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. 2025 Jun 5;13(1):105.
doi: 10.1186/s40337-025-01301-2.

Why are so many individuals with bulimia nervosa low in weight suppression?

Sarah M Fisher  1   2 , J Ingrid Friedman  3 , Michael R Lowe  1
Affiliations

Why are so many individuals with bulimia nervosa low in weight suppression?

Sarah M Fisher et al. J Eat Disord. .

Abstract

Background: Weight suppression (WS) is associated with many problematic characteristics in individuals with bulimia nervosa (BN). It is theorized that WS contributes to eating disorder (ED) characteristics through the initiation of metabolic and appetitive responses that contribute to dysregulated food intake and weight gain. However, some individuals with BN exhibit little or no WS, and we investigated two possible explanations for this: that low-WS individuals were once weight-suppressed but regained most of the weight they previously lost, or that low-WS individuals never underwent the large weight losses that some of those with BN have shown.

Methods: Participants were 453 female patients with BN. We used mixed-model ANOVAs to compare individuals with low and high WS on four weight variables (i.e., premorbid high, postmorbid high, postmorbid low, and current z-BMI). We conducted these analyses using a new, developmentally sensitive measure called developmental weight suppression (DWS).

Results: Our results revealed strikingly different weight histories between low and high WS groups. The high WS groups displayed dramatic weight losses (and only partial weight regain), but the low WS groups demonstrated only modest weight losses and an overall pattern of weight gain over time.

Conclusions: Individuals with BN and low WS do not show the same large and rapid z-BMI losses that are characteristic of most individuals with BN; rather, they show patterns of weight gain that are more characteristic of individuals with BED. Therefore, it may not be appropriate to include individuals who never lost significant weight in studies of WS in BN, as weight suppression would not be relevant to their presentation. Thus, there may be two groups of individuals with BN: those for whom weight suppression is a maintaining factor of binge eating, and those for whom it is not.

Keywords: Bulimia nervosa; Developmental weight suppression; Weight history; Weight suppression.

Plain language summary

Weight suppression (WS), the difference between one’s highest past weight (or, for those with diagnosed eating disorders, their highest premorbid past weight) and current weight, has been found to be associated with symptom severity and treatment outcome among individuals with bulimia nervosa. It is theorized that these associations are due to metabolic and appetitive responses to being in a weight-suppressed state, yet some individuals with bulimia nervosa exhibit very low or no WS. This may be because they were once highly weight suppressed and have subsequently gained weight, or it could be that this subgroup was never significantly weight suppressed. We compared the weight histories of individuals with bulimia nervosa with low or no WS with individuals with bulimia nervosa with high WS. We found that the low WS subgroup has a dramatically different weight history than those high in WS, displaying only modest weight losses and a general pattern of weight gain over time. This suggests that the weight suppression model may not be applicable for this subgroup.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All research activities were approved (deemed exempt) by Drexel University’s institutional review board, in addition to the research department housed at the treatment center. All participants provided their informed consent prior to participating in this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
z-BMI-based weight history by age for low and high DWS groups. Note: Of those included in weight history analyses among the DWS sample (n = 368), age of symptom onset was 14.6 (SD = 4.0) for low DWS and 14.7 (SD = 4.5) for high DWS
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