Predicting Weight Maintenance after Discharge for Teens with AN

The mean length of stay for inpatient
treatment of anorexia nervosa (AN) is
between 24 and 40 days. Trying to reduce
hospital stay is a general trend in treatment for all psychiatric disorders in teens, since it is important not to interrupt school and family or social life longer than is necessary and because hospital costs are so expensive. However, shortening hospitalization may mean that the main part of psychological treatment is left to the day hospital or outpatient follow-up. Thus, it is important to know which variables may help predict a good outcome for the short- and the long term.

A team of psychiatrists and psychologists in Barcelona, Spain administered a series of questionnaires to 49 patients with AN. The patients were from 10 to 17 years of age (mean age: 14.3 years) and were consecutively admitted to an eating disorder unit. The questionnaires were the Eating Attitudes Test, the Beck Depression Inventory, the Leyton Obsessional Inventory, and the Anorexia Nervosa Stages of Change Questionnaire. The girls were evaluated at admission, upon discharge from the hospital, and at a 9 months’ follow-up session.

Factors linked to successful weight maintenance

As Josephina Castro-Fornieles, MD reports (Int J Eat Disord 2007; 40:129), high motivation to change, low abnormal eating attitudes, depressive symptomatology at discharge, and high body mass index (BMI) at admission were all associated with weight maintenance in this group of teens with AN.

The authors note that among young adolescent patients, variables that affect weight maintenance after hospital discharge may differ from those identified in adult patients. The reason for this is that the teens present special characteristics of their own age group and in many cases treatment is not voluntary. The single best indicator of successful weight maintenance after hospital discharge was willingness to change, which the authors defined as the willingness of patients to introduce any change that leads to improvement of their disorder and to perform those actions necessary to achieve it.

As the authors predicted, the group with poor weight maintenance after discharge from the hospital had higher scores in abnormal eating attitudes, reflecting more serious eating disorders and more abnormal ideas and behaviors in relation to food intake, body weight and body image. There were no differences between the patients’ ability to maintain weight after discharge and the type of AN or the type of pharmacologic treatment they were receiving. Also, BMI at discharge did not differ between teens with good or poor weight maintenance. This unexpected result might have been due to the fact that the patients’ BMIs were very similar at discharge.