Short-Term Outcome of Inpatient Treatment for Adolescents with Anorexia Nervosa Using DSM-5 Remission Criteria

Objective Early weight gain during inpatient treatment for anorexia nervosa (AN) is a dynamic process characterised by within‐person variability that may be age‐dependent. We examined whether age moderates the effect of within‐person weight gain and variability on treatment outcome. Method Within‐person level estimates of N = 2881 underweight adolescents and adults with AN for daily average weight gain (linear slope) and variability (root mean squared errors) were obtained using random‐effects modelling. Between‐person level regression analyses were calculated to assess effects on weight, eating disorder psychopathology and attaining normal body weight (body mass index [BMI]: 18.5–25 kg/m2). Results Higher weight gain during first 2 weeks of inpatient treatment predicted higher weight, lower drive for thinness and lower body dissatisfaction at discharge, but not lower bulimic symptoms. Moreover, it predicted a higher probability of discharge weight within normal range. Younger age was associated with stronger effects of early weight gain on weight, drive for thinness and body dissatisfaction at discharge. Weight variability was not associated with any outcome. Conclusions Age moderated effects of early weight gain on treatment outcomes, with larger effects for younger patients. Weight variability alone did not influence treatment across age and should be of lesser clinical concern during early inpatient treatment.

Section: Resultscontrasting

confidence: 61%

Early within‐person weight gain and variability during inpatient treatment for anorexia nervosa: Age‐dependent effects on treatment outcome

Kolar

Meule

Naab

et al. 2022

“…TAU consists of psychiatric/psychotherapeutic inpatient treatment with nutritional rehabilitation aimed at the restoration of a healthy weight and starting a psychotherapeutic process (details on TAU with outcome data can be found in Mairhofer et al. [ 2021 ]). It is important to include inpatients only, as nutritional rehabilitation needs supervision and very detailed reporting of food, fluid and probiotics/placebo intake.…”

Section: Methodsmentioning

confidence: 99%

The effects of probiotics administration on the gut microbiome in adolescents with anorexia nervosa—A study protocol for a longitudinal, double‐blind, randomized, placebo‐controlled trial

Gröbner

Zeiler

Fischmeister

et al. 2021

Self Cite

Objective Knowledge on gut–brain interaction might help to develop new therapies for patients with anorexia nervosa (AN), as severe starvation‐induced changes of the microbiome (MI) do not normalise with weight gain. We examine the effects of probiotics supplementation on the gut MI in patients with AN. Method This is a study protocol for a two‐centre double‐blind randomized‐controlled trial comparing the clinical efficacy of multistrain probiotic administration in addition to treatment‐as‐usual compared to placebo in 60 patients with AN (13–19 years). Moreover, 60 sex‐ and age‐matched healthy controls are included in order to record development‐related changes. Assessments are conducted at baseline, discharge, 6 and 12 months after baseline. Assessments include measures of body mass index, psychopathology (including eating‐disorder‐related psychopathology, depression and anxiety), neuropsychological measures, serum and stool analyses. We hypothesise that probiotic administration will have positive effects on the gut microbiota and the treatment of AN by improvement of weight gain, gastrointestinal complaints and psychopathology, and reduction of inflammatory processes compared to placebo. Conclusions If probiotics could help to normalise the MI composition, reduce inflammation and gastrointestinal discomfort and increase body weight, its administration would be a readily applicable additional component of multi‐modal AN treatment.

“…In clinical terms, complete weight restoration entails substantial psychological improvements as shown in different longitudinal studies of adolescent inpatients with AN (Mairhofer et al, 2021), who in contrast to adult patients more frequently achieve their target weight during inpatient treatment. Improvements usually set in slowly and only become noticeable after substantial weight gain.…”

Section: Slow Psychological Improvements Of Both Patients With Anorex...mentioning

confidence: 99%

Does hypoleptinemia trigger entrapment in anorexia nervosa? Etiological and clinical considerations

Hebebrand,

Plieger,

Milos

et al. 2024

Based on the recent observation that human recombinant leptin (r‐Met‐hu‐leptin; metreleptin) may induce a profound alleviation of the complex symptomatology of patients with anorexia nervosa (AN), we examine the implications for our conceptualisation of this eating disorder. Hypoleptinemia as a core endocrine feature of AN serves as a central and peripheral trigger of tissue‐specific adaptations to starvation. In this narrative review, we argue that leptin deficiency may explain many of the puzzling features of this eating disorder. Weight loss can be viewed as a two‐step process, with only the second step entailing hypoleptinemia and thereby the entrapment characteristic of AN. We discuss the central and peripheral distribution of leptin receptors and consider possible functional implications of hypoleptinemia. We contrast the slow psychological recovery of patients with AN and of people who experienced starvation upon weight recovery with the rapid onset of improvements upon off‐label metreleptin treatment. Characteristics of the sex and age dependent secretion of leptin may contribute to the elevated vulnerability of young females to develop AN.