Weight suppression as a predictor variable in the treatment of eating disorders: A systematic review

Abstract

WHAT IS KNOWN ON THE SUBJECT?: Weight suppression (WS) has been suggested to predict outcome following psychological treatment for an eating disorder (ED). Some findings are contradictory and have not been considered systematically. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The review suggests that weight gain at post-treatment is reliably predicted by pretreatment WS, but findings regarding other outcomes (e.g., treatment dropout) are less consistent. Approximate effect sizes for observed relationships are identified, alongside support for biobehavioural theories of metabolic adaptation to weight loss. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Degree of WS at pretreatment is associated with weight gain and is important for clinicians to consider before offering treatment to patients with EDs. Patients high in WS might benefit from further support (e.g., psychoeducation) prior to beginning treatment. ABSTRACT: Introduction Weight suppression (WS-the difference between highest body weight and current body weight) has been proposed as a predictor of treatment outcome within eating disorders (EDs), although this hypothesis has not been consistently supported. Aim/Question Review the association between pretreatment WS and outcome following psychological treatment for EDs. Method A comprehensive electronic database search for published and unpublished literature from 1979 to 2017. Reference lists were also inspected. Eligibility criteria were determined according to relevant guidelines and a quality appraisal was conducted. Results Twelve studies met inclusion criteria (one was subsequently excluded based on insufficient data). Greater WS was generally associated with weight gain at post-treatment although not with other treatment outcomes. Discussion The existing evidence, with data from 1,566 participants, is summarized according to three main post-treatment outcomes: weight change; treatment completion; and symptom abstinence. Patients with disordered eating and greater WS may need to gain more weight than others during treatment to achieve good outcomes. Recommendations for future studies are provided. Implications for practice Evidence-based treatments for EDs may benefit from considering WS when planning treatment, such as further psychoeducation on weight changes. Societal interventions regarding promotion of healthy eating may also draw on these findings.

Weight suppression and its relation to eating disorder and weight outcomes: a narrative review

“…The majority of research on WS has evaluated its association with ED symptoms. A recent systematic review, which focused on the role of WS as a predictor of treatment outcome in EDs, determined that WS was associated with weight gain following treatment, but not with other treatment outcomes (e.g., treatment completion; symptom abstinence) (Jenkins et al, 2018). A more detailed investigation of the existing literature is warranted, as the hypothesis that WS impacts treatment outcome is not consistently supported.…”

“…Interest in WS and its links to eating pathology has burgeoned over the past decade, under the proposition that maintaining a relatively low weight for one’s body will create metabolic and psychological resistance and pressure to return to a higher weight. Reflecting increased interest in WS in eating disorder (ED) and weight management research, along with a growing emphasis on metabolic and biological mechanisms underlying the development of eating pathology and obesity, recent reviews of WS have been published that examined the predicted outcome of psychological treatment for ED (e.g., Jenkins, Lebow, & Rienecke, 2018). However, no reviews to date have provided a more extensive examination of WS, across a wide range of individuals with and without eating and weight disorders.…”

Examining the placement of atypical anorexia nervosa in the eating disorder diagnostic hierarchy relative to bulimia nervosa and binge‐eating disorder

“…Weight suppression is correlated with eating disorder severity and/or illness duration within eating disorder populations (Bodell & Keel, 2015;Gorrell et al, 2019;Hagan et al, 2017;Keel et al, 2017;Lowe et al, 2018). Greater weight suppression prospectively predicts a longer illness course and worse treatment outcomes within BN (Keel & Heatherton, 2010;Lowe et al, 2011), although these findings are not always consistent (Dawkins et al, 2013;Jenkins et al, 2018;Zunker et al, 2011) Historically, distinguishing between AN "restricting" and "bingepurge" subtypes has had clinical utility (Peat et al, 2009), and the current DMS-5 criteria, in effect, distinguishes between atypical AN "restricting" and atypical AN "binge-purge" through the BN diagnosis.…”

Lifetime Weight Course as a Phenotypic Marker of Severity and Therapeutic Response in Patients with Eating Disorders

“…However, it is difficult to draw firm conclusions as the evidence is mixed. Some studies found no associations between WS and clinical variables [31,32], whereas others found that WS was related to more severe ED symptomatology, greater depression, poorer prognosis, and greater weight gain at post treatment [17,[33][34][35].…”