Weight Suppression in Adolescents with Anorexia Nervosa

Weight suppression, defined as the discrepancy between an individual’s highest past weight at adult height and their current weight, has attracted the interest of researchers and clinicians studying and treating eating disorders over the last decade.

The studies on weight suppression have been stimulated by the findings that it is associated with important physical adaptations (e.g., reduced energy expenditure and alteration of signals of hunger and satiety) and psychosocial symptoms (food preoccupation, irritability, mood swing, social withdrawal, decreased sexual drive, etc.) creating a pressure to return to a higher weight and therefore contributing to the maintenance of eating disorder psychopathology and influencing treatment outcome.

Most research on weight suppression has been conducted in adults with bulimia nervosa. In summary, the studies found that higher weight suppression is associated with increased eating disorder psychopathology, greater frequency of binge-eating and purging episodes, weight gain during treatment, and increased treatment dropout. However, the data on the role of weight suppression in the maintenance of binge eating episodes following treatment are inconsistent.

The role of weight suppression in adults with anorexia nervosa has been less studied. However, the available data suggest that higher weight suppression is associated with increased eating disorder psychopathology and greater and more rapid weight gain during treatment. However, the data on the impact of weight suppression and the likelihood of successful weight maintenance or time to relapse following restoration to a minimally normal weight are inconsistent.

Very few data are available on the role of weight suppression in adolescents with eating disorders. A study on a community sample of adolescent-onset anorexia nervosa found that higher weight suppression at the time of lowest weight was associated with a higher body mass index (BMI) at 6- and 10-year follow-ups. On the contrary, a study of 201 adolescents with a restrictive eating disorder and a wide range of BMI at the presentation found that lower weight suppression at follow-up was associated with a favorable one-year outcome of family-based treatment.

The role of weight suppression in cognitive behavioral therapy for adolescents with anorexia nervosa

A study by my team recently published in the International Journal of Environmental Research and Public Health aimed to establish the role of developmental weight suppression in a cohort of adolescents with anorexia nervosa treated with intensive enhanced cognitive behavioral therapy (CBT-E).

128 adolescent patients with anorexia nervosa, aged between 14 and 19 years, who failed previous outpatient treatment, were recruited from consecutive referrals to a community-based eating disorder clinic offering intensive CBT-E. 101 (94.4%) of the 107 patients who completed the treatment were classed as having a “good BMI outcome” (i.e., BMI percentile corresponding to an adult BMI of ≥ 18.5 kg/m2), and 75 (70.1%) displayed a “full response” (good BMI outcome and minimal eating disorder psychopathology) at the end of therapy. Among the 78 patients who completed the 20-week follow-up, 79.5% had a “good BMI outcome,” and 61.5% had a “full response.”

Developmental weight suppression was unrelated to either interruption of treatment or “good BMI outcome” or “full response” at the end of treatment or at the 20-week follow-up. However, developmental weight suppression was negatively correlated with end-of-treatment and follow-up BMI. In other words, the lower the baseline weight suppression, the better the BMI outcome. Since higher weight suppression could correspond to lower baseline BMI and higher maximum weight, it is possible that the negative association between weight suppression and BMI at the end of treatment and follow-up found could depend in part on the difficulties of adolescent patients with anorexia nervosa in accepting their naturally healthy body weight.

In conclusion, the data of this study confirm that intensive CBT-E is effective for adolescent patients with anorexia nervosa who have failed previous outpatient treatment and indicate that weight suppression is a negative predictor of BMI outcome. Future research should confirm these findings, which potentially pave the way to using information about weight suppression to refine treatment and set individualized goals in adolescent patients with anorexia nervosa.