Premorbid body weight predicts weight loss in both anorexia nervosa and atypical anorexia nervosa: Further support for a single underlying disorder

Johannes Hebebrand^{1

2}, Jochen Seitz^{1

2

3}, Manuel Föcker^{4

5}, Hanna Preuss-van Viersen⁶, Michael Huss⁶, Katharina Bühren⁷, Brigitte Dahmen³, Katja Becker^{8

9}, Linda Weber⁸, Christoph U Correll^{10

11

12}, Charlotte Jaite¹⁰, Karin Egberts¹³, Marcel Romanos¹³, Stefan Ehrlich^{14

15}, Maria Seidel¹⁴, Veit Roessner¹⁵, Christian Fleischhaker¹⁶, Eva Möhler¹⁷, Freia Hahn¹⁸, Michael Kaess^{19

20}, Tanja Legenbauer⁵, Daniela Hagmann²¹, Tobias J Renner²¹, Ulrike M E Schulze²², Ulf Thiemann²³, Ida Wessing⁴, Gisela Antony²⁴, Beate Herpertz-Dahlmann³, Abigail Matthews²⁵, Triinu Peters^{1

2}

Affiliations

¹ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany.
² Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
³ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Aachen, Germany.
⁴ Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany.
⁵ LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Ruhr University-Bochum, Hamm, Germany.
⁶ Department of Child and Adolescent Psychiatry, University Medicine Mainz, Johannes Gutenberg-University, Mainz, Germany.
⁷ kbo-Heckscher Klinikum for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Academic Teaching Hospital, Ludwig Maximilian University, Munich, Germany.
⁸ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Philipps-University and University Hospital Marburg, Marburg, Germany.
⁹ Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany.
¹⁰ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
¹¹ Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA.
¹² The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, New York, USA.
¹³ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Centre for Mental Health, University Hospital Würzburg, Würzburg, Germany.
¹⁴ Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Germany.
¹⁵ Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany.
¹⁶ Department of Child and Adolescent Psychiatry and Psychotherapy, University Freiburg, Germany.
¹⁷ Department of Child and Adolescent Psychiatry, Saarland University, Homburg, Germany.
¹⁸ Department of Child & Adolescent Psychiatry and Psychotherapy, LVR-Klinik Viersen, Viersen, Germany.
¹⁹ University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
²⁰ Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
²¹ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Tübingen, Tübingen, Germany.
²² Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Germany.
²³ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR Hospital Bonn, Bonn, Germany.
²⁴ Central Information Office, CIO Marburg GmbH, Fronhausen, Germany.
²⁵ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.

PMID: 38528714
DOI: 10.1002/eat.24189

Free article

Premorbid body weight predicts weight loss in both anorexia nervosa and atypical anorexia nervosa: Further support for a single underlying disorder

Johannes Hebebrand et al. Int J Eat Disord. 2024 Apr.

Free article

. 2024 Apr;57(4):967-982.

doi: 10.1002/eat.24189. Epub 2024 Mar 25.

