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

Published online by Cambridge University Press:  10 October 2008

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: allan_Kaplan@camh.net)

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.

Type
Original Articles
Copyright
Copyright © Cambridge University Press 2008

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