Body composition, eating disorder psychopathology, and psychological distress in anorexia nervosa: a longitudinal study. Does percent body fat predict outcome in anorexia nervosa? Percent body fat is a risk factor for relapse in anorexia nervosa: a replication study. Percentage body fat by dual-energy X-ray absorptiometry is associated with menstrual recovery in adolescents with anorexia nervosa. Patterns and predictors of recovery in anorexia nervosa and bulimia nervosa. A 1-year follow-up of a multi-center treatment trial of adults with anorexia nervosa Follow-up of bone mineral density and body composition in adolescents with restrictive anorexia nervosa: role of dual-energy X-ray absorptiometry The slippery slope: prediction of successful weight maintenance in anorexia nervosa. Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Changes in regional fat redistribution and the effects of estrogen during spontaneous weight gain in women with anorexia nervosa. First recovery in anorexia nervosa patients in the long-term course: a discrete-time survival analysis. Postremission predictors of relapse in women with eating disorders. Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study. Outcome of anorexia nervosa: eating attitudes, personality, and parental bonding. 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. Comparison of Family Therapy and Family Group Psychoeducation in Adolescents with Anorexia Nervosa A controlled study of the effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa.
BACKGROUND Although the effect of immediate weight restoration on body composition and body fat distribution has previously been studied in anorexia nervosa ( AN ) , its influence in women with AN on eating disorder psychopathology and psychological distress has not previously been investigated to our knowledge . OBJECTIVES We assessed body composition and fat mass distribution before and after body weight restoration and investigated any relation between changes in body fat patterns of patients with AN treated in a specialist inpatient unit and their eating disorder and psychological distress features . DESIGN Body composition was measured by using dual-energy X-ray absorptiometry in 50 female , adult patients with AN before and after complete weight restoration [ body mass index ( BMI ; in kg/m² ) ≥18.5 ] and 100 healthy control subjects matched by age and posttreatment BMI of study group participants . Eating disorder psychopathology and psychological distress were assessed in the AN group before and after weight restoration by using the Eating Disorder Examination interview and the Global Severity Index of the Brief Symptom Inventory ( BSI-GSI ) , respectively . RESULTS After the achievement of complete weight restoration , patients with AN had higher trunk ( P < 0.001 ) , and roid ( P < 0.001 ) , and gynoid ( P < 0.001 ) fat masses and lower arm ( P < 0.001 ) and leg ( P = 0.001 ) fat masses with respect to control subjects . No relation was shown between body-composition variables and eating disorder psychopathology in the AN group , and the only significant predictor of change in BSI-GSI was the baseline BSI-GSI score . CONCLUSION The normalization of body weight in patients with AN is associated with a preferential distribution of body fat in central regions , which does not , however , seem to influence either eating disorder psychopathology or psychological distress scores OBJECTIVE The goal of this study was to investigate the relationship of body composition and neuroendocrine levels with clinical outcome in women with anorexia nervosa in a relapse-prevention trial . METHOD Body composition and fasting cortisol and leptin levels were assessed before r and om assignment in 32 weight-recovered subjects with anorexia nervosa from the New York site of the Fluoxetine to Prevent Relapse in Women With Anorexia Nervosa trial . Clinical outcome at the end of study participation was defined using modified Morgan-Russell criteria ( full , good , fair , poor ) , then dichotomized into treatment " success " or " failure . " RESULTS In a binary logistic regression model examining the effect of percent body fat , body mass index , anorexia nervosa subtype , waist-to-hip ratio , and serum cortisol and leptin levels on treatment outcome , only percent body fat was significantly associated with outcome . CONCLUSIONS In recently weight-restored women with anorexia nervosa , lower percent body fat was associated with poor long-term outcome OBJECTIVE We aim ed to replicate and extend our previous findings of an association between percent body fat in recently weight-restored patients with Anorexia Nervosa ( AN ) and clinical outcome in the year following treatment . METHOD Twenty-two hospitalized , weight-restored women with AN underwent  whole body MRI to determine percent adipose tissue . Following hospital discharge , patients were contacted regularly , and at the end of the year , clinical outcome was