Authors

Affiliations

¹ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen (AöR), University of Duisburg-Essen, Essen, Germany.
² Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
³ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, RWTH Aachen, Aachen, Germany.
⁴ Department of Child and Adolescent Psychiatry, University Hospital Münster, Münster, Germany.
⁵ LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Ruhr University-Bochum, Hamm, Germany.
⁶ Department of Child and Adolescent Psychiatry, University Medicine Mainz, Johannes Gutenberg-University, Mainz, Germany.
⁷ kbo-Heckscher Klinikum for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Academic Teaching Hospital, Ludwig Maximilian University, Munich, Germany.
⁸ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Faculty of Medicine, Philipps-University and University Hospital Marburg, Marburg, Germany.
⁹ Center for Mind, Brain and Behavior (CMBB), University of Marburg and Justus Liebig University Giessen, Germany.
¹⁰ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
¹¹ Zucker School of Medicine at Hofstra/Northwell, Department of Psychiatry and Molecular Medicine, Hempstead, New York, USA.
¹² The Zucker Hillside Hospital, Department of Psychiatry, Northwell Health, Glen Oaks, New York, USA.
¹³ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Centre for Mental Health, University Hospital Würzburg, Würzburg, Germany.
¹⁴ Translational Developmental Neuroscience Section, Division of Psychological and Social Medicine and Developmental Neurosciences, Faculty of Medicine, TU Dresden, Germany.
¹⁵ Eating Disorder Research and Treatment Center, Department of Child and Adolescent Psychiatry, Faculty of Medicine, TU Dresden, Dresden, Germany.
¹⁶ Department of Child and Adolescent Psychiatry and Psychotherapy, University Freiburg, Germany.
¹⁷ Department of Child and Adolescent Psychiatry, Saarland University, Homburg, Germany.
¹⁸ Department of Child & Adolescent Psychiatry and Psychotherapy, LVR-Klinik Viersen, Viersen, Germany.
¹⁹ University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
²⁰ Clinic of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
²¹ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Tübingen, Tübingen, Germany.
²² Department of Child and Adolescent Psychiatry/Psychotherapy, University Hospital Ulm, University of Ulm, Germany.
²³ Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, LVR Hospital Bonn, Bonn, Germany.
²⁴ Central Information Office, CIO Marburg GmbH, Fronhausen, Germany.
²⁵ Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA.

PMID: 38528714
DOI: 10.1002/eat.24189

Abstract

Objective: For adolescents, DSM-5 differentiates anorexia nervosa (AN) and atypical AN with the 5th BMI-centile-for-age. We hypothesized that the diagnostic weight cut-off yields (i) lower weight loss in atypical AN and (ii) discrepant premorbid BMI distributions between the two disorders. Prior studies demonstrate that premorbid BMI predicts admission BMI and weight loss in patients with AN. We explore these relationships in atypical AN.

Method: Based on admission BMI-centile < or ≥5th, participants included 411 female adolescent inpatients with AN and 49 with atypical AN from our registry study. Regression analysis and t-tests statistically addressed our hypotheses and exploratory correlation analyses compared interrelationships between weight loss, admission BMI, and premorbid BMI in both disorders.

Results: Weight loss in atypical AN was 5.6 kg lower than in AN upon adjustment for admission age, admission height, premorbid weight and duration of illness. Premorbid BMI-standard deviation scores differed by almost one between both disorders. Premorbid BMI and weight loss were strongly correlated in both AN and atypical AN.

Discussion: Whereas the weight cut-off induces discrepancies in premorbid weight and adjusted weight loss, AN and atypical AN overall share strong weight-specific interrelationships that merit etiological consideration. Epidemiological and genetic associations between AN and low body weight may reflect a skewed premorbid BMI distribution. In combination with prior findings for similar psychological and medical characteristics in AN and atypical AN, our findings support a homogenous illness conceptualization. We propose that diagnostic subcategorization based on premorbid BMI, rather than admission BMI, may improve clinical validity.

Public significance: Because body weights of patients with AN must drop below the 5th BMI-centile per DSM-5, they will inherently require greater weight loss than their counterparts with atypical AN of the same sex, age, height and premorbid weight. Indeed, patients with atypical AN had a 5.6 kg lower weight loss after controlling for these variables. In comparison to the reference population, we found a lower and higher mean premorbid weight in patients with AN and atypical AN, respectively. Considering previous psychological and medical comparisons showing little differences between AN and atypical AN, we view a single disorder as the most parsimonious explanation. Etiological models need to particularly account for the strong relationship between weight loss and premorbid body weight.

Keywords: 5th BMI‐for‐age centile; admission weight; diagnostic classification; premorbid weight; starvation; weight criterion; weight loss.

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References

REFERENCES

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Premorbid body weight predicts weight loss in both anorexia nervosa and atypical anorexia nervosa: Further support for a single underlying disorder

Affiliations

Premorbid body weight predicts weight loss in both anorexia nervosa and atypical anorexia nervosa: Further support for a single underlying disorder

Authors

Affiliations

Abstract

References

REFERENCES

MeSH terms

LinkOut - more resources

Full Text Sources