‘Pudgy’ Patients During Rehabilitation

Q: During the course of nutritional rehabilitation from anorexia nervosa, many of my patients insist that they are really getting fat and misshapen. Are all these complaints due to their body image distortions? At times some of them actually do appear to be getting “pudgy” to me, and appear to be putting on extra weight around the midsection.

( B.L., Memphis)

A: Your patients may be reacting to a very real phenomenon. Recent studies by Laurel Mayer and colleagues at Columbia University have shown that anorexia nervosa inpatients who gain about 3 lb per week to the point of discharge from the hospital tend to develop fat distributions that favor the central abdomen and hips, at least in the short run.(Mayer L, et al: Body-fat distribution before and after weight gain in anorexia nervosa. Presented at the Annual Meeting of the American Psychiatric Association, May 8, 2001, New Orleans.) These patterns of weight distribution differed from normal comparison group women, who tended to have less central fat.

The resulting appearance may be particularly distressing for recovering anorexia nervosa patients, who have been fearful of just such outcomes, and, according to Mayer et al., may contribute to the risk of relapse. I reassure patients that normal redistribution is likely to occur as fat moves from these labile storage areas to more permanent, normal storage areas elsewhere in the body. Additional study is needed to determine just how and over what period of time these fat distributions will normalize.

— J.Y.