determined using modified Morgan-Russell ( MR ) criteria : full , good , fair or poor . Identical to our previous study , outcome was dichotomized into " full , good or fair " and " poor " groups . RESULTS Data from 21 subjects were available for analysis . Percent body fat was significantly lower in the poor outcome group ( 22 % ± 5 % ) compared to the " full , good or fair " outcome group ( 27 % ± 4%)(p < 0.035 ) . To further examine the relationship , we combined data from the current study with data from the 26 subjects on whom we had previously reported . Univariate analysis of variance ( ANOVA ) demonstrated a significant difference in percent adipose tissue across the four MR outcome groups ( F = 3.416 , df = 3 , p<0.03 ) . DISCUSSION Lower percent adipose tissue after short-term weight normalization is associated with poor clinical outcome in the year following inpatient treatment . These findings may be important in the assessment of risk for relapse in patients with AN PURPOSE To evaluate mediators of resumption of menses ( ROM ) in adolescents with anorexia nervosa ( AN ) . METHODS Anthropometrics , body composition by dual-energy X-ray absorptiometry , hormonal studies , and responses to mental health screens  were obtained at 6-month intervals for 18 months in 37 adolescents with AN r and omized to the placebo arm of a double-blind treatment trial . Outcomes were compared between subjects with menstrual recovery and those without . RESULTS Twenty-four subjects ( 65 % ) had ROM . Higher percentage body fat was associated with ROM ( odds ratio , 1.19 ; 95 % confidence interval , 1.06 , 1.33 ; p < .01 ) , as was body mass index and percent median body weight . Estradiol ≥30 ng/mL alone did not predict menses ( p = .08 ) but was associated with ROM when coupled with percent mean body weight ( odds ratio , 2.49 ; 95 % confidence interval , 1.09 , 5.65 ; p = .03 ) . Changes in leptin , cortisol , and mental health were not associated with return of menses . CONCLUSIONS Percentage body fat may be an additional , useful clinical assessment to follow in caring for adolescents with AN OBJECTIVE The purpose of this study was to assess the course and outcome of anorexia nervosa and bulimia nervosa at 1 year in a large cohort of women with eating disorders . METHOD A prospect i ve , naturalistic , longitudinal design was used to map the course of 225 women with anorexia nervosa , bulimia nervosa , and mixed anorexia and bulimia nervosa .  Structured interviews were conducted quarterly . Follow-up data are presented in terms of patterns of recovery , clinical features predictive of time to recovery , and the role of comorbid disorders as fixed predictors . RESULTS The recovery rate of bulimics was significantly better than that of anorexic or mixed subjects , yet nearly half the anorexic and mixed subjects no longer met full DSM-III-R criteria for at least 8 consecutive weeks during the first year of follow-up . Percent ideal body weight and type of eating disorder were significantly associated with outcome . CONCLUSIONS Our findings suggest that the diagnosis of anorexia nervosa has severe implication OBJECTIVE : To examine maintenance of recovery following treatment in an adult anorexia nervosa ( AN ) population . METHOD : One year follow-up of a r and omized clinical trial with 122 participants treated with : cognitive behavioral therapy ( CBT ) , drug therapy ( fluoxetine ) , or a combination ( CBT+fluoxetine ) for 12 months . Participants were assessed at baseline , end of treatment , and follow-up . The primary outcomes were weight and the global scores from the Eating Disorder Examination ( EDE ) separately and combined . RESULTS : Fifty-two participants completed the follow-up . Mean weight increased from end of treatment to follow-up . Seventy-five percent ( 75 % ) of those weight recovered at end of treatment maintained this recovery at follow-up . Recovery of eating disorder psychopathology was stable from end of treatment to follow-up , with 40 % of participants with a global EDE score within normal range . Using the most stringent criteria for recovery , only 21 % of the completer sample was recovered . DISCUSSION : The findings suggest that while adults with AN improve with treatment and maintain these improvements during follow-up , the majority is not recovered . Additionally , further research is needed to underst and barriers to treatment and assessment completion Background / Objectives : Restrictive Anorexia nervosa ( ANR ) is an eating disorder ( ED ) characterized by a low bone mineral content ( BMC ) and by an alteration in body composition ( reduction and abnormal distribution of fat mass — FM and lean mass — LM ) . The aim of our study was to address whether bone and body composition changes could be influenced by hormonal status and sport in female adolescents with restrictive anorexia nervosa-ANR.Subjects/ Methods : Prospect i ve study on 79 adolescents with ANR su bmi tted