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The relationship between premorbid body weight and weight at referral, at discharge and at 1-year follow-up in anorexia nervosa

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Abstract

Body mass index (BMI) is one of the most important outcome predictors in patients with anorexia nervosa (AN). A low premorbid BMI percentile calculated by the patients recalled premorbid weight and the height at first admission has been found to predict the BMI at first inpatient admission. In this study, we sought to confirm this relationship. We additionally analyze the relationship between premorbid BMI percentile and BMI percentile at discharge from the first inpatient treatment and at 1-year follow-up or alternatively if applicable upon readmission within this time period. We included 161 female patients aged 11–18 years of the multisite ANDI-trial with a DSM-IV diagnosis of AN. We used a multivariate statistical model including the independent variables age, duration of illness, duration of treatment, BMI at admission and BMI percentile at discharge. The relationship between premorbid BMI percentile and BMI at admission was solidly confirmed. In addition to premorbid BMI percentile, BMI at admission and age were significant predictors of BMI percentile at discharge. BMI percentile at discharge significantly predicted BMI percentile at 1-year follow-up. An additional analysis that merely included variables available upon referral revealed that premorbid BMI percentile predicts the 1-year follow-up BMI percentile. Further studies are required to identify the underlying biological mechanisms and to address the respective treatment strategies for AN patients with a low or high premorbid BMI percentile.

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References

  1. Bayer O, Kruger H, von Kries R, Toschke AM (2011) Factors associated with tracking of BMI: a meta-regression analysis on BMI tracking. Obesity (Silver Spring) 19:1069–1076

    Article  Google Scholar 

  2. Bradfield JP, Taal HR, Timpson NJ, Scherag A, Lecoeur C, Warrington NM, Hypponen E, Holst C, Valcarcel B, Thiering E, Salem RM, Schumacher FR, Cousminer DL, Sleiman PM, Zhao J, Berkowitz RI, Vimaleswaran KS, Jarick I, Pennell CE, Evans DM, St Pourcain B, Berry DJ, Mook-Kanamori DO, Hofman A, Rivadeneira F, Uitterlinden AG, van Duijn CM, van der Valk RJ, de Jongste JC, Postma DS, Boomsma DI, Gauderman WJ, Hassanein MT, Lindgren CM, Magi R, Boreham CA, Neville CE, Moreno LA, Elliott P, Pouta A, Hartikainen AL, Li M, Raitakari O, Lehtimaki T, Eriksson JG, Palotie A, Dallongeville J, Das S, Deloukas P, McMahon G, Ring SM, Kemp JP, Buxton JL, Blakemore AI, Bustamante M, Guxens M, Hirschhorn JN, Gillman MW, Kreiner-Moller E, Bisgaard H, Gilliland FD, Heinrich J, Wheeler E, Barroso I, O’Rahilly S, Meirhaeghe A, Sorensen TI, Power C, Palmer LJ, Hinney A, Widen E, Farooqi IS, McCarthy MI, Froguel P, Meyre D, Hebebrand J, Jarvelin MR, Jaddoe VW, Smith GD, Hakonarson H, Grant SF (2012) A genome-wide association meta-analysis identifies new childhood obesity loci. Nat Genet 44:526–531

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  3. Coners H, Remschmidt H, Hebebrand J (1999) The relationship between premorbid body weight, weight loss, and weight at referral in adolescent patients with anorexia nervosa. Int J Eat Disord 26:171–178

    Article  CAS  PubMed  Google Scholar 

  4. Dei M, Seravalli V, Bruni V, Balzi D, Pasqua A (2008) Predictors of recovery of ovarian function after weight gain in subjects with amenorrhea related to restrictive eating disorders. Gynecol Endocrinol 24:459–464

    Article  CAS  PubMed  Google Scholar 

  5. Dempfle A, Herpertz-Dahlmann B, Timmesfeld N, Schwarte R, Egberts KM, Pfeiffer E, Fleischhaker C, Wewetzer C, Buhren K (2013) Predictors of the resumption of menses in adolescent anorexia nervosa. BMC Psychiatry 13:308

