Hostname: page-component-586b7cd67f-rdxmf Total loading time: 0 Render date: 2024-11-27T19:33:24.489Z Has data issue: false hasContentIssue false
  • English
  • Français

The slippery slope: prediction of successful weight maintenance in anorexia nervosa

Published online by Cambridge University Press:  10 October 2008

A. S. Kaplan ,
B. T. Walsh ,
M. Olmsted ,
E. Attia ,
J. C. Carter ,
M. J. Devlin ,
K. M. Pike ,
B. Woodside ,
W. Rockert  and
C. A. Roberto
...Show all authors
A. S. Kaplan*
Affiliation:
Program for Eating Disorders, Toronto General Hospital, University of Toronto, Ontario, Canada Center for Addiction and Mental Health, Department of Psychiatry, Faculty of Medicine, University of Toronto, Ontario, Canada
B. T. Walsh
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University/New York State Psychiatric Institute, New York, NY, USA
M. Olmsted
Affiliation:
Program for Eating Disorders, Toronto General Hospital, University of Toronto, Ontario, Canada
E. Attia
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University/New York State Psychiatric Institute, New York, NY, USA
J. C. Carter
Affiliation:
Program for Eating Disorders, Toronto General Hospital, University of Toronto, Ontario, Canada
M. J. Devlin
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University/New York State Psychiatric Institute, New York, NY, USA
K. M. Pike
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University/New York State Psychiatric Institute, New York, NY, USA
B. Woodside
Affiliation:
Program for Eating Disorders, Toronto General Hospital, University of Toronto, Ontario, Canada
W. Rockert
Affiliation:
Program for Eating Disorders, Toronto General Hospital, University of Toronto, Ontario, Canada
C. A. Roberto
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University/New York State Psychiatric Institute, New York, NY, USA
M. Parides
Affiliation:
Department of Psychiatry, College of Physicians and Surgeons of Columbia University/New York State Psychiatric Institute, New York, NY, USA
*
*Address for correspondence: A. S. Kaplan M.D., FRCP(C), Senior Scientist and Director Research Training, Center for Addiction and Mental Health, Loretta Anne Rogers Chair in Eating Disorders, Toronto General Hospital, and Vice Chairman of Research, Professor of Psychiatry, University of Toronto, 250 College Street, Room 832, Toronto, Ontario, CanadaM5T 1R8. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Previous research has found that many patients with anorexia nervosa (AN) are unable to maintain normal weight after weight restoration. The objective of this study was to identify variables that predicted successful weight maintenance among weight-restored AN patients.

Method

Ninety-three patients with AN treated at two sites (Toronto and New York) through in-patient or partial hospitalization achieved a minimally normal weight and were then randomly assigned to receive fluoxetine or placebo along with cognitive behavioral therapy (CBT) for 1 year. Clinical, demographic and psychometric variables were assessed after weight restoration prior to randomization and putative predictors of successful weight maintenance at 6 and 12 months were examined.

Results

The most powerful predictors of weight maintenance at 6 and 12 months following weight restoration were pre-randomization body mass index (BMI) and the rate of weight loss in the first 28 days following randomization. Higher BMI and lower rate of weight loss were associated with greater likelihood of maintaining a normal BMI at 6 and 12 months. An additional predictor of weight maintenance was site; patients in Toronto fared better than those in New York.

Conclusions

This study found that the best predictors of weight maintenance in weight-restored AN patients over 6 and 12 months were the level of weight restoration at the conclusion of acute treatment and the avoidance of weight loss immediately following intensive treatment. These results suggest that outcome might be improved by achieving a higher BMI during structured treatment programs and on preventing weight loss immediately following discharge from such programs.

