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. 2021 Aug;54(8):1328-1357.
doi: 10.1002/eat.23519. Epub 2021 Apr 17.

Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature

Erin N Harrop  1   2 , Janell L Mensinger  3 , Megan Moore  2 , Taryn Lindhorst  2
Affiliations

Restrictive eating disorders in higher weight persons: A systematic review of atypical anorexia nervosa prevalence and consecutive admission literature

Erin N Harrop et al. Int J Eat Disord. 2021 Aug.

Abstract
in English, Spanish

Objective: Currently, there is debate in the eating disorders field regarding how to define atypical anorexia (AAN), how prevalent it is in community and clinical settings, and how AAN rates compare with low-weight AN. This systematic review assesses AAN literature from 2007 to 2020, to investigate: (a) the demographic characteristics of AAN studies, (b) the prevalence of AAN compared with AN, (c) the range of operational definitions of AAN and the implications of these definitions, and (d) the proportion of patients with AAN and AN represented in consecutive admission and referral samples.

Method: PsychINFO, CINAHL, PubMed, Greylit.org, and ProQuest databases were searched according to methods for Preferred Reporting Items for Systematic Reviews and Meta-Analyses systematic reviews, yielding 3,184 potential articles. Seventy-five eligible studies were coded for sixty-one variables.

Results: Clinical samples predominantly included younger, female, white samples with limited diversity. In epidemiological designs, AAN was typically as common or more common than AN, and AAN rates varied significantly based on the population studied and operational definitions. In consecutive clinical samples, AAN was frequently less represented.

Discussion: Although AAN appears to occur more frequently than AN in communities, fewer patients with AAN are being referred and admitted to eating disorder specific care, particularly in the United States. Given the significant medical and psychosocial consequences of AAN, and the importance of early intervention, this represents a crucial treatment gap. Additionally, results suggest the need for fine-tuning diagnostic definitions, greater diversity in AAN studies, and increased screening and referral for this vulnerable population.

Objetivo: Actualmente, hay debate en el campo de los trastornos alimenticios sobre cómo definir la anorexia atípica (ANA), cuán prevalente es en entornos comunitarios y clínicos, y cómo las tasas de ANA se comparan con AN de bajo peso. Esta revisión sistemática evalúa la literatura de ANA de 2007 a 2020, para investigar: 1) las características demográficas de los estudios de ANA, 2) la prevalencia de ANA en comparación con AN, 3) el rango de definiciones operativas de ANA y las implicaciones de estas definiciones, y 4) la proporción de pacientes con ANA y AN representados en muestras consecutivas de admisión y derivación. MÉTODO: Las bases de datos de PsychINFO, CINAHL, PubMed, Greylit.orgy y ProQuest fueron buscados de acuerdo con los métodos preferidos para el reporte de ítems para Revisiones Sistemáticas y Metanálisis de Revisiones Sistemáticas, dando lugar a 3184 artículos potenciales. Setenta y cinco estudios elegibles fueron codificados para 61 variables.

Resultados: Las muestras clínicas incluían predominantemente muestras de femeninas, más jóvenes, y blancas con diversidad limitada. En los diseños epidemiológicos, la ANA era típicamente tan común o más común que AN, y las tasas de ANA variaban significativamente en función de la población estudiada y las definiciones operacionales. En muestras clínicas consecutivas, la ANA fue frecuentemente menos representada. DISCUSIÓN: Aunque ANA parece ocurrir con más frecuencia que AN en las comunidades, menos pacientes con ANA están siendo referidos y admitidos a la atención específica del trastorno alimentario, particularmente en los Estados Unidos. Dadas las importantes consecuencias médicas y psicosociales de ANA, y la importancia de la intervención temprana, esto representa una brecha de tratamiento crucial. Además, los resultados sugieren la necesidad de ajustar las definiciones diagnósticas, una mayor diversidad en los estudios de ANA y un mayor cribado y referencia a tratamiento para esta población vulnerable.

Keywords: atypical anorexia nervosa; eating disorder not otherwise specified; higher weight eating disorder; other specified feeding and eating disorder; prevalence.

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Conflict of interest statement

CONFLICT OF INTEREST

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow chart. AAN, atypical anorexia nervosa; AN, anorexia nervosa; ARFID, avoidant/restrictive food intake disorder; BED, binge-eating disorder; BMI, body mass index; BN, bulimia nervosa; EDNOS, eating disorder not otherwise specified; OSFED, other specified feeding or eating disorder; PRISMA, Preferred Reported Items for Systematic Reviews and Meta-Analyses
FIGURE 2
FIGURE 2
Forest plot of female point prevalence rates of AN and AAN with 95% confidence intervals. Black: prevalence rates of AAN. Orange: prevalence rates of AN. AAN, atypical anorexia nervosa; AN, anorexia nervosa
FIGURE 3
FIGURE 3
Forest plot of female lifetime prevalence rates of AN and AAN with 95% confidence intervals. Black: prevalence rates of AAN. Orange: prevalence rates of AN. AAN, atypical anorexia nervosa; AN, anorexia nervosa
See this image and copyright information in PMC

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