    Article  PubMed Central  PubMed  Google Scholar 

  6. Favaro A, Santonastaso P (2009) Seasonality and the prediction of weight at resumption of menses in anorexia nervosa. Fertil Steril 91:1395–1397

    Article  PubMed  Google Scholar 

  7. Fuentes RM, Notkola IL, Shemeikka S, Tuomilehto J, Nissinen A (2003) Tracking of body mass index during childhood: a 15-year prospective population-based family study in eastern Finland. Int J Obes Relat Metab Disord 27:716–721

    Article  CAS  PubMed  Google Scholar 

  8. Golden NH, Jacobson MS, Schebendach J, Solanto MV, Hertz SM, Shenker IR (1997) Resumption of menses in anorexia nervosa. Arch Pediatr Adolesc Med 151:16–21

    Article  CAS  PubMed  Google Scholar 

  9. Haas L, Stargardt T, Schreyoegg J, Schlosser R, Danzer G, Klapp BF (2012) Inpatient costs and predictors of costs in the psychosomatic treatment of anorexia nervosa. Int J Eat Disord 45:214–221

    Article  PubMed  Google Scholar 

  10. Hebebrand J, Herpertz-Dahlmann B (2009) Psychological and psychiatric aspects of pediatric obesity. Child Adolesc Psychiatr Clin N Am 18:49–65

    Article  PubMed  Google Scholar 

  11. Hebebrand J, Himmelmann GW, Herzog W, Herpertz-Dahlmann BM, Steinhausen HC, Amstein M, Seidel R, Deter HC, Remschmidt H, Schafer H (1997) Prediction of low body weight at long-term follow-up in acute anorexia nervosa by low body weight at referral. Am J Psychiatry 154:566–569

    Article  CAS  PubMed  Google Scholar 

  12. Herpertz-Dahlmann B, Schwarte R, Krei M, Egberts K, Warnke A, Wewetzer C, Pfeiffer E, Fleischhaker C, Scherag A, Holtkamp K, Hagenah U, Buhren K, Konrad K, Schmidt U, Schade-Brittinger C, Timmesfeld N, Dempfle A (2014) Day-patient treatment after short inpatient care versus continued inpatient treatment in adolescents with anorexia nervosa (ANDI): a multicentre, randomised, open-label, non-inferiority trial. Lancet

  13. Herpertz S, Herpertz-Dahlmann B, Fichter MM, Tuschen-Caffier B, Zeeck A (2010) S3 Leitlinie Diagnostik und Behandlung der Essstörungen. In:

  14. Kaplan AS, Walsh BT, Olmsted M, Attia E, Carter JC, Devlin MJ, Pike KM, Woodside B, Rockert W, Roberto CA, Parides M (2009) The slippery slope: prediction of successful weight maintenance in anorexia nervosa. Psychol Med 39:1037–1045

    Article  CAS  PubMed  Google Scholar 

  15. Keski-Rahkonen A, Hoek HW, Susser ES, Linna MS, Sihvola E, Raevuori A, Bulik CM, Kaprio J, Rissanen A (2007) Epidemiology and course of anorexia nervosa in the community. Am J Psychiatry 164:1259–1265

    Article  PubMed  Google Scholar 

  16. Kromeyer-Hauschild K, Wabitsch M, Geller F, Ziegler A, Geiß H, Hesse V, Hippel V, Jaeger U, Johnsen D, Kiess W, Korte W, Kunze D, Menner K, Müller M, Niemann-Pilatus A, Remer T, Schaefer F, Wittchen H, Zabransky S, Zellner K, Hebebrand J (2001) Perzentile für den Body Mass Index für das Kindes- und Jugendalter unter Heranziehung verschiedener deutscher Stichproben. Monatschrift Kinderheilkunde 149:807–818

    Article  Google Scholar 

  17. Lock J, Agras WS, Le Grange D, Couturier J, Safer D, Bryson SW (2013) Do end of treatment assessments predict outcome at follow-up in eating disorders? Int J Eat Disord 46:771–778

