Discharge Body Mass Index, Not Illness Chronicity, Predicts 6-Month Weight Outcome in Patients Hospitalized With Anorexia Nervosa

Abstract

Proposed treatments for severe and enduring anorexia nervosa (SE-AN) focus on quality of life, and psychological and social functioning. By de-emphasizing weight restoration as a priority, however, premature diagnosis of SE-AN may reduce potential for recovery. The present study assessed the effect of weight restoration, illness duration, and severity on treatment outcome 6 months after discharge from an intensive, meal-based behavioral treatment program. Participants included hospitalized adult women (N = 191) with AN or underweight other specified feeding and eating disorder (OSFED). Participants were characterized as short-term (ill <7 years; n = 74) or long-term ill (ill ≥ 7 years; n = 117). Compared with short-term ill, long-term ill patients were older, had lower lifetime body mass index (BMI), more prior admissions, and exhibited greater depression and neuroticism. Long-term vs. short-term ill patients gained weight at the same rate (~2 kg/wk) and were equally likely to be weight restored by discharge (>75% reached BMI ≥ 19 kg/m2 in both groups). At 6-month follow-up (n = 99), both groups had equivalent self-reported BMI, and depression, drive for thinness, body dissatisfaction, and bulimia scores. The only predictor of BMI ≥ 19 kg/m2 at follow-up was discharge BMI. The likelihood of a BMI ≥ 19 kg/m2 at follow-up was 5-fold higher for those with discharge BMI ≥ 19 kg/m2. Few studies of long-term ill inpatients with AN have examined the impact of full weight restoration on short-term outcomes. This study supports the therapeutically optimistic stance that, regardless of illness duration, hospitalized patients with AN benefit from gaining weight to a BMI ≥ 19 kg/m2.

Lifetime Weight Characteristics of Adult Inpatients With Severe Anorexia Nervosa: Maximal Lifetime BMI Predicts Treatment Outcome

“…However, higher maximal BMI or weight suppression of 1.0 kg/m 2 was associated with a 0.25 kg/m 2 increase in BMI at follow-up. The lack of predictive power of the BMI at discharge is in contrast to reports of a 6-month follow-up (21), however this difference might be explained by the longer time to follow-up in our study. Consistent with our results, the above-mentioned study reports low predictive power for the minimal BMI (21).…”

“…The lack of predictive power of the BMI at discharge is in contrast to reports of a 6-month follow-up (21), however this difference might be explained by the longer time to follow-up in our study. Consistent with our results, the above-mentioned study reports low predictive power for the minimal BMI (21). Maximal BMI itself has not been considered as predictor of follow-up BMI in previous research, but appears to be the driving force behind weight suppression at admission given their high correlation.…”

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“…However, higher maximal BMI or weight suppression of 1.0 kg/m2 was associated with a 0.25 kg/m2 increase in BMI at follow-up. The lack of predictive power of the BMI at discharge is in contrast to reports of a 6-month follow-up (22), however this difference might be explained by the longer time to follow-up in our study. Consistent with our results, the abovementioned study reports low predictive power for the minimal BMI (22).…”

“…The lack of predictive power of the BMI at discharge is in contrast to reports of a 6-month follow-up (22), however this difference might be explained by the longer time to follow-up in our study. Consistent with our results, the abovementioned study reports low predictive power for the minimal BMI (22). Maximal BMI itself has not been considered as predictor of follow-up BMI in previous research, but appears to be the driving force behind weight suppression at admission given their high correlation.…”

Exploring the Mechanisms of Recovery in Anorexia Nervosa through a Translational Approach: From Original Ecological Measurements in Human to Brain Tissue Analyses in Mice

“…It could be considered such as a sequelae of the undernutrition state. Weight restoration is a cornerstone of treatment [ 59 ] and a strong prognostic factor for treatment efficacy [ 60 ]. However, persistence of symptoms after weight gain, illustrated here through treatment-seeking patients with prAN, has to be further investigated.…”