Research: A third of hospitalised adolescents with life-threatening anorexia are not thin

December 3, 2018, University of Melbourne
Credit: CC0 Public Domain

Health workers are being urged to closely monitor adolescents losing weight after a study of patients with anorexia nervosa found 31 per cent had all the cognitive features and physical complications of the disease without being underweight.

Dietitian Melissa Whitelaw is calling for a change to nervosa's diagnostic criteria after finding that patients with "atypical anorexia" suffer serious health concerns despite being within or above the healthy range.

Her study, published in the Journal of Adolescent Health, looked at 171 patients aged 12-19 admitted to the Royal Children's Hospital's eating disorder program between 2005-2013 suffering anorexia nervosa. She found:

  • 51 of the patients were "atypical" with significant eating disorder psychopathology, but not
  • Rather than being underweight, greater was associated with life threateningly low pulse rates, a complication of starvation in anorexia nervosa that requires admission
  • Those with atypical anorexia nervosa also suffered and deranged blood electrolytes
  • Importantly, no complication was independently associated with underweight, the hallmark of anorexia
  • No participant in the study was being monitored by a health professional for weight loss, their relationship with food, or their methods of losing weight.

Mrs Whitelaw said atypical patients may have been encouraged by family or to lose weight, which frequently resulted in positive re-enforcement and encouragement about how good they looked, praise for losing weight and the ability to wear trendier clothes, which spurred them on to try to lose more weight.

Atypical anorexia nervosa patients might have lost about a quarter of their body weight, but the body could go into "starvation mode" if as little as 10 per cent of weight was lost quickly, causing the heart rate to slow to preserve energy.

"If adolescents lose weight, it doesn't matter what weight they are, a health professional should monitor them to check that weight loss is appropriate and if so, that it is done gradually. They should also monitor the adolescent's dietary intake and relationship with food and exercise for signs the patient was spiralling into an . Following large amounts of weight loss, careful medical assessment is also recommended," Mrs Whitelaw said.

Once a person entered starvation mode the only way to increase the heart rate was re-feeding and weight gain, which in this cohort, required hospitalisation.

Mrs Whitelaw said people could understand an extremely thin patient needing to gain weight, but it was often a shock to individuals and families when someone within or above the healthy weight range needed to gain weight.

Mrs Whitelaw said atypical anorexia nervosa was commonly perceived as less severe than anorexia nervosa, but her research showed the health consequences could be just as dangerous and it was time to change the current which stated those with anorexia nervosa must be underweight.

"What we are seeing now is that you can have a healthy body weight but be just as sick as someone with typical anorexia nervosa, including having the same thoughts about eating and food," she said. "We need to redefine anorexia because an increasing proportion of patients are atypical and more difficult to recognise. The definition should refer to weight loss, not just underweight."

Mrs Whitelaw said: "The face of eating disorders is changing against a backdrop of increasing prevalence of overweight and obesity. Families, teachers, sports coaches and others interacting with young people should not delay seeking help for adolescents with worrying eating patterns if they have lost weight, even if they are not underweight."

Explore further: Researchers develop model on how brain reward response may impact anorexia nervosa

More information: Melissa Whitelaw et al. Predictors of Complications in Anorexia Nervosa and Atypical Anorexia Nervosa: Degree of Underweight or Extent and Recency of Weight Loss?, Journal of Adolescent Health (2018). DOI: 10.1016/j.jadohealth.2018.08.019

Related Stories

Researchers develop model on how brain reward response may impact anorexia nervosa

July 26, 2018
Researchers at the University of Colorado Anschutz Medical Campus have found that the brain's response to taste stimuli is linked to high anxiety and a drive for thinness that could play a role in driving anorexia nervosa.

Anorexia nervosa patients prefer underweight bodies

October 9, 2018
An interdisciplinary team of scientists from the Max Planck Institute for Biological Cybernetics, the University of Tübingen and the Max Planck Institute for Intelligent Systems placed test persons in front of their virtual ...

Anorexia more stubborn to treat than previously believed, analysis shows

August 30, 2018
Anorexia nervosa is a psychiatric illness that primarily effects young people during their adolescence. While anorexia is relatively uncommon, affecting about 1 percent of the population, it can be lethal. Indeed, despite ...

More rapid refeeding protocol seems safe in anorexia nervosa

February 16, 2015
(HealthDay)—Refeeding patients with anorexia nervosa to achieve more rapid weight gain can be safe and effective in a hospital-based protocol, according to a study published online Jan. 27 in the International Journal of ...

Even after treatment, brains of anorexia nervosa patients not fully recovered

March 1, 2017
Even after weeks of treatment and considerable weight gain, the brains of adolescent patients with anorexia nervosa remain altered, putting them at risk for possible relapse, according to researchers at the University of ...

The role of sexuality in eating disorders

January 3, 2018
A new study published in the current issue of Psychotherapy and Psychosomatics explores the role of sexuality in the long-term outcome of anorexia nervosa and bulimia nervosa. As with other psychiatric disorders, anorexia ...

Recommended for you

Teens get more sleep with later school start time, researchers find

December 12, 2018
When Seattle Public Schools announced that it would reorganize school start times across the district for the fall of 2016, the massive undertaking took more than a year to deploy. Elementary schools started earlier, while ...

Large restaurant portions a global problem, study finds

December 12, 2018
A new multi-country study finds that large, high-calorie portion sizes in fast food and full service restaurants is not a problem unique to the United States. An international team of researchers found that 94 percent of ...

Study highlights potential benefits of continuous EEG monitoring for infant patients

December 12, 2018
A recent retrospective study evaluating continuous electroencephalography (cEEG) of children in intensive care units (ICUs) found a higher than anticipated number of seizures. The work also identified several conditions closely ...

Scientists have identified and modelled a distinct biology for paediatric AML

December 11, 2018
Scientists have identified and modelled a distinct biology for paediatric acute myeloid leukaemia, one of the major causes of death in children.

A correlation between obesity and income has only developed in the past 30 years

December 11, 2018
It is well known that poorer Americans are more likely to be obese or suffer from diabetes; there is a strong negative correlation between household income and both obesity and diabetes. This negative correlation, however, ...

BMI is a good measure of health after all, new study finds

December 11, 2018
A new study from the University of Bristol supports body mass index (BMI) as a useful tool for assessing obesity and health.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.