    Article  PubMed  Google Scholar 

  18. Mander J, Teufel M, Keifenheim K, Zipfel S, Giel KE (2013) Stages of change, treatment outcome and therapeutic alliance in adult inpatients with chronic anorexia nervosa. BMC Psychiatry 13:111

    Article  PubMed Central  PubMed  Google Scholar 

  19. Miyasaka N, Yoshiuchi K, Yamanaka G, Sasaki T, Kumano H, Kuboki T (2003) Relations among premorbid weight, referral weight, and psychological test scores for patients with anorexia nervosa. Psychol Rep 92:67–74

    Article  PubMed  Google Scholar 

  20. Morgan HG, Hayward AE (1988) Clinical assessment of anorexia nervosa. The Morgan-Russell outcome assessment schedule. Br J Psychiatry 152:367–371

    Article  CAS  PubMed  Google Scholar 

  21. Nozoe S, Soejima Y, Yoshioka M, Naruo T, Masuda A, Nagai N, Tanaka H (1995) Clinical features of patients with anorexia nervosa: assessment of factors influencing the duration of in-patient treatment. J Psychosom Res 39:271–281

    Article  CAS  PubMed  Google Scholar 

  22. Ohlmer R, Jacobi C, Taylor CB (2013) Preventing symptom progression in women at risk for AN: results of a pilot study. Eur Eat Disord Rev 21:323–329

    Article  PubMed  Google Scholar 

  23. Preti A, Girolamo G, Vilagut G, Alonso J, Graaf R, Bruffaerts R, Demyttenaere K, Pinto-Meza A, Haro JM, Morosini P (2009) The epidemiology of eating disorders in six European countries: results of the ESEMeD-WMH project. J Psychiatr Res 43:1125–1132

    Article  PubMed  Google Scholar 

  24. R Development Core Team (2009) R: a language and environment for statistical computing. In: Computing RFfS (ed) Vienna, Austria

  25. Salbach-Andrae H, Schneider N, Seifert K, Pfeiffer E, Lenz K, Lehmkuhl U, Korte A (2009) Short-term outcome of anorexia nervosa in adolescents after inpatient treatment: a prospective study. Eur Child Adolesc Psychiatry 18:701–704

    Article  PubMed  Google Scholar 

  26. Sly R, Morgan JF, Mountford VA, Lacey JH (2013) Predicting premature termination of hospitalised treatment for anorexia nervosa: the roles of therapeutic alliance, motivation, and behaviour change. Eat Behav 14:119–123

    Article  PubMed  Google Scholar 

  27. Sly R, Mountford VA, Morgan JF, Lacey JH (2014) Premature termination of treatment for anorexia nervosa: differences between patient-initiated and staff-initiated discharge. Int J Eat Disord 47:40–46

    Article  PubMed  Google Scholar 

  28. Speliotes EK, Willer CJ, Berndt SI, Monda KL, Thorleifsson G, Jackson AU, Lango Allen H, Lindgren CM, Luan J, Magi R, Randall JC, Vedantam S, Winkler TW, Qi L, Workalemahu T, Heid IM, Steinthorsdottir V, Stringham HM, Weedon MN, Wheeler E, Wood AR, Ferreira T, Weyant RJ, Segre AV, Estrada K, Liang L, Nemesh J, Park JH, Gustafsson S, Kilpelainen TO, Yang J, Bouatia-Naji N, Esko T, Feitosa MF, Kutalik Z, Mangino M, Raychaudhuri S, Scherag A, Smith AV, Welch R, Zhao JH, Aben KK, Absher DM, Amin N, Dixon AL, Fisher E, Glazer NL, Goddard ME, Heard-Costa NL, Hoesel V, Hottenga JJ, Johansson A, Johnson T, Ketkar S, Lamina C, Li S, Moffatt MF, Myers RH, Narisu N, Perry JR, Peters MJ, Preuss M, Ripatti S, Rivadeneira F, Sandholt C, Scott LJ, Timpson NJ, Tyrer JP, van Wingerden S, Watanabe RM, White CC, Wiklund F, Barlassina C, Chasman DI, Cooper MN, Jansson JO, Lawrence RW, Pellikka N, Prokopenko I, Shi J, Thiering E, Alavere H, Alibrandi MT, Almgren P, Arnold AM, Aspelund T, Atwood LD, Balkau B, Balmforth AJ, Bennett AJ, Ben-Shlomo Y, Bergman RN, Bergmann S, Biebermann H, Blakemore AI, Boes T, Bonnycastle LL, Bornstein SR, Brown MJ, Buchanan TA et al (2010) Association analyses of 249,796 individuals reveal 18 new loci associated with body mass index. Nat Genet 42:937–948

