Weight suppression and weight maintenance following treatment of anorexia nervosa

Uniacke, Blair; Attia, Evelyn; Kaplan, Allan S.; Walsh, B. Timothy

doi:10.1002/eat.23269

Cited by 9 publications

(14 citation statements)

References 23 publications

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“…The predictors were classified into three groups: biological predictors, psychological predictors, and ED-related predictors. Of the 19 studies included in this review, 8 excluded patients with a BMI below 18.5 kg/m 2 at discharge [ 12 , 16 , 30 , 32 , 33 , 37 , 38 , 39 ]. Another eight studies had not excluded patients with BMI below 18.5 kg/m 2 , but the variability of BMI at discharge indicated that potentially a minor subgroup of these patients was not in complete remission [ 23 , 25 , 26 , 31 , 34 , 35 , 36 , 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…In total, 13 studies concerned biological predictors of relapse, and 8 of these described BMI or weight as a predictor of relapse [ 24 , 28 , 30 , 31 , 32 , 34 , 39 ]. Only one of these studies had a high [ 31 ], most others moderate, and only one had a low quality of evidence [ 39 ]. The studies differed in design, BMI measurement time points, and whether weight or/and BMI were assessed.…”

Section: Resultsmentioning

confidence: 99%

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BMI at Discharge from Treatment Predicts Relapse in Anorexia Nervosa: A Systematic Scoping Review

Frostad

Rozakou-Soumalia

Dârvariu

et al. 2022

JPM

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Background: Anorexia nervosa (AN) has high rates of enduring disease and mortality. Currently, there is insufficient knowledge on the predictors of relapse after weight normalization and this is why a systematic literature review was performed. Methods: PubMed, EMBASE, PsychInfo, and Cochrane databases were searched for literature published until 13 July 2021. All study designs were eligible for inclusion if they focused on predictors of relapse after weight normalization in AN. Individual study definitions of relapse were used, and in general, this was either a drop in BMI and/or reccurrence of AN symptoms. Results: The database search identified 11,507 publications, leaving 9511 publications after the removal of duplicates and after a review of abstracts and titles; 191 were selected for full-text review. Nineteen publications met the criteria and included 1398 AN patients and 39 healthy controls (HC) from adults and adolescents (ages range 11–73 years). The majority used a prospective observational study design (12 studies), a few used a retrospective observational design (6 studies), and only one was a non-randomized control trial (NRCT). Sample sizes ranged from 16 to 191 participants. BMI or measures of body fat and leptin levels at discharge were the strongest predictors of relapse with an approximate relapse rate of 50% at 12 months. Other predictors included signs of eating disorder psychopathology at discharge. Conclusions: BMI at the end of treatment is a predictor of relapse in AN, which is why treatment should target a BMI well above 20. Together with the time to relapse, these outcomes are important to include in the evaluation of current and novel treatments in AN and for benchmarking.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

BMI at Discharge from Treatment Predicts Relapse in Anorexia Nervosa: A Systematic Scoping Review

Frostad

Rozakou-Soumalia

Dârvariu

et al. 2022

JPM

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“…Greater current weight suppression has been found to predict future onset of AN (11) and has been associated with faster and greater weight normalization during inpatient treatment of AN [e.g., (12,13)]. However, there are mixed findings regarding long-term treatment outcomes, with reports of higher weight suppression at the time of lowest BMI being associated with higher BMI at 6-to 18-year follow-up (14), and higher weight suppression at discharge predicting better weight maintenance at 1-year follow-up (15), but also reports showing no effect of weight suppression at discharge on weight maintenance at 1-year follow-up (16).…”

