Weight suppression as a predictor of weight gain and response to intensive behavioral treatment in patients with anorexia nervosa

Abstract Background Fear of weight gain is a characteristic feature of anorexia nervosa (AN), and reducing this fear is often a main target of treatment. However, research shows that 20% of individuals with AN do not report fear of weight gain. Studies are needed that evaluate the centrality of fear of weight gain for AN with a method less susceptible to deception than self-report. Methods We approximated implicit fear of weight gain by measuring implicit drive for thinness using implicit association tests (IATs). We asked 64 participants (35 AN, 29 healthy controls [HCs]) to categorize statements as pro-dieting vs. non-dieting and true vs. false in a questionnaire-based IAT, and pictures of underweight vs. normal-weight models and positive vs. negative words in a picture-based IAT using two response keys. We tested for associations between implicit drive for thinness and explicitly reported psychopathology within AN as well as group differences between AN and HC groups. Results Correlation analyses within the AN group showed that higher implicit drive for thinness was associated with more pronounced eating disorder-specific psychopathology. Furthermore, the AN group showed a stronger implicit drive for thinness than HCs in both IATs. Conclusion The results highlight the relevance of considering fear of weight gain as a continuous construct. Our implicit assessment captures various degrees of fear of weight gain in AN, which might allow for more individually tailored interventions in the future.

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Weight gain, thermic effect of glucose and resting metabolic rate during recovery from anorexia nervosa

American Journal of Clinical Nutrition ◽

10.1093/ajcn/30.2.138 ◽

1977 ◽

Vol 30 (2) ◽

pp. 138-146 ◽

Cited By ~ 67

Author(s):

B J Stordy ◽

V Marks ◽

R S Kalucy ◽

A H Crisp

Keyword(s):

Anorexia Nervosa ◽

Weight Gain ◽

Metabolic Rate ◽

Resting Metabolic Rate ◽

Effect Of Glucose ◽

Thermic Effect

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Antimicrobial peptides in patients with anorexia nervosa: comparison with healthy controls and the impact of weight gain

Scientific Reports ◽

10.1038/s41598-020-79302-1 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Marie-Christin Bendix ◽

Michael Stephan ◽

Mariel Nöhre ◽

Wally Wünsch-Leiteritz ◽

Hagen Schmidt ◽

...

Keyword(s):

Anorexia Nervosa ◽

Weight Gain ◽

Antimicrobial Peptides ◽

Pathogenic Bacteria ◽

Innate Immune ◽

Effect Sizes ◽

Healthy Controls ◽

Clinical Observations ◽

The Impact

AbstractClinical observations show that patients with anorexia nervosa (AN) are surprisingly free from infectious diseases. There is evidence from studies in Drosophila melanogaster that starvation leads to an increased expression of antimicrobial peptides (AMPs). AMPs are part of the innate immune system and protect human surfaces from colonization with pathogenic bacteria, viruses and fungi. We compared the expression of AMPs between patients with AN and healthy controls (HC) and investigated the influence of weight gain. Using a standardized skin rinsing method, quantitative determination of the AMPs psoriasin and RNase 7 was carried out by ELISA. Even though non-significant, effect sizes revealed slightly higher AMP concentrations in HC. After a mean weight gain of 2.0 body mass index points, the concentration of psoriasin on the forehead of patients with AN increased significantly. We could not confirm our hypotheses of higher AMP concentrations in patients with AN that decrease after weight gain. On the contrary, weight gain seems to be associated with increasing AMP concentrations.

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Vitamin D status in young Swedish women with anorexia nervosa during intensive weight gain therapy

European Journal of Nutrition ◽

10.1007/s00394-016-1244-7 ◽

2016 ◽

Vol 56 (6) ◽

pp. 2061-2067 ◽

Cited By ~ 3

Author(s):

Anna Svedlund ◽

Cecilia Pettersson ◽

Bojan Tubic ◽

Per Magnusson ◽

Diana Swolin-Eide

Keyword(s):

Vitamin D ◽

Anorexia Nervosa ◽

Weight Gain ◽

Vitamin D Status

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The Gut Microbiome Derived From Anorexia Nervosa Patients Impairs Weight Gain and Behavioral Performance in Female Mice

Endocrinology ◽

10.1210/en.2019-00408 ◽

2019 ◽

Vol 160 (10) ◽

pp. 2441-2452 ◽

Cited By ~ 15

Author(s):

Tomokazu Hata ◽

Noriyuki Miyata ◽

Shu Takakura ◽

Kazufumi Yoshihara ◽

Yasunari Asano ◽

...

Keyword(s):

Body Weight ◽

Anorexia Nervosa ◽

Weight Gain ◽

Food Intake ◽

Brain Stem ◽

Body Weight Gain ◽

Field Tests ◽

Compulsive Behavior ◽

The Brain ◽

Poor Weight Gain

Abstract Anorexia nervosa (AN) results in gut dysbiosis, but whether the dysbiosis contributes to AN-specific pathologies such as poor weight gain and neuropsychiatric abnormalities remains unclear. To address this, germ-free mice were reconstituted with the microbiota of four patients with restricting-type AN (gAN mice) and four healthy control individuals (gHC mice). The effects of gut microbes on weight gain and behavioral characteristics were examined. Fecal microbial profiles in recipient gnotobiotic mice were clustered with those of the human donors. Compared with gHC mice, gAN mice showed a decrease in body weight gain, concomitant with reduced food intake. Food efficiency ratio (body weight gain/food intake) was also significantly lower in gAN mice than in gHC mice, suggesting that decreased appetite as well as the capacity to convert ingested food to unit of body substance may contribute to poor weight gain. Both anxiety-related behavior measured by open-field tests and compulsive behavior measured by a marble-burying test were increased only in gAN mice but not in gHC mice. Serotonin levels in the brain stem of gAN mice were lower than those in the brain stem of gHC mice. Moreover, the genus Bacteroides showed the highest correlation with the number of buried marbles among all genera identified. Administration of Bacteroides vulgatus reversed compulsive behavior but failed to exert any substantial effect on body weight. Collectively, these results indicate that AN-specific dysbiosis may contribute to both poor weight gain and mental disorders in patients with AN.

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Lifetime Weight Characteristics of Adult Inpatients With Severe Anorexia Nervosa: Maximal Lifetime BMI Predicts Treatment Outcome

Frontiers in Psychiatry ◽

10.3389/fpsyt.2021.682952 ◽

2021 ◽

Vol 12 ◽

Author(s):

Lisa-Katrin Kaufmann ◽

Hanspeter Moergeli ◽

Gabriella Franca Milos

Keyword(s):

Anorexia Nervosa ◽

Treatment Outcome ◽

Strong Predictor ◽

Negative Influence ◽

Positive Influence ◽

The Body ◽

Linear Regression Models ◽

Weight Suppression ◽

Positive Treatment

Background: The body mass index is a key predictor of treatment outcome in patients with anorexia nervosa. In adolescents, higher premorbid BMI is a strong predictor of a favorable treatment outcome. It is unclear whether this relationship holds true for adults with anorexia nervosa. Here, we examine adult patients with AN and investigate the lowest and highest lifetime BMI and weight suppression as predisposing factors for treatment outcome.Methods: We included 107 patients aged 17–56 with anorexia nervosa and tracked their BMI from admission to inpatient treatment, through discharge, to follow-up at 1–6 years. Illness history, including lowest and highest lifetime BMI were assessed prior to admission. We used multiple linear regression models with minimal or maximal lifetime BMI or weight suppression at admission as independent variables to predict BMI at admission, discharge and follow-up, while controlling for patients' age, sex, and duration of illness.Results: Low minimal BMI had a negative influence on the weight at admission, which in turn resulted in a lower BMI at discharge. Higher maximal BMI had a substantial positive influence on BMI at discharge and follow-up. Weight suppression was highly correlated with maximal BMI and showed similar effects to maximal BMI.Conclusion: Our findings strongly support a relationship between low minimal lifetime BMI and lower BMI at admission, and between higher maximal lifetime BMI or weight suppression and a positive treatment outcome, even years after discharge. Overall, maximal BMI emerged as the most important factor in predicting the weight course in adults with AN.

