Earlier diagnosis in anorexia nervosa: better watch growth charts!

Abstract

Background: A better understanding of the healthcare pathway of children and adolescents with anorexia nervosa (AN) may contribute to earlier detection and better disease management. Here we measured and compared the symptomatic time to diagnosis (TTD) (time between the first symptoms, as reported by parents, and the diagnosis) and the auxological TTD (time between the deviation in the weight growth curve and the diagnosis). Methods: We performed a monocentric retrospective study including all patients age 9 years to 16 years who were hospitalized in Nantes University Hospital for AN between 2013 and 2016. We analysed the two TTDs by medical record review and growth curve investigation. TTDs were described by medians and Kaplan-Meier curves. Two profiles of patients were compared according to the kinetics of growth deviation and the occurrence of symptoms. Results: Among the 137 patients included, the median symptomatic and auxological TTDs was 7.0 months (IQR: 4.0-12.0) and 7.2 months (IQR: 2.0-18.0). TTDs were significantly different but clinically similar. For 48% of the patients, a deviation in the growth curve could have been noted at a median of 9.7 months (IQR: 3.0-18.0) before the first symptoms were reported by parents. Those patients showed significantly slower weight loss than did patients with first symptoms reported before growth deviation (weight loss rate 0.41% vs 1.90% per month, p < 0.0001). Conclusions: Careful study of growth curves remains an essential step in detecting eating disorders, possibly allowing for earlier detection of the disease in nearly half of these patients.

Linear growth in young people with restrictive eating disorders: “Inching” toward consensus

“…One retrospective study aimed to compare the time to diagnosis as characterized by two distinct measurements: time of parental identification of symptoms to diagnosis versus time of noted deviation in weight growth curve to diagnosis (44). This study confirms anecdotal reports that those with rapid weight loss come to medical attention more quickly, resulting in earlier diagnosis and treatment initiation (44).…”

“…Those with less stark physical changes, including weight stagnation, went undetected longersuggesting less recognition by caregivers and less clinician urgency in pursuing further evaluation, despite deviation from expected growth trajectory. Importantly, almost half of this sample of patients could have been identified with deviations in the growth curve at a median of 9.7 months before caregiver report of symptoms (44). This study highlights the need for clinicians to carefully evaluate any deviations in growth curves, particularly in younger patients for whom slowed growth trajectory may be a red flag for disordered eating.…”

“…One retrospective study aimed to compare the time to diagnosis as characterized by two distinct measurements: time of parental identification of symptoms to diagnosis versus time of noted deviation in weight growth curve to diagnosis (44). This study confirms anecdotal reports that those with rapid weight loss come to medical attention more quickly, resulting in earlier diagnosis and treatment initiation (44). Those with less stark physical changes, including weight stagnation, went undetected longersuggesting less recognition by caregivers and less clinician urgency in pursuing further evaluation, despite deviation from expected growth trajectory.…”

Promising effect of multi-family therapy on BMI, eating disorders and perceived family functioning in adolescent anorexia nervosa: an uncontrolled longitudinal study

“…The emotional and somatic consequences of these beliefs and behaviors sustain the disorder and increase the risk of mortality from malnutrition, suicide and medical problems, as well as long and repeated hospitalizations (e.g., Smink et al, 2012). AN is under-diagnosed (Marion et al, 2020) and difficult to treat (Kaplan & Garfinkel, 1999). The importance of early intervention is now well established (Kalindjian et al, 2021), considering that a longer disease duration (without a proper intervention) is associated with a poorer prognosis.…”

Gender and sex in eating disorders: A narrative review of the current state of knowledge, research gaps, and recommendations

“…Neurodevelopment and growth are both associated with risk for ED symptoms (e.g., Herle et al., 2020 ; Marion et al., 2020 ; Watson et al., 2019 ). Importantly, these two processes do not occur at the same rate for boys and girls (Culbert et al., 2021 ; Fisher et al., 2018 ; Franceschini & Fattore, 2021 ; McCarthy et al., 2017 ).…”