Skip to main content
Top
Published in: BMC Psychiatry 1/2016

Open Access 01-12-2016 | Research article

Influence of premorbid BMI on clinical characteristics at presentation of adolescent girls with eating disorders

Author: Ingemar Swenne

Published in: BMC Psychiatry | Issue 1/2016

Login to get access

Abstract

Background

Considering the prevalence of obesity in society it can be expected that some adolescents with an eating disorder (ED) start weight loss from an overweight and present at a near-normal weight. Presently, the influence of premorbid BMI on clinical characteristics of adolescent girls presenting with an ED has ben studied.

Method

Premorbid growth charts were available for 275 postmenarcheal adolescent girls presenting with an ED (anorexia nervosa = 27, (subthreshold) bulimia nervosa = 9, restrictive EDNOS = 239). Initial assessment included measurement of weight and length, physical examination, blood sampling and administration of the Eating Disorder Examination-Questionnaire youth version (EDE-Q).

Results

Despite greater weight loss girls with a high premorbid body mass index (BMI) had a higher BMI at presentation compared to those with a lower premorbid BMI. Although not underweight some presented with clinical and laboratory signs of starvation. These signs were related to not only low BMI but also to rapid and large weight loss. Their EDE-Q scores did not differ from those of girls who presented with an underweight.