to Dual Energy X-Ray Absorptiometry — DXA at baseline-T0  and after 12 months-T12 . Among the 46/79—58.2 % patients that completed the study , we evaluated total and regional FM and LM% , as well as lumbar bone mineral density ( BMD ) and Z-score , linking them to clinical variables : menarche/amenorrhea/hormonal therapy and physical activity . Results : At T0 : body mass index ( BMI ) = 16.4±1.4 kg/m2 with low levels of FM% ( 21.7±5.7 ) low BMC in 12/46—26.0 % ( mean Z-score : −1.21±1.27 , with higher values related to physical activity — P=0.001 ) . At T12 : a significant increase in BMI —P=0.001 , with LM reduction and FM increase ( more evident in the trunk — P<0.001 ) ; regarding bone , no significant changes were observed , though a tendency in terms of improvement associated with resumption of menses . Conclusions : After 1 year , weight recovery was not associated with a reestablishment of bone values ; by contrast , it was associated with an increase and a distortion in FM distribution , more evident in trunk region ( potential and adjunctive risk factor for the relapse of the psychiatric condition ) . The complexity of these clinical findings suggested DXA , a low-dose and low-cost technique , in long-term monitoring of ANR patients 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 r and omly 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 r and omization 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-r and omization body mass index ( BMI ) and the rate of weight loss in the first 28 days following r and omization . 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 CONTEXT Evidence -based treatment trials for adolescents with anorexia nervosa are few . OBJECTIVE To evaluate the relative efficacy of family-based treatment ( FBT ) and adolescent-focused individual therapy ( AFT ) for adolescents with anorexia nervosa in full remission . DESIGN R and omized controlled trial . SETTING Stanford University and The University of Chicago ( April 2005 until March 2009 ) . PARTICIPANTS One hundred twenty-one participants , aged 12 through 18 years , with DSM-IV diagnosis of anorexia nervosa excluding the amenorrhea requirement . Intervention Twenty-four outpatient hours of treatment over 12 months of FBT or AFT . Participants were assessed at baseline , end of treatment ( EOT ) , and 6 months ' and 12 months ' follow-up posttreatment . MAIN OUTCOME MEASURES Full remission from anorexia nervosa defined as normal weight ( ≥95 % of expected for sex , age , and height ) and mean global Eating Disorder Examination score within 1 SD of published means . Secondary outcome measures included partial remission rates ( > 85 % of expected weight for height plus those who were in full remission ) and changes in body mass index percentile and eating-related psychopathology . RESULTS There were no differences in full remission between treatments at EOT . However , at both the 6- and 12-month follow-up , FBT was significantly superior to AFT on this measure . Family-based treatment was significantly superior for partial remission at EOT but not at follow-up . In addition , body mass index percentile at EOT was significantly superior for FBT , but this effect was not found at follow-up . Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT , but there were no differences at follow-up . CONCLUSION Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT , FBT was more effective in facilitating full remission at both follow-up points . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00149786 BACKGROUND Anorexia nervosa is a disease of severe acquired undernutrition with a high and increasing prevalence among young women in the United States . OBJECTIVE The objective was to investigate the effects of spontaneous outpatient weight recovery and estrogen administration on fat distribution in patients with anorexia nervosa . DESIGN Twenty-seven amenorrheic women aged 26.6 + /- 1.2 y with anorexia nervosa were identified through an outpatient study of bone loss and were r and omly assigned to receive or not receive estrogen without any dietary intervention other than calcium and multivitamin supplements .  Body composition was measured at baseline and at 6 and 9 mo and was compared with cross-sectional values obtained in 20 healthy , eumenorrheic , age-matched ( 25.4 + /- 0.5 y ) control subjects . RESULTS Twenty of the 27 patients with anorexia aged 27.0 + /- 1.3 y spontaneously gained weight ( 4.1 + /- 0.9 kg ) ; body mass index ( in kg/m(2 ) ) increased from 16.1 + /- 0.3 to 17.5 + /- 0.4 . Fat mass and lean mass accounted for 68 % and 32 % of the gain in total body mass , respectively . With spontaneous weight gain , there was a significant increase in the percentage of trunk fat from 32.4 + /- 1.3 % at baseline to 36.5 + /- 1.0 % at 9 mo ( P = 0.03 ) , which correlated with urinary free cortisol ( r = 0.66 , P = 0.003 ) . Estrogen treatment was not protective against the gain in trunk fat with