Reprinted from Eating Disorders Review
September/October 2000 Volume 11, Number 5
©2000 Gürze Books
Low body mass index (BMI) at admission for treatment may predict a poor outcome for patients with anorexia nervosa (AN). Professor Wolfgang Herzog reported the results of his 21-year follow-up of 84 consecutively treated female AN patients (Lancet 2000;355:721).
A polarization of patients. At the 21-year mark, 50.6% of patients had fully recovered, 10.4% still met full diagnostic criteria for AN, and 15.6% had died from the effects of AN. AN patients had a 10-fold higher mortality rate than age-matched controls. A common denominator among those who died was a low BMI. All patients who died had had a BMI of 13 or less when first referred. Other factors that predicted outcome were severity of psychosocial symptoms when treatment began and weight gain during the first inpatient treatment. Duration of illness before first treatment was the best predictor.
Osteoporosis, renal failure. Low bone mineral density and chronic renal disorders were common at the 12-year follow-up mark. The incidence of osteoporosis among the entire group was 17%. Among those with a poor outcome, bone density was more than 2 standard deviations below normal. Five percent of patients had chronic renal insufficiency that required hemodialysis.