Conclusion

Girls with a restrictive ED and premorbid overweight may present with a near-normal BMI. They can nevertheless be medically compromised and have eating disturbed cognitions at the level of underweight girls. They should not be regarded as having a less severe ED but merit full assessment and a start of treatment.
Literature
1.
go back to reference Neumark-Sztainer D, Wall M, Guo J, Story M, Haines J, Eisenberg M. Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: How do dieters fare 5 years later? J Am Diet Ass. 2006;106:559–68.CrossRef Neumark-Sztainer D, Wall M, Guo J, Story M, Haines J, Eisenberg M. Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: How do dieters fare 5 years later? J Am Diet Ass. 2006;106:559–68.CrossRef
2.
go back to reference Neumark-Sztainer D, Wall M, Story M, Standish AR. Dieting and unhealthy weight control behaviors during adolescence: Associations with 10-year changes in body mass index. J Adolesc Health. 2012;50:80–6.CrossRefPubMedPubMedCentral Neumark-Sztainer D, Wall M, Story M, Standish AR. Dieting and unhealthy weight control behaviors during adolescence: Associations with 10-year changes in body mass index. J Adolesc Health. 2012;50:80–6.CrossRefPubMedPubMedCentral
3.
go back to reference Neumark-Sztainer D, Paxton SJ, Hannan PJ, Haines J, Story M. Does body dissatisfaction matter? Five-year longitudinal associations between body dissatisfaction and health behaviours in adolescent females and males. J Adolesc Health. 2006;39:244–51.CrossRefPubMed Neumark-Sztainer D, Paxton SJ, Hannan PJ, Haines J, Story M. Does body dissatisfaction matter? Five-year longitudinal associations between body dissatisfaction and health behaviours in adolescent females and males. J Adolesc Health. 2006;39:244–51.CrossRefPubMed
4.
go back to reference Villarejo C, Fernández-Aranda F, Jiménez-Murcia S, Penas-Lledo E, Granero R, Penelo E, Tinahones FJ, Sancho C, Vilarrasa N, Montserrat-Gil de Bernabé M, Casanueva FF, Fernández-Real JM, Frühbeck G, De la Torre R, Treasure J, Botella C, Menchón JM. Lifetime obesity in patients with eating disorders: Increasing prevalence, clinical and personality correlates. Eur Eat Disord Rev. 2012;20:250–4.CrossRefPubMedPubMedCentral Villarejo C, Fernández-Aranda F, Jiménez-Murcia S, Penas-Lledo E, Granero R, Penelo E, Tinahones FJ, Sancho C, Vilarrasa N, Montserrat-Gil de Bernabé M, Casanueva FF, Fernández-Real JM, Frühbeck G, De la Torre R, Treasure J, Botella C, Menchón JM. Lifetime obesity in patients with eating disorders: Increasing prevalence, clinical and personality correlates. Eur Eat Disord Rev. 2012;20:250–4.CrossRefPubMedPubMedCentral
5.
go back to reference Crisp AH, Hsu LKG, Harding B, Hartshorn J. Clinical features of anorexia nervosa. A study of a consecutive series of 102 female patients. J Psychosom Res. 1980;24:179–91.CrossRefPubMed Crisp AH, Hsu LKG, Harding B, Hartshorn J. Clinical features of anorexia nervosa. A study of a consecutive series of 102 female patients. J Psychosom Res. 1980;24:179–91.CrossRefPubMed
6.
go back to reference Swenne I. Changes in body weight and body mass index (BMI) in teenage girls prior to the onset and diagnosis of an eating disorder. Acta Paediatr. 2001;90:677–81.CrossRefPubMed Swenne I. Changes in body weight and body mass index (BMI) in teenage girls prior to the onset and diagnosis of an eating disorder. Acta Paediatr. 2001;90:677–81.CrossRefPubMed
7.
go back to reference Coners H, Remschmidt H, Hebebrand J. The relationship between premorbid body weight, weight loss, and weight at referral in adolescent patients with anorexia nervosa. Int J Eat Disord. 1999;26:171–8.CrossRefPubMed Coners H, Remschmidt H, Hebebrand J. The relationship between premorbid body weight, weight loss, and weight at referral in adolescent patients with anorexia nervosa. Int J Eat Disord. 1999;26:171–8.CrossRefPubMed
8.
go back to reference Sim LA, Lebow J, Bilings M. Eating disorders in adolescents with a history of obesity. Pediatrics. 2013;132:e106–30.CrossRef Sim LA, Lebow J, Bilings M. Eating disorders in adolescents with a history of obesity. Pediatrics. 2013;132:e106–30.CrossRef
9.
go back to reference Lebow J, Sim LA, Kransdorf LN. Prevalence of a history of overweight and obesity in adolescents with restrictive eating disorders. J Adolesc Health. 2015;56:19–24.CrossRefPubMed Lebow J, Sim LA, Kransdorf LN. Prevalence of a history of overweight and obesity in adolescents with restrictive eating disorders. J Adolesc Health. 2015;56:19–24.CrossRefPubMed
10.
go back to reference Föcker M, Bühren K, Timmesfeld N, Dempfle A, Knoll S, Schwarte R, Egberts KM, Pfeiffer E, Fleischhaker C, Wewetzer C, Hebebrand J, Herpertz-Dahlman B. The relationship between premorbid body weight and weight at referral, at discharge and at 1-year follow-up in anorexia nervosa. Eur Child Adolesc Psychiatr. 2015;24:537–44.CrossRef Föcker M, Bühren K, Timmesfeld N, Dempfle A, Knoll S, Schwarte R, Egberts KM, Pfeiffer E, Fleischhaker C, Wewetzer C, Hebebrand J, Herpertz-Dahlman B. The relationship between premorbid body weight and weight at referral, at discharge and at 1-year follow-up in anorexia nervosa. Eur Child Adolesc Psychiatr. 2015;24:537–44.CrossRef
11.
go back to reference Cotrufo P, Gnisci A, Caputo I. Brief report: Psychological characteristics of less severe forms of eating disorders: an epidemiological study among 259 female adolescents. J Adolesc. 2005;28:147–54.CrossRefPubMed Cotrufo P, Gnisci A, Caputo I. Brief report: Psychological characteristics of less severe forms of eating disorders: an epidemiological study among 259 female adolescents. J Adolesc. 2005;28:147–54.CrossRefPubMed
12.
go back to reference Eddy KT, Doyle AC, Hoste RR, Herzog DB, Le Grange D. Eating disorders not otherwise specified in adolescents. J Am Acad Child Adolesc Psychiatr. 2008;47:156–64.CrossRef Eddy KT, Doyle AC, Hoste RR, Herzog DB, Le Grange D. Eating disorders not otherwise specified in adolescents. J Am Acad Child Adolesc Psychiatr. 2008;47:156–64.CrossRef
13.
go back to reference Lowe MR. The effects of dieting on eating behavior: A three-factor model. Psychol Bull. 1993;114:100–21.CrossRefPubMed Lowe MR. The effects of dieting on eating behavior: A three-factor model. Psychol Bull. 1993;114:100–21.CrossRefPubMed
14.
go back to reference Berner LA, Shaw JA, Witt AA, Lowe MR. The relation of weight suppression and body mass index to symptomatology and treatment response in anorexia nervosa. J Abnormal Psychol. 2013;122:694–708.CrossRef Berner LA, Shaw JA, Witt AA, Lowe MR. The relation of weight suppression and body mass index to symptomatology and treatment response in anorexia nervosa. J Abnormal Psychol. 2013;122:694–708.CrossRef
15.
go back to reference Witt AA, Berkowitz SA, Gillberg C, Lowe MR, Råstam M, Wentz E. Weight suppression and body mass index interact to predict long-term weight outcomes in adolescent-onset anorexia nervosa. J Consult Clin Psychol. 2014;82:1207–11.CrossRefPubMed Witt AA, Berkowitz SA, Gillberg C, Lowe MR, Råstam M, Wentz E. Weight suppression and body mass index interact to predict long-term weight outcomes in adolescent-onset anorexia nervosa. J Consult Clin Psychol. 2014;82:1207–11.CrossRefPubMed
16.
17.
go back to reference Whitelaw M, Gilbertson H, Lee KJ, Sawyer SM. Restrictive eating disorders among adolescent inpatients. Pediatrics. 2014;134:e758–64.CrossRefPubMed Whitelaw M, Gilbertson H, Lee KJ, Sawyer SM. Restrictive eating disorders among adolescent inpatients. Pediatrics. 2014;134:e758–64.CrossRefPubMed
18.
go back to reference Swenne I, Thurfjell B. Clinical onset and diagnosis of eating disorders in premenarcheal girls is preceded by inadequate weight gain and growth retardation. Acta Paediatr. 2003;92:1133–7.CrossRefPubMed Swenne I, Thurfjell B. Clinical onset and diagnosis of eating disorders in premenarcheal girls is preceded by inadequate weight gain and growth retardation. Acta Paediatr. 2003;92:1133–7.CrossRefPubMed
19.
go back to reference Månsson J, Parling T, Swenne I. Favorable effect of clearly defined interventions by parents at the start of treatment of adolescents with restrictive eating disorders. Int J Eat Disord. 2015. doi:10.1002/eat.22379.PubMed Månsson J, Parling T, Swenne I. Favorable effect of clearly defined interventions by parents at the start of treatment of adolescents with restrictive eating disorders. Int J Eat Disord. 2015. doi:10.​1002/​eat.​22379.PubMed
20.
go back to reference Lindgren G, Strandell A, Cole T, Healy M, Tanner J. Swedish population standards for height, weight and body mass index attained at 6 to 16 years (girls) or 19 years (boys). Acta Paediatr. 1995;84:1019–28.CrossRefPubMed Lindgren G, Strandell A, Cole T, Healy M, Tanner J. Swedish population standards for height, weight and body mass index attained at 6 to 16 years (girls) or 19 years (boys). Acta Paediatr. 1995;84:1019–28.CrossRefPubMed
21.
go back to reference Carter JC, Stewart DA, Fairburn C. Eating disorders examination questionnaire: norms for young adolescent girls. Behaviour Res Ther. 2001;39:625–32.CrossRef Carter JC, Stewart DA, Fairburn C. Eating disorders examination questionnaire: norms for young adolescent girls. Behaviour Res Ther. 2001;39:625–32.CrossRef
22.
go back to reference Svanborg P, Åsberg M. A new self-rating scale for depression and anxiety based on the Comprehensive Psychopathology Rating Scale. Acta Psychiatr Scand. 1994;89:21–8.CrossRefPubMed Svanborg P, Åsberg M. A new self-rating scale for depression and anxiety based on the Comprehensive Psychopathology Rating Scale. Acta Psychiatr Scand. 1994;89:21–8.CrossRefPubMed
23.
go back to reference Svanborg P, Åsberg M. A comparison between the Beck depression rating inventory (BDI) and the self-rating version of the Montgomery-Åsberg depression rating scale (MADRS). J Affect Disord. 2001;64:203–16.CrossRefPubMed Svanborg P, Åsberg M. A comparison between the Beck depression rating inventory (BDI) and the self-rating version of the Montgomery-Åsberg depression rating scale (MADRS). J Affect Disord. 2001;64:203–16.CrossRefPubMed
24.
go back to reference Swenne I, Engström I. Medical assessment of adolescent girls with eating disorders: An evaluation of symptoms and signs of starvation. Acta Paediatr. 2005;94:1363–71.CrossRefPubMed Swenne I, Engström I. Medical assessment of adolescent girls with eating disorders: An evaluation of symptoms and signs of starvation. Acta Paediatr. 2005;94:1363–71.CrossRefPubMed
25.
go back to reference Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, Garber AK, Kohn M, Kreipe RE. Position paper of the Society for Adolescent Health and Medicine: Medical management of restrictive eating disorders in adolescents and young adults. J Adolesc Health. 2015;56:121–5.CrossRefPubMed Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, Garber AK, Kohn M, Kreipe RE. Position paper of the Society for Adolescent Health and Medicine: Medical management of restrictive eating disorders in adolescents and young adults. J Adolesc Health. 2015;56:121–5.CrossRefPubMed
26.
go back to reference Swenne I, Larsson PT. Heart risk associated with weight loss in anorexia nervosa and eating disorders: risk factors for QTc interval prolongation and dispersion. Acta Paediatr. 1999;88:304–9.CrossRefPubMed Swenne I, Larsson PT. Heart risk associated with weight loss in anorexia nervosa and eating disorders: risk factors for QTc interval prolongation and dispersion. Acta Paediatr. 1999;88:304–9.CrossRefPubMed
27.
go back to reference Swenne I, Stridsberg M, Thurfjell B, Rosling A. Insulin-like growth factor-1 as an indicator of nutrition during treatment of adolescent girls with eating disorders. Acta Paediatr. 2007;96:1203–8.CrossRefPubMed Swenne I, Stridsberg M, Thurfjell B, Rosling A. Insulin-like growth factor-1 as an indicator of nutrition during treatment of adolescent girls with eating disorders. Acta Paediatr. 2007;96:1203–8.CrossRefPubMed
28.
go back to reference Swenne I, Stridsberg M, Thurfjell B, Rosling A. Triiodothyronine is an indicator of nutritional status in adolescent girls with eating disorders. Horm Res. 2009;71:268–75.CrossRefPubMed Swenne I, Stridsberg M, Thurfjell B, Rosling A. Triiodothyronine is an indicator of nutritional status in adolescent girls with eating disorders. Horm Res. 2009;71:268–75.CrossRefPubMed
29.
go back to reference Estour B, Germain N, Diconne E, Frere D, Cottet-Emard J-M, Carrot G, Lang F, Galusca B. Hormonal profile heterogeneity and short-term risk in restrictive anorexia nervosa. J Clin Endocrinol Metab. 2010;95:2203–10.CrossRefPubMed Estour B, Germain N, Diconne E, Frere D, Cottet-Emard J-M, Carrot G, Lang F, Galusca B. Hormonal profile heterogeneity and short-term risk in restrictive anorexia nervosa. J Clin Endocrinol Metab. 2010;95:2203–10.CrossRefPubMed
30.
go back to reference Swenne I. Weight requirements for return of menstruations in teenage girls with eating disorders, weight loss and amenorrhea. Acta Paediatr. 2004;93:1449–55.CrossRefPubMed Swenne I. Weight requirements for return of menstruations in teenage girls with eating disorders, weight loss and amenorrhea. Acta Paediatr. 2004;93:1449–55.CrossRefPubMed
31.
go back to reference Sours HE, Frattali VP, Brand CD, Feldman RA, Forbes AL, Swanson RC, Paris AL. Sudden death associated with very low calorie weight reduction regimens. Am J Clin Nutr. 1981;34:453–61.PubMed Sours HE, Frattali VP, Brand CD, Feldman RA, Forbes AL, Swanson RC, Paris AL. Sudden death associated with very low calorie weight reduction regimens. Am J Clin Nutr. 1981;34:453–61.PubMed
32.
go back to reference Isner JM, Roberts WC, Heymsfield SB, Yager J. Anorexia nervosa and sudden death. Ann Int Med. 1985;102:49–52.CrossRefPubMed Isner JM, Roberts WC, Heymsfield SB, Yager J. Anorexia nervosa and sudden death. Ann Int Med. 1985;102:49–52.CrossRefPubMed
33.
go back to reference Loth K, Wall M, Larson N, Neumark-Sztainer D. Disordered eating and psychological well-being in overweight and nonoverweight adolescents: Secular trends from 1999 to 2010. Int J Eat Disord. 2015;48:323–7.CrossRefPubMed Loth K, Wall M, Larson N, Neumark-Sztainer D. Disordered eating and psychological well-being in overweight and nonoverweight adolescents: Secular trends from 1999 to 2010. Int J Eat Disord. 2015;48:323–7.CrossRefPubMed
34.
go back to reference Wolk SL, Loeb KL, Walsh B. Assessment of patients with anorexia nervosa: Interview versus self report. Int J Eat Disord. 2005;37:92–9.CrossRefPubMed Wolk SL, Loeb KL, Walsh B. Assessment of patients with anorexia nervosa: Interview versus self report. Int J Eat Disord. 2005;37:92–9.CrossRefPubMed
35.
go back to reference Flament MF, Henderson K, Buchholz A, Obeid N, Nguyen HNT, Birmingham M, Goldfield G. Weight status and DSM-5 diagnoses of eating disorders in adolescents from the community. J Am Acad Child Adolesc Psychiatr. 2015;54:403–11.CrossRef Flament MF, Henderson K, Buchholz A, Obeid N, Nguyen HNT, Birmingham M, Goldfield G. Weight status and DSM-5 diagnoses of eating disorders in adolescents from the community. J Am Acad Child Adolesc Psychiatr. 2015;54:403–11.CrossRef
Metadata
Title
Influence of premorbid BMI on clinical characteristics at presentation of adolescent girls with eating disorders
Author
Ingemar Swenne
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2016
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/s12888-016-0788-7

Other articles of this Issue 1/2016

BMC Psychiatry 1/2016 Go to the issue