Section: Introductionmentioning

confidence: 99%

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

2021

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Background: The body mass index is a key predictor of treatment outcome in patients with anorexia nervosa. In adolescents, higher premorbid BMI is a strong predictor of a favorable treatment outcome. It is unclear whether this relationship holds true for adults with anorexia nervosa. Here, we examine adult patients with AN and investigate the lowest and highest lifetime BMI and weight suppression as predisposing factors for treatment outcome.Methods: We included 107 patients aged 17–56 with anorexia nervosa and tracked their BMI from admission to inpatient treatment, through discharge, to follow-up at 1–6 years. Illness history, including lowest and highest lifetime BMI were assessed prior to admission. We used multiple linear regression models with minimal or maximal lifetime BMI or weight suppression at admission as independent variables to predict BMI at admission, discharge and follow-up, while controlling for patients' age, sex, and duration of illness.Results: Low minimal BMI had a negative influence on the weight at admission, which in turn resulted in a lower BMI at discharge. Higher maximal BMI had a substantial positive influence on BMI at discharge and follow-up. Weight suppression was highly correlated with maximal BMI and showed similar effects to maximal BMI.Conclusion: Our findings strongly support a relationship between low minimal lifetime BMI and lower BMI at admission, and between higher maximal lifetime BMI or weight suppression and a positive treatment outcome, even years after discharge. Overall, maximal BMI emerged as the most important factor in predicting the weight course in adults with AN.

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“…Prior studies on inpatient samples specifically have tended toward examining predictors of outcome unrelated to treatment (e.g., age of onset, comorbidities, family support) and report overall prognosis categorically [42][43][44][45][46][47]. Fewer have studied continuous outcomes, such as weight, symptoms, and overall clinical impairment over time [13,23,38,48,49], and these have generally been limited to short-term follow up [13,19,49] or to a single assessment point [23,25,34]. Together, these studies suggest that higher BMI at discharge and shorter duration of illness are important factors in the course of AN.…”

Section: Introductionmentioning

confidence: 99%

Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa

et al. 2020

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Background Anorexia nervosa (AN) is a life-threatening psychiatric disorder associated with significant medical and psychosocial impairment. Hospital-based behavioral treatment is an effective intervention in the short-term. However, relapse rates following discharge are high and thus, there is a need to identify predictors of longitudinal outcome. The current study provides information regarding illness course and health maintenance among patients with AN over 5 years following discharge from an eating disorder inpatient unit. Methods Participants were individuals with AN who were discharged from a specialized, inpatient behaviorally-based unit. Prior to discharge, height and weight were measured and participants completed self-report measures of eating disorder severity and general psychopathology (depression, anxiety, harm avoidance). Participants were contacted annually for self-report measures of weight, eating disorder severity and clinical impairment. Outcome was defined by illness course (body mass index (BMI) and clinical impairment during the 5 years) and health maintenance (categories of weight and eating disorder symptom severity) across follow-up, using all available data. Linear mixed models were used to examine whether demographic and clinical parameters at discharge predicted BMI and clinical impairment over time. Additional analyses examined whether these variables significantly influenced an individual’s likelihood of maintaining inpatient treatment gains. Results One-hundred and sixty-eight individuals contributed data. Higher trait anxiety at discharge was associated with a lower BMI during follow-up (p = 0.012). There was a significant interaction between duration of illness and time, whereby duration of illness was associated with a faster rate of weight loss (p = 0.003) during follow-up. As duration of illness increased, there was a greater increase in self-reported clinical impairment (p = 0.011). Increased eating disorder severity at discharge was also associated with greater clinical impairment at follow-up (p = 0.004). Higher BMI at discharge was significantly associated with maintaining healthy weight across a priori BMI-based definitions of health maintenance. Conclusions Weight status (higher BMI) and duration of illness are key factors in the prognosis of AN. Higher weight targets in intensive treatments may be of value in improving outcomes.

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Weight suppression and weight maintenance following treatment of anorexia nervosa

Cited by 9 publications

References 23 publications

BMI at Discharge from Treatment Predicts Relapse in Anorexia Nervosa: A Systematic Scoping Review

BMI at Discharge from Treatment Predicts Relapse in Anorexia Nervosa: A Systematic Scoping Review

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

Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa

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