Skip to main content
×
Home

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

  • A. S. Kaplan (a1) (a2), B. T. Walsh (a3), M. Olmsted (a1), E. Attia (a3), J. C. Carter (a1), M. J. Devlin (a3), K. M. Pike (a3), B. Woodside (a1), W. Rockert (a1), C. A. Roberto (a3) and M. Parides (a3)...
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.

Copyright
Corresponding author
*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, Canada M5T 1R8. (Email: allan_Kaplan@camh.net)
References
Hide All
Cachelin FM, Maher BA (1998). Is amenorrhea a critical criterion for anorexia nervosa? Journal of Psychosomatic Research 44, 435440.
Carter JC, Blackmore E, Sutandar-Pinnock K, Woodside DB (2004). Relapse in anorexia nervosa: a survival analysis. Psychological Medicine 34, 19.
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, 129135.
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.
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, 611628.
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, 143156.
Endicott J, Nee J, Harrison W, Blumenthal R (1993). Quality of Life Enjoyment and Satisfaction Questionnaire: a new measure. Psychopharmacology Bulletin 29, 321326.
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. 317360. Guilford Press: New York.
Federici A, Kaplan AS (2008). The patients' account of relapse and recovery in AN: a qualitative study. European Eating Disorders Review 16, 110.
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.
Garner DM, Olmsted MP (1984). The Eating Disorder Inventory Manual. Psychological Assessment Resources: Odessa, FL.
Garfinkel PE, Kaplan AS (1985). Starvation based perpetuating mechanisms in anorexia nervosa and bulimia. International Journal of Eating Disorders 4, 651665.
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, 500506.
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, 829837.
Hollingshead AB, Redlich FC (1958). Social Class and Mental Illness. John Wiley and Sons: New York.
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, 515521.
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, 22632268.
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, 425445.
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, 29312937.
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, 415421.
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, 95100.
Olmsted MP, Kaplan AS, Jacobsen M, Rockert W (1996). Rapid responders to treatment of bulimia nervosa. International Journal of Eating Disorders 19, 279285.
Pike KM (1998). Long-term course of anorexia nervosa: response, relapse, remission and recovery. Clinical Psychology Review 18, 447475.
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, 20462049.
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, 180190.
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, 339360.
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, 26052612.
Watson TL, Andersen AE (2003). A critical examination of the amenorrhea and weight criteria for diagnosing anorexia nervosa. Acta Psychiatrica Scandanavica 108, 175182.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Psychological Medicine
  • ISSN: 0033-2917
  • EISSN: 1469-8978
  • URL: /core/journals/psychological-medicine
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords:

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 1
Total number of PDF views: 75 *
Loading metrics...

Abstract views

Total abstract views: 386 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 23rd November 2017. This data will be updated every 24 hours.