Atypical anorexia nervosa after bariatric surgery and the DSM‐5 diagnostic criteria: Commentary on Walsh et al. (2023)

Abstract

The applicability of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) criteria for anorexia nervosa (AN) and atypical AN to individuals having undergone bariatric surgery poses several challenges due to the atypical presentation of AN‐like symptoms in this population. We describe these challenges, propose modifications to the corresponding diagnostic criteria, and delineate areas of research to inform possible adaptations of atypical AN criteria with applicability to postbariatric surgery populations. We discuss the utility of a strict definition of “significantly low weight” and “significant weight loss” as part of DSM‐5 Criterion A for AN and atypical AN, highlighting the importance of clinical judgment. We also question the clinical distinction between AN and atypical AN based solely on weight and argue that the hallmark feature of both diagnoses in postbariatric surgery populations should be persistent energy intake restriction coupled with persistent weight‐control behaviors. Finally, criteria B and C need to allow the distinction between common concerns of bariatric surgery patients regarding weight and eating, and clinically relevant symptoms of atypical AN and AN. Knowing the rates, the specificities, and the impact of atypical AN on postsurgical weight loss has important implications for the clinical attention of these often‐overlooked patients.

Attitudes and Behaviors towards Food and Weight in Late Pregnancy: A Comparative Approach between Individuals with and without Previous Bariatric Surgery

“…Indeed, patients reduce their dietary intakes and modify their diet (i.e., avoid high-calorie foods and liquids, stop eating when feeling full, eat smaller amounts of food), but also adapt their eating behaviors to reduce postprandial discomfort in the short-term and to ensure no surgical complications in the long-term, especially when undergoing a surgery with a malabsorptive component [35]. It is also important to mention that, in the bariatric surgery population, suboptimal eating behaviors (e.g., restriction, binge eating) are common and may persist or even develop after surgery [36,37]. On the other hand, pregnant individuals with a history of bariatric surgery may have received more guidance, compared to pregnant individuals without surgery, because bariatric surgery pregnancies are considered highrisk in some settings.…”