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  29. Steinhausen HC (2002) The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 159:1284–1293

    Article  PubMed  Google Scholar 

  30. Steinhausen HC, Grigoroiu-Serbanescu M, Boyadjieva S, Neumarker KJ, Metzke CW (2009) The relevance of body weight in the medium-term to long-term course of adolescent anorexia nervosa. Findings from a multisite study. Int J Eat Disord 42:19–25

    Article  PubMed  Google Scholar 

  31. Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR (2011) Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement. Arch Gen Psychiatry 68:714–723

    Article  PubMed  Google Scholar 

  32. Swenne I (2004) Weight requirements for return of menstruations in teenage girls with eating disorders, weight loss and secondary amenorrhoea. Acta Paediatr 93:1449–1455

    Article  CAS  PubMed  Google Scholar 

  33. WHO (2014) Global Database on Body Mass Index. In: BMI Classification

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Acknowledgments

This study was funded by the German Ministry for Education and Research (Grants 01GV0602 and 01GV0623).

Conflict of interest

Christian Fleischhaker received grants from Bristol-Myers-Squibb, Novartis, Shire and Pfizer; Beate Herpertz-Dahlmann has received industry research funding from Medice and Vifor; Johannes Hebebrand received grants by Lilly GmbH Germany (speaker’s honorarium). Ernst Pfeiffer has received speakers fee from Infectopharm; Christoph Wewetzer has received industry research funding from Shire. Katharina Bühren, Astrid Dempfle, Karin Maria Egberts, Manuel Föcker, Susanne Knoll, Reinhild Schwarte and Nina Timmesfeld report no conflict of interest.

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Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Essen, University of Duisburg-Essen, Wickenburgstr. 21, 45147, Essen, Germany

    Manuel Föcker, Susanne Knoll & Johannes Hebebrand

  2. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of the RWTH Aachen, Aachen, Germany

    Katharina Bühren, Reinhild Schwarte & Beate Herpertz-Dahlmann

  3. Institute of Medical Biometry and Epidemiology, Philipps-University Marburg, Marburg, Germany

    Nina Timmesfeld & Astrid Dempfle

  4. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital Würzburg, Würzburg, Germany

    Karin Maria Egberts

  5. Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Charité, Berlin, Germany

    Ernst Pfeiffer

  6. Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany

    Christian Fleischhaker

  7. Department of Child and Adolescent Psychiatry and Psychotherapy, Kliniken der Stadt Köln, Cologne, Germany

    Christoph Wewetzer

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  1. Manuel Föcker
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  2. Katharina Bühren
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  4. Astrid Dempfle
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  7. Karin Maria Egberts
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  8. Ernst Pfeiffer
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  9. Christian Fleischhaker
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  10. Christoph Wewetzer
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  11. Johannes Hebebrand
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  12. Beate Herpertz-Dahlmann
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Correspondence to Manuel Föcker.

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Föcker, M., Bühren, K., Timmesfeld, N. et al. The relationship between premorbid body weight and weight at referral, at discharge and at 1-year follow-up in anorexia nervosa. Eur Child Adolesc Psychiatry 24, 537–544 (2015). https://doi.org/10.1007/s00787-014-0605-0

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  • DOI: https://doi.org/10.1007/s00787-014-0605-0

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