spontaneous weight gain . CONCLUSIONS In women with anorexia nervosa , spontaneous weight gain is associated with a significant increase in trunk adiposity , and estrogen administration may not protect against the accumulation of central fat with weight gain The results of a 12-year follow-up study of occurrence and timing of first recovery in 69 hospitalized patients with severe anorexia nervosa ( AN ) are presented . For the first time discrete-time survival analysis methods were used to determine the likelihood of recovery in AN patients . Furthermore , predictors gleaned from pretreatment-posttreatment studies of long-term outcome in AN could be evaluated as to their effect on a change in the time course structure of the likelihood of first recovery . Results show that AN condition did not improve until after 6 years after the first inpatient treatment in 50 % of patients . However , a restricter-type AN and low serum creatinine levels were predictors for earlier recovery . One specific effect was that AN patients who show purging behavior in combination with additional social disturbances have a lower chance of recovering . The use of discrete-time survival analysis methodology in further prospect i ve studies will contribute to the development of more tailored treatment of AN , which also takes the individual phase of illness and specific aspects of the symptomatology into account OBJECTIVE The authors sought to evaluate patterns and predictors of relapse among women with eating disorders . METHOD Interviews were conducted biannually to annually to assess symptoms of eating disorders , axis I disorders , treatment , and psychosocial function on a weekly basis for women diagnosed with anorexia nervosa ( N=136 ) or bulimia nervosa ( N=110 ) and prospect ively followed for 9 years . At the last follow-up , 229 ( 93 % ) of the subjects had been retained in the study group . RESULTS Relapse occurred in 36 % of the women with anorexia nervosa and 35 % of the women with bulimia nervosa . Women with intake diagnoses of anorexia nervosa , restricting subtype , tended to develop bulimic symptoms during relapse , whereas women with intake diagnoses of anorexia nervosa , binge-purge subtype , or bulimia nervosa tended to return to bulimic patterns during relapse . Greater body image disturbance contributed to a risk of relapse in both eating disorders , and worse psychosocial function increased the risk of relapse in bulimia nervosa . CONCLUSIONS These results may explain the long-term efficacy of interpersonal therapy for bulimia nervosa and suggest that focused body image work during relapse prevention may enhance long-term recovery from eating disorders OBJECTIVE To assess the course and outcome of anorexia nervosa ( AN ) and bulimia nervosa ( BN ) at a median of 90 months of follow-up in a large cohort of women with eating disorders . METHOD A prospect i ve , naturalistic , longitudinal design was used to map the course of AN and BN in 246 women . Follow-up data are presented in terms of full and partial recovery , predictors of time to recovery , and rates and predictors of relapse . RESULTS The full recovery rate of women with BN was significantly higher than that of women with AN , with 74 % of those with BN and 33 % of those with AN achieving full recovery by a median of 90 months of follow-up . Intake diagnosis of AN was the strongest predictor of worse outcome . No predictors of recovery emerged among bulimic subjects . Eighty-three percent of women with AN and 99 % of those with BN achieved partial recovery . Approximately one third of both women with AN and women with BN relapsed after full recovery . No predictors of relapse emerged . CONCLUSIONS The findings suggest that the course of AN is characterized by high rates of partial recovery and low rates of full recovery , while the course of BN is characterized by higher rates of both partial and full recovery BACKGROUND We examined eating attitudes , personality , and parental bonding in women with a history of anorexia nervosa stratified by degree of recovery in comparison to r and omly selected controls . We were interested in the distinguishing characteristics of recovery and of chronic anorexia nervosa . METHOD All female new referrals to an eating disorders service between January 1 , 1981 and December 31 , 1984 with probable or definite anorexia nervosa were eligible for inclusion . 86.4 % of these women ( " cases " ) were located and agreed to participate . The control group was a r and om community sample .  All subjects were interviewed with a structured diagnostic instrument and completed a battery of psychological inventories including the Eating Disorder Inventory ( EDI ) , the Three-Factor Eating Question naire ( TFEQ ) , the Temperament and Character Inventory ( TCI ) , and the Parental Bonding Instrument ( PBI ) .  