A new approach for anorexia patients who are not underweight.
In a recent editorial in the Journal of Adolescent Health(2018;63:669), Andrea K. Garber, PhD, RD, from the University of California, and Benioff Children’s Hospital, San Francisco, notes that “skinniness” is not sufficient to assess malnutrition in patients with restrictive eating disorders.
The classic face of patients with anorexia nervosa is changing, with a growing number of atypical patients, she says. “Atypical anorexia nervosa” features patients who have lost significant amounts of weight and who meet the criteria for anorexia nervosa (AN) but who are not currently underweight. The few studies that have described this group note that the patients were largely overweight or obese before becoming ill. Other characteristics of these atypical anorexics include more males and youth from lower socioeconomic groups. Even though they are not technically underweight, they have marked malnutrition.
Dr. Garber refers to a recent study of 171 adolescents aged 12 to 19 who were first admitted with malnutrition secondary to AN or Atypical anorexia nervosa (J Adoles Health. 2018; 63:717). Those with Atypical AN met all criteria for AN except for being at weights that were not as low. The study focused not merely on admission weight, but on recent and total amount of weight lost.
Total weight loss plus admission weight predicted risk for the refeeding syndrome (low serum phosphate levels) and longer hospital stays. Greater recent weight loss predicted worse eating disorder psychopathology in the study group. Alone, lower admission weight was not predictive of any outcome.
These findings are important for several reasons. First, they argue strongly for diminishing emphasis on admission weight. Understanding both the time course and total amount of weight loss appear critical. Moreover, these results underscore the seriousness of Atypical AN. It is distinguished from full AN by weight, yet this study strongly argues that this is a distinction without a difference. These results should counter the tendency to view Atypical AN as being “less severe” in any meaningful way.