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: 2.47). 05/2010; 177(3):330-4. DOI: 10.1016/j.psychres.2010.03.002
Source: PubMed


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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    • "Findings from previous studies have shown that greater weight suppression (i.e., larger discrepancy between highest and current weight) is associated with: (a) maintenance and onset of BN symptoms over the long term in college men and women (Keel and Heatherton, 2010); (b) weight gain over the short term (i.e., during treatment) and long term in non-clinical (Stice et al., 2011) and ED samples (Herzog et al., 2010; Lowe, et al., 2006a; Lowe, et al., 2006b; Wildes and Marcus, 2012; Witt et al., 2014); (c) longer time to ED recovery (Lowe et al., 2011); and (d) maintenance of bulimic symptoms following bulimia nervosa (BN) treatment (Butryn et al., 2006) and anorexia nervosa (AN) treatment (Wildes and Marcus, 2012; Witt et al., 2014). However, not all studies have found weight suppression to be a significant predictor of ED symptoms and/or treatment outcome variables (e.g., Carter et al., 2008; Dawkins et al., 2013; Van Son et al., 2013; Zunker et al., 2011). "
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    ABSTRACT: Evidence suggests that weight suppression, the difference between an individual's highest historical body weight and current body weight, may play a role in the etiology and/or maintenance of eating disorders (EDs), and may also impact ED treatment. However, there are limited findings regarding the association between weight suppression and dimensions of ED psychopathology, particularly in multi-diagnostic ED samples. Participants were 1748 adults (94% female) from five sites with a variety of DSM-IV ED diagnoses who completed the Eating Disorder Questionnaire, a self-report measure of various attitudinal, behavioral, and medical features of EDs. Four factor analytically derived dimensions of ED psychopathology were examined: (a) weight/shape concerns, (b) binge eating/vomiting, (c) exercise/restrictive eating behaviors, and (d) weight control medication use. Hierarchical regression analyses were conducted to examine the unique association of weight suppression with each dimension (controlling for ED diagnosis and BMI), as well as the independent unique associations of three interactions: (a) weight suppression × BMI, (b) weight suppression × ED diagnosis, and (c) BMI × ED diagnosis. Results revealed that weight suppression was uniquely associated with all of the ED psychopathology dimensions except binge eating/vomiting. The weight suppression × BMI interaction was significant only for weight/shape concerns, whereas the weight suppression × ED diagnosis was not significant for any of the dimensions. Significant BMI × ED diagnosis interactions were found for all dimensions except weight/shape concerns. Overall, the current results support the salience of weight suppression across multiple dimensions of ED psychopathology, with the exception of binge eating/vomiting.
    Full-text · Article · Oct 2015 · Journal of Psychiatric Research
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    • "Individuals with higher WS may fear returning to their premorbid weight, which may contribute to the maintenance of bulimic symptoms. For individuals with high WS, evidence indicates that weight gain concerns may be realistic (e.g., Stice, Durant, Burger, & Schoeller, 2011); increased WS has been found to predict increased weight gain during short-term inpatient (Lowe et al., 2006) and outpatient treatment (Carter, McIntosh, Joyce, & Bulik, 2008) as well as over 5-year follow-up (Herzog et al., 2010). Importantly, several studies have documented changes in energy expenditure resulting from reduced weight (i.e., WS; e.g., Leibel, Rosenbaum, & Hirsch, 1995; Stice et al., 2011) and the role of leptin in influencing resting metabolic rate, energy expenditure, and subsequent body weight (e.g., Leibel, 2002; Rosenbaum et al., "
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    ABSTRACT: Bulimia nervosa (BN) is a serious eating disorder that can persist for years and contribute to medical complications and increased mortality, underscoring the need to better understand factors maintaining this disorder. Higher levels of weight suppression (WS) have been found to predict both the onset and maintenance of BN; however, no studies have examined mechanisms that may account for the effects of WS on BN. We hypothesized that high WS would lead to reduced leptin levels, which may increase risk of binge eating by modulating reward responses to food. The current study examined the relationship between WS, leptin levels, and the reinforcing value of food in women with BN (n = 32) and noneating disorder controls (n = 30). Participants provided information on WS, completed a fasting blood draw to obtain serum leptin, and completed a progressive ratio task to measure the reinforcing value of food. Individuals with BN had greater WS (p < .01) and reinforcing food value (p < .05) compared with controls. Additionally, higher WS was associated with both lower leptin (p < .05) and increased reinforcing value of food (p < .05). Contrary to hypotheses, BN and control participants did not differ on leptin levels, and leptin levels were not significantly associated with the reinforcing value of food. Findings support that efforts to conform to the thin ideal may alter drive to consume rewarding foods and leave women vulnerable to binge episodes. However, mechanisms through which WS contributes to food reward and binge eating remain unknown. (PsycINFO Database Record (c) 2015 APA, all rights reserved).
    Full-text · Article · Jul 2015 · Journal of Abnormal Psychology
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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.
    Full-text · Article · Jul 2014 · Journal of obesity
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