Keywords

Anorexia nervosaoutcomeprediction
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 6 , June 2009 , pp. 1037 - 1045
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Cachelin, FM, Maher, BA (1998). Is amenorrhea a critical criterion for anorexia nervosa? Journal of Psychosomatic Research 44, 435–440.CrossRefGoogle ScholarPubMed
Carter, JC, Blackmore, E, Sutandar-Pinnock, K, Woodside, DB (2004). Relapse in anorexia nervosa: a survival analysis. Psychological Medicine 34, 1–9.CrossRefGoogle ScholarPubMed
Castro-Fornieles, J, Casula, V, Saura, B, Martinez, E, Lazaro, L, Vila, M, Plana, MT, Toro, J (2007). Predictors of weight maintenance after hospital discharge in adolescent anorexia nervosa. International Journal of Eating Disorders 40, 129–135.CrossRefGoogle ScholarPubMed
Cloninger, TK, Przybeck, TR, Surakic, DM, Wetzel, RD (1994). The Temperament and Character Inventory (TCI): A Guide to its Development and Use. Center for Psychobiology of Personality, Washington University: St Louis, MI.Google Scholar
Davis, C, Brewer, H, Ratusny, D (1993). Behavioural frequency and attitudinal commitment: necessary concepts in the study of obligatory exercising. Journal of Behavioral Medicine 16, 611–628.CrossRefGoogle Scholar
Eckert, ED, Halmi, KA, Marchi, P, Grove, W, Crosby, R (1995). Ten-year follow-up of anorexia nervosa: clinical course and outcome. Psychological Medicine 25, 143–156.CrossRefGoogle ScholarPubMed
Endicott, J, Nee, J, Harrison, W, Blumenthal, R (1993). Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacology Bulletin 29, 321–326.Google ScholarPubMed
Fairburn, CG, Cooper, Z (1993). The Eating Disorder Examination, 12th edition. In Binge Eating: Nature, Assessment and Treatment (ed. Fairburn, C. G. and Wilson, G. T.), pp. 317–360. Guilford Press: New York.Google Scholar
Federici, A, Kaplan, AS (2008). The patients' account of relapse and recovery in AN: a qualitative study. European Eating Disorders Review 16, 1–10.CrossRefGoogle Scholar
First, MB, Spitzer, RL, Gibbon, M, Williams, JBW (1996). Structured Clinical Interview for DSM IV Axis 1 Disorders, Research Version, Patient Edition with Psychotic Screen. Biometrics Research, New York State Psychiatric Institute: New York.Google Scholar
Garner, DM, Olmsted, MP (1984). The Eating Disorder Inventory Manual. Psychological Assessment Resources: Odessa, FL.Google Scholar
Garfinkel, PE, Kaplan, AS (1985). Starvation based perpetuating mechanisms in anorexia nervosa and bulimia. International Journal of Eating Disorders 4, 651–665.CrossRefGoogle Scholar
Garfinkel, PE, Lin, E, Goering, P, Garfinkel, PE, Spegg, C, Goldbloom, D, Kennedy, S, Kaplan, AS, Woodside, DB (1996). Should amenorrhoea be necessary for the diagnosis of anorexia nervosa? Evidence from a Canadian community sample. British Journal of Psychiatry 168, 500–506.CrossRefGoogle ScholarPubMed
Herzog, DB, Dorer, DJ, Keel, PK, Selwyn, SE, Ekeblad, ER, Flores, AT, Greenwood, DN, Burwell, RA, Keller, MB (1999). Recovery and relapse in anorexia nervosa and bulimia nervosa: a 7.5-year follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry 38, 829–837.CrossRefGoogle ScholarPubMed
Hollingshead, AB, Redlich, FC (1958). Social Class and Mental Illness. John Wiley and Sons: New York.CrossRefGoogle Scholar
Isager, T, Brinch, M, Kreiner, S, Tolstrup, K (1985). Death and relapse in anorexia nervosa: survival analysis of 151 cases. Journal of Psychiatric Research 19, 515–521.CrossRefGoogle Scholar
Keel, PK, Dorer, DJ, Franko, DL, Jackson, SC, Herzog, DB (2005). Postremission predictors of relapse in women with eating disorders. American Journal of Psychiatry 162, 2263–2268.CrossRefGoogle ScholarPubMed
Mazure, CM, Halmi, KA, Sunday, SR, Romano, SJ, Einhorn, AM (1994). The Yale–Brown–Cornell Eating Disorder Scale: development, use reliability and validity. Journal of Psychiatric Research 28, 425–445.CrossRefGoogle ScholarPubMed
Miller, K, Lee, E, Lawson, E, Misra, M, Minihan, M, Grinspoon, S, Gleysteen, S, Mickley, D, Herzog, D, Klibanski, A (2006). Determinants of skeletal loss and recovery in anorexia nervosa. Journal of Clinical Endocrinology and Metabolism 91, 2931–2937.CrossRefGoogle ScholarPubMed
Mizes, JS, Christiano, B, Madison, J, Post, G, Seime, R, Varnado, P (2000). Development of the Mizes Anorectic Cognitions questionnaire-revised: psychometric properties and factor structure in a large sample of eating disorder patients. International Journal of Eating Disorders 28, 415–421.3.0.CO;2-Z>CrossRefGoogle Scholar
Mulder, R, Joyce, P, Frampton, C, Luty, S, Sullivan, P (2006). Six months of treatment for depression: outcome and predictors of the course of illness. American Journal of Psychiatry 163, 95–100.CrossRefGoogle ScholarPubMed
Olmsted, MP, Kaplan, AS, Jacobsen, M, Rockert, W (1996). Rapid responders to treatment of bulimia nervosa. International Journal of Eating Disorders 19, 279–285.3.0.CO;2-J>CrossRefGoogle ScholarPubMed
Pike, KM (1998). Long-term course of anorexia nervosa: response, relapse, remission and recovery. Clinical Psychology Review 18, 447–475.CrossRefGoogle ScholarPubMed
Pike, KM, Walsh, BT, Vitousek, K, Wilson, GT, Bauer, J (2003). Cognitive behavior therapy in the posthospitalization treatment of anorexia nervosa. American Journal of Psychiatry 160, 2046–2049.CrossRefGoogle ScholarPubMed
Richard, M, Bauer, S, Kordy, H (2005). Relapse in anorexia and bulimia nervosa – a 2.5-year follow-up study. European Eating Disorders Review 13, 180–190.CrossRefGoogle Scholar
Strober, M, Freeman, R, Morrell, W (1997). The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse and outcome predictors over 10–15 years in a prospective study. International Journal of Eating Disorders 22, 339–360.3.0.CO;2-N>CrossRefGoogle ScholarPubMed
Walsh, BT, Kaplan, AS, Attia, E, Olmsted, M, Parides, M, Carter, J, Pike, K, Devlin, M, Woodside, B, Roberto, C, Rockert, W (2006). Fluoxetine after weight restoration in anorexia nervosa. Journal of the American Medical Association 295, 2605–2612.Google ScholarPubMed
Watson, TL, Andersen, AE (2003). A critical examination of the amenorrhea and weight criteria for diagnosing anorexia nervosa. Acta Psychiatrica Scandanavica 108, 175–182.CrossRefGoogle ScholarPubMed