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Weight suppression predicts weight change over 5 years in bulimia nervosa

Harris Center, Department of Psychiatry, Massachusetts General Hospital, 2 Longfellow Place, Ste 200, Boston, MA 02114, USA.
Psychiatry Research (Impact Factor: 2.68). 05/2010; 177(3):330-4. DOI: 10.1016/j.psychres.2010.03.002
Source: PubMed

ABSTRACT Recent studies suggest that weight suppression (WS), defined as the discrepancy between current and highest past weight, predicts short-term weight gain in bulimia nervosa (BN) during treatment. The current study was designed to build on this preliminary work by examining the relation between WS and long-term weight change in BN. Treatment-seeking women (N=97) with DSM-IV BN participated in a naturalistic longitudinal follow-up study of eating disorders. At intake, height and weight were measured and highest past weight was assessed. Self-reported weights were collected every 6 months for 5 years. Hierarchical Linear Modeling (HLM) estimated growth curves for weight change over time. Significant inter-person variability was detected for intercepts and slopes (P<0.001) so both were treated as random effects. Participants' weights increased over the study course, moderated by baseline WS (P<0.001), such that higher WS predicted more rapid weight gain. Weight change was not associated with entry weight, height, or highest-ever weight, suggesting that WS per se predicted weight change. These findings complement previous short-term studies in BN by demonstrating that WS predicts weight gain over 5 years. Because weight gain could spur radical dieting that maintains BN, these results have important treatment implications.

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    • "Abrupt disruptions in caloric expenditures brought on by binge eating and the use of compensatory behaviors may also be linked to weight cycling and the associated negative outcomes described above [72] [76]. Furthermore, attempts to suppress weight are associated with poorer outcomes in treating patients with bulimia: those who have bulimia who try to maintain a weight-suppressed state are likely to binge eat [77], gain weight [75] [78], and drop out of psychotherapeutic treatment [77]. Notably, behavioral weight loss (BWL) has been considered one treatment option for binge eating disorder (BED). "
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    ABSTRACT: USING AN ETHICAL LENS, THIS REVIEW EVALUATES TWO METHODS OF WORKING WITHIN PATIENT CARE AND PUBLIC HEALTH: the weight-normative approach (emphasis on weight and weight loss when defining health and well-being) and the weight-inclusive approach (emphasis on viewing health and well-being as multifaceted while directing efforts toward improving health access and reducing weight stigma). Data reveal that the weight-normative approach is not effective for most people because of high rates of weight regain and cycling from weight loss interventions, which are linked to adverse health and well-being. Its predominant focus on weight may also foster stigma in health care and society, and data show that weight stigma is also linked to adverse health and well-being. In contrast, data support a weight-inclusive approach, which is included in models such as Health at Every Size for improving physical (e.g., blood pressure), behavioral (e.g., binge eating), and psychological (e.g., depression) indices, as well as acceptability of public health messages. Therefore, the weight-inclusive approach upholds nonmaleficience and beneficience, whereas the weight-normative approach does not. We offer a theoretical framework that organizes the research included in this review and discuss how it can guide research efforts and help health professionals intervene with their patients and community.
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    • "There also is evidence that weight suppression predicts weight gain in individuals with BN during inpatient (Lowe, Davis, Lucks, Annunziato, & Butryn, 2006) and outpatient (Carter, McIntosh, Joyce, & Bulik, 2008) treatment and over five-year follow-up (D. B. Herzog, et al., 2010). In contrast, other measures of weight history, such as highest or lowest body mass index (BMI) at current height and the difference between lowest weight and current weight, have failed to demonstrate consistent associations with disordered eating symptoms or weight gain (Butryn et al., 2011; Butryn, Lowe, Safer, & Agras, 2006; Carter et al., 2008), suggesting that weight suppression may be particularly salient to the presentation and course of eating disorders. "
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    ABSTRACT: Previous studies have documented that weight suppression (a person's highest adult weight minus current weight) predicts weight gain and disordered eating symptoms during treatment of bulimia spectrum disorders, but no research has examined weight suppression in individuals with anorexia nervosa (AN). Thus, this study sought to characterize weight suppression in a large sample of patients with AN (N = 185), and to evaluate whether weight suppression at admission for intensive behavioral treatment predicts weight gain and clinical outcomes at discharge. Weight suppression varied from 0 kg to 78 kg (M [SD] = 17.1 [10.8] kg) in AN patients. Higher levels of weight suppression predicted greater total weight gain, a faster rate of weight gain, and bulimic symptoms during intensive treatment even after controlling for body mass index on admission, length and type of intensive treatment received, restricting versus binge-eating/purging AN subtype, and other predictors of study outcomes. These findings converge with previous research documenting the clinical significance of weight suppression in the treatment of eating disorders. Future work is needed to replicate the current findings, and examine whether weight suppression predicts the course of AN following discharge from intensive treatment.
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    ABSTRACT: To characterize factors associated to diagnostic crossover from anorexia nervosa restricting type (ANR) and anorexia nervosa binge-purging type (ANBP) to bulimia nervosa (BN) and to compare BN individuals with initial ANR or ANBP to subjects with stable BN. Two hundred thirty-eight patients with current and lifetime diagnosis of AN or BN underwent diagnostic, psychopathological, and historical examinations by means of ad hoc clinical interviews and rating scales. One hundred twenty-three individuals had a stable BN. Seventy patients had a diagnosis of ANR and 45 of ANBP at the time of disease onset; 24 ANR patients and 23 ANBP subjects developed BN, whereas 46 ANR patients and 22 ANBP subjects did not crossover. Although the rate of diagnostic crossover was higher in the ANBP group than in the ANR one, the difference was not statistically significant. Longer illness duration, higher maximum past body mass index (BMI), higher novelty seeking, and lower self-directedness resulted significantly associated to crossover from ANR to BN, whereas higher maximum past BMI, higher desired body weight, higher novelty seeking, and lower harm avoidance were significantly associated to crossover from ANBP to BN. As compared to stable BN subjects, BN patients with initial ANR exhibited lower minimum past BMI, lower desired body weight, higher drive for thinness, ascetism, and social insecurity scores; BN patients with initial ANBP exhibited lower minimum past BMI and decreased enteroceptive awareness scores. Different clinical and personality factors seem to be associated to crossover from ANR and ANBP to BN. Moreover, BN with initial ANR seems to differ clinically from stable BN. These findings may have therapeutic and prognostic implications.
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