantly less than they currently weigh. Garner and Fairburn 3 reviewed evidence suggesting that most individuals with BN lose a great deal of weight in the process of developing their disorder, with roughly a third reaching body weights characteristic of anorexia nervosa before gaining weight and transitioning to BN. 7 Further, case study and non-experimental research suggests that significant weight loss precedes -and presumably spurs the development of -binge eating. [8][9][10] In sum, many individuals with BN report a history of both higher and lower body weights relative to their weights when they come to the attention of researchers or clinicians. However, little is known about whether weight gain or weight loss increases risk for the development of BN.A fundamental weakness in existing studies of the possible role of ...

Elevated pre‐morbid weights in bulimic individuals are usually surpassed post‐morbidly: Implications for perpetuation of the disorder

“…Thus in terms of both the observed elevation of pre-morbid weights in the High Precedes group and observed rates of post-onset weight rebound, the results of this study are consistent with the hypothesis that bulimia nervosa may be linked to a predisposition towards overweight or obesity. Also consistent with this conclusion is a recent study by Thomas et al (42), who showed that both large weight losses and large weight gains were associated with the onset of a bulimic-spectrum disorder. Of greater relevance to the current results was the finding that both those who underwent a major weight loss and those who underwent a major weight gain were significantly higher in body mass than a weight stable comparison group one and two years following the year in which they lost or gained at least 10% of their body weight.…”

Elevated pre‐morbid weights in bulimic individuals are usually surpassed post‐morbidly: Implications for perpetuation of the disorder

“…Thus in terms of both the observed elevation of pre-morbid weights in the High Precedes group and observed rates of post-onset weight rebound, the results of this study are consistent with the hypothesis that bulimia nervosa may be linked to a predisposition towards overweight or obesity. Also consistent with this conclusion is a recent study by Thomas et al (42), who showed that both large weight losses and large weight gains were associated with the onset of a bulimic-spectrum disorder. Of greater relevance to the current results was the finding that both those who underwent a major weight loss and those who underwent a major weight gain were significantly higher in body mass than a weight stable comparison group one and two years following the year in which they lost or gained at least 10% of their body weight.…”

Childhood Mental Health and Body Mass Index as Mediators of Genetic Risk for Eating Disorders

“…It is possible that metabolic liability of lower BMI may become pathogenic only later, when it interacts with increasing psychological stress, body dissatisfaction, and sociocultural pressures that intensify across pubertal development. The findings regarding ΔBMI further highlight the protective effect of weight stability against eating pathology among young females during this early developmental period 47 . Together, these findings suggest that genetically driven metabolic traits may exert shifting influences on disordered eating behaviors depending on developmental stage and co-occurring psychological factors 30 .…”

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

“…40,[43][44][45][46][47][48] A childhood history of overweight or obesity and substantial weight gain during adolescence increase risk for EDs, with increased weight concerns as a mechanism. [49][50][51] It is also important to note that weight stigma is a known risk factor for disordered eating. 52 Both children and adults who experience weight stigma have an increased risk of low self-esteem and poor body image.…”

Elevated pre‐morbid weights in bulimic individuals are usually surpassed post‐morbidly: Implications for perpetuation of the disorder

“…Thus in terms of both the observed elevation of pre-morbid weights in the High Precedes group and observed rates of post-onset weight rebound, the results of this study are consistent with the hypothesis that bulimia nervosa may be linked to a predisposition towards overweight or obesity. Also consistent with this conclusion is a recent study by Thomas et al (42), who showed that both large weight losses and large weight gains were associated with the onset of a bulimic-spectrum disorder. Of greater relevance to the current results was the finding that both those who underwent a major weight loss and those who underwent a major weight gain were significantly higher in body mass than a weight stable comparison group one and two years following the year in which they lost or gained at least 10% of their body weight.…”

Childhood Mental Health and Body Mass Index as Mediators of Genetic Risk for Eating Disorders

“…It is possible that metabolic liability of lower BMI may become pathogenic only later, when it interacts with increasing psychological stress, body dissatisfaction, and sociocultural pressures that intensify across pubertal development. The findings regarding ΔBMI further highlight the protective effect of weight stability against eating pathology among young females during this early developmental period 47 . Together, these findings suggest that genetically driven metabolic traits may exert shifting influences on disordered eating behaviors depending on developmental stage and co-occurring psychological factors 30 .…”

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

“…40,[43][44][45][46][47][48] A childhood history of overweight or obesity and substantial weight gain during adolescence increase risk for EDs, with increased weight concerns as a mechanism. [49][50][51] It is also important to note that weight stigma is a known risk factor for disordered eating. 52 Both children and adults who experience weight stigma have an increased risk of low self-esteem and poor body image.…”

Elevated pre‐morbid weights in bulimic individuals are usually surpassed post‐morbidly: Implications for perpetuation of the disorder

“…Thus in terms of both the observed elevation of pre-morbid weights in the High Precedes group and observed rates of post-onset weight rebound, the results of this study are consistent with the hypothesis that bulimia nervosa may be linked to a predisposition towards overweight or obesity. Also consistent with this conclusion is a recent study by Thomas et al (42), who showed that both large weight losses and large weight gains were associated with the onset of a bulimic-spectrum disorder. Of greater relevance to the current results was the finding that both those who underwent a major weight loss and those who underwent a major weight gain were significantly higher in body mass than a weight stable comparison group one and two years following the year in which they lost or gained at least 10% of their body weight.…”

Childhood Mental Health and Body Mass Index as Mediators of Genetic Risk for Eating Disorders

“…It is possible that metabolic liability of lower BMI may become pathogenic only later, when it interacts with increasing psychological stress, body dissatisfaction, and sociocultural pressures that intensify across pubertal development. The findings regarding ΔBMI further highlight the protective effect of weight stability against eating pathology among young females during this early developmental period 47 . Together, these findings suggest that genetically driven metabolic traits may exert shifting influences on disordered eating behaviors depending on developmental stage and co-occurring psychological factors 30 .…”

Patient-Centered Care for Obesity: How Health Care Providers Can Treat Obesity While Actively Addressing Weight Stigma and Eating Disorder Risk

“…40,[43][44][45][46][47][48] A childhood history of overweight or obesity and substantial weight gain during adolescence increase risk for EDs, with increased weight concerns as a mechanism. [49][50][51] It is also important to note that weight stigma is a known risk factor for disordered eating. 52 Both children and adults who experience weight stigma have an increased risk of low self-esteem and poor body image.…”