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Assessment of brain function in adolescent anorexia nervosa before and after weight gain

Journal of Clinical and Experimental Neuropsychology ◽

10.1080/01688639708403833 ◽

1997 ◽

Vol 19 (1) ◽

pp. 20-33 ◽

Cited By ~ 42

Author(s):

Susan J. Bradley ◽

Margot J. Taylor ◽

Joanne F. Rovet ◽

Eudice Goldberg ◽

Jane Hood ◽

...

Keyword(s):

Anorexia Nervosa ◽

Weight Gain ◽

Brain Function ◽

Before And After ◽

Adolescent Anorexia Nervosa

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Effects of Intensive Behavioral Treatment for Children With Varying Levels of Conduct Problems and Callous-Unemotional Traits

Behavior Therapy ◽

10.1016/j.beth.2018.03.003 ◽

2019 ◽

Vol 50 (1) ◽

pp. 1-14 ◽

Cited By ~ 6

Author(s):

Pevitr S. Bansal ◽

Daniel A. Waschbusch ◽

Sarah M. Haas ◽

Dara E. Babinski ◽

Sara King ◽

...

Keyword(s):

Conduct Problems ◽

Behavioral Treatment ◽

Callous Unemotional ◽

Callous Unemotional Traits ◽

Unemotional Traits ◽

Intensive Behavioral Treatment

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Rate of Weight Gain of Inpatients with Anorexia Nervosa Under Two Behavioral Contracts

PEDIATRICS ◽

10.1542/peds.93.6.989 ◽

1994 ◽

Vol 93 (6) ◽

pp. 989-991

Author(s):

Mary V. Solanto ◽

Stanley Hertz ◽

Marc S. Jacobson ◽

Neville H. Golden ◽

Lenore Heller

Keyword(s):

Anorexia Nervosa ◽

Weight Gain ◽

Female Gender ◽

Analysis Of Covariance ◽

Adolescent Medicine ◽

Medical Illness ◽

Chronic Medical Illness ◽

Criterion Weight ◽

Behavioral Contracts

Objective. To ascertain the rate of weight gain of inpatients with anorexia nervosa under two behavioral contracts, differing in criterion weight gain required to earn increasing privileges. Design. Follow-up comparison of cohorts receiving different interventions. Setting. Eating disorders service, operating on a general adolescent medicine unit. Patients. Patients admitted consecutively who met the following criteria: (1) weight at least 15% less than that expected for age, sex, and height; (2) female gender; (3) absence of chronic medical illness; (4) hospital stay of at least 28 days. Twenty-two patients meeting these criteria were treated between July 1987 and October 1988, when contract 1 was in effect. This cohort of patients was compared with a group of 31 patients, also meeting the these criteria, who were treated between November 1988 and December 1991, when contract 2 was in effect. Interventions. The behavioral contract, signed by the patient on admission, specifies the minimum 4-day weight gain necessary to earn increasing ward privileges, such as use of phone, frequency of visits, etc. Contracts 1 and 2 differed only in the 4-day weight gain criterion: 0.8 lb (0.36 kg) and 1.2 lb (0.55 kg), respectively. Results. The results of analysis of covariance, with admission weight as the covariate, revealed a significant interaction between contract and day, such that patients receiving contract 2 gained weight more rapidly (0.36 lb/d) than those receiving contract 1 (0.20 lb/d). There was no confounding difference between groups in the use of psychotropic medication, and no complications of refeeding in either group. Conclusion. Increasing the 4-day criterion weight gain from 0.8 to 12 lb in a behavioral contracting intervention was associated with a significant increase in the rate of weight gain, without an accompanying increase in complications of refeeding. This result simultaneously: (a) provides support for the efficacy of behavioral contracting and (b) reveals malleability in the rate of gain based on the targeted gain specified in the contract.

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