RESULTS We divided the anorexia follow-up sample into full recovery ( n = 21 ) , partial recovery ( n = 34 ) , and chronically ill ( n = 15 ) and compared them to community controls ( n = 98 ) . The chronically ill group was distinguished by a lower desired body mass index ( BMI ) , higher cognitive restraint on the TFEQ , higher Drive for Thinness and Bulimia on the EDI , lower maternal and paternal care on the PBI , and high harm avoidance and low self-directedness on the TCI . The full recovery group scored high on self-directedness and cooperativeness on the TCI . CONCLUSIONS The domains of personality , character , and parental bonding differ among categories of recovery in anorexia nervosa . Whether these differences contribute to recovery or emerge during recovery or lack thereof remains an unanswered question OBJECTIVE To assess the long-term course of recovery and relapse and predictors of outcome in anorexia nervosa . METHOD A naturalistic , longitudinal prospect i ve design was used to assess recovery and relapse in patients ascertained through a university-based specialty treatment program . Patients were assessed semiannually for 5 years and annually thereafter over 10 - 15 years from the time of their index admission . Recovery was defined in terms of varying levels of symptom remission maintained for no fewer than 8 consecutive weeks . RESULTS Nearly 30 % of patients had relapses following hospital discharge , prior to clinical recovery . However , most patients were weight recovered and menstruating regularly by the end of follow-up , with nearly 76 % of the cohort meeting criteria for full recovery . Relapse after recovery was relatively uncommon . Of note , time to recovery was protracted , ranging from 57 - 79 months depending on definition of recovery . Among restrictors at intake , nearly 30 % developed binge eating , occurring within 5 years of intake . A variety of predictors of chronic outcome and binge eating were identified . There were no deaths in the cohort . CONCLUSION The course of anorexia nervosa is protracted . Predictors of outcome are surprisingly few , but those identified are in keeping with previous accounts . The intensive treatment received by these patients may account for the lower levels of morbidity and mortality when considered in relation to other reports in the follow-up literature Objective : To compare the effects of 4 months of 2 family-oriented treatments , family therapy and family psychoeducation , on female adolescents with newly diagnosed restrictive eating disorders . Method : Twenty-five female adolescents requiring hospitalization were r and omized into either family therapy or family group psychoeducation . Outcome measures included medical ( body weight ) and psychosocial ( specific and nonspecific eating disorder psychopathology ) variables at baseline and after 4 months of treatments every 2 weeks . Results : A significant time effect was found in both treatment groups for the restoration of body weight ( percentage of ideal body weight , P < 0.000 01 ) . The group averages ranged from 75 % to 77 % ideal body weight before treatment to 91 % to 96 % after it . A time effect was also seen on the Family Assessment Measure ( P < 0.018 ) , in that the patients of both groups acknowledged more family psychopathology at the end of treatment . No significant group differences were found on any of the self-report measures of specific and nonspecific eating disorder pathology . Conclusions : Weight restoration was achieved following the 4-month period of treatment in both the family therapy and family psychoeducation groups , but no significant change was reported in psychological functioning by either adolescents or parents . Family group psychoeducation , the less expensive form of treatment , is an equally effective method of providing family-oriented treatment to newly diagnosed , medically compromised anorexia nervosa patients and their families Ninety patients with severe anorexia nervosa fulfilling DSM-III-R criteria were assessed in depth in terms of their family developmental psychopathology and then r and omly allocated to either one of three treatment groups or to no treatment . In three treatment regimes , a behavioural approach to diet and weight gain was coupled with individual and family psychotherapy directed at the adolescent maturational problems . All three treatment regimes were highly significantly effective at one year in terms of weight gain , return of menstruation , and aspects of social and sexual adjustment . Body weights above those at pubertal onset were achieved for the group mean maximum and one-year follow-up weights for all three treatment groups but not the control group
First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat .
Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females .
Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls .
Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults .
Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .
The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .