Weight Suppression in Eating Disorders: a Research and Conceptual Update

Abstract

Studies were reviewed under the categories of anorexia nervosa, bulimia nervosa, and mixed or miscellaneous samples, with more studies falling into the last category than in the first two. Recent findings have continued to show that weight suppression is related to a wide variety of biological and behavioral features in both diagnosed and sub-clinical samples. Weight suppression promotes weight gain which is anathema to individuals with eating disorders, putting them in a biobehavioral bind that appears to prolong their disorder. Priorities for future research are to understand the mechanisms underlying the effects of weight suppression, evaluate new ways of defining weight suppression, and study its implications for modifying treatment.

The independent and interacting effects of weight suppression and admission body mass index on treatment weight change in patients with anorexia nervosa or bulimia nervosa

“…Individuals with BN also typically lose significant amounts of weight during the course of illness (Herzog & Eddy, ; Shaw et al, ) and, similar to individuals with AN, evince varying levels of WS. Prior research has found average WS levels ranging from 15 to 35 lb for patients with AN or BN (Lowe, Piers, & Benson, ), significantly higher than the average WS levels of nonclinical samples (Stice, Durant, Burger, & Schoeller, ).…”

“…The degree of WS varies between and within diagnostic groups (see Lowe et al, for review), and has been implicated in a number of important cognitive and behavioral findings in patients with eating disorders (EDs) such as body dissatisfaction (Zanetti, Santonastaso, Sgaravatti, Degortes, & Favaro, ), binge‐eating frequency (Butryn, Juarascio, & Lowe, ), and global ED symptom severity (Bodell & Keel, ). One of the most consistent findings is that WS, controlling for initial body mass index (BMI), predicts future weight gain (Herzog et al, ; Lowe, Davis, Lucks, Annunziato, & Butryn, ; Witt et al, ), showing that WS influences biological variables as well.…”

Weight suppression and weight maintenance following treatment of anorexia nervosa

“…The last decade has witnessed increased interest in understanding the impact of weight suppression (WS: the difference between highest adult weight and current weight) (Bodell, Racine, & Wildes, 2016; Lowe, Piers, & Benson, 2018) on the severity and course of illness of eating disorders. Much of the recent work has focused on bulimia nervosa, and suggests that greater WS is associated with increased psychological symptoms, increased frequencies of binge eating and purging, and increased weight gain during treatment (Gorrell, Reilly, Schaumberg, Anderson, & Donahue, 2019; Lowe et al, 2018).…”

Why is premorbid BMI consistently elevated in clinical samples, but not in risk factor samples, of individuals with eating disorders?

“…Higher weight suppression consistently predicts greater weight gain in the future (which likely intensifies efforts to counteract it) and lengthier disorders (Lowe, Piers, & Benson, 2018). One reason for this is that the higher an individual's premorbid weight, the more weight she will have to lose to reach her ideal body weight.…”

“…Furthermore, holding other factors constant, eating disorderprone individuals with higher premorbid BMIs will be more weight suppressed when their disorder develops. Higher weight suppression consistently predicts greater weight gain in the future (which likely intensifies efforts to counteract it) and lengthier disorders (Lowe, Piers, & Benson, 2018). This proposed chain of events (i.e., higher premorbid BMIs lead to greater weight losses, to greater efforts to prevent weight regain and to longer or more severe disorders) could be tested in future research.…”