Clues to Improved Long-term Recovery in Anorexia Nervosa Discovered

Anorexia nervosa (AN), an eating disorder characterized by low body weight and distorted body image, impacts approximately one percent of Ontario’s female population.  In severe cases, this complex disorder can lead to death. Previous research has found that many people with AN are unable to maintain a normal body weight, even after successful weight restoration programs and therapies.  Relapse rates can be as high as 70 percent, with the greatest risk of relapse occurring during the first year following discharge from initial treatment.

In a new study, led by CAMH’s Dr. Allan Kaplan, scientists sought to identify variables that could predict successful weight maintenance among AN patients who had restored their body weight to a healthy range in intensive treatment.  Dr. Kaplan and his team chose to focus on predictors of weight maintenance, rather than relapse predictors, as identifying factors in this area might allow for enhanced weight maintenance treatments to be designed.

Dr. Kaplan and his team studied approximately 100 patients with AN treated at New York State Psychiatric Institute and Toronto General Hospital. Once participating individuals reached a minimally normal weight after acute treatment, they were randomly assigned to receive an antidepressant or placebo along with cognitive behavioral therapy for one year. Participants were then examined at 6 and 12 months to determine if the treatments were helping patients successfully maintain their weight.

The data showed that the most powerful predictors of weight maintenance at 6 and 12 months were the level of weight restoration at the end of acute treatment and avoiding weight loss immediately following intensive treatment, rather than any specific psychological variables. Interestingly, site was also a predictor of weight maintenance as patients in Toronto fared better than those in New York.  As Dr. Kaplan explains, there is no compelling empirical evidence for this difference; the treatment and treatment philosophy were similar in both hospitals.  The variation may be due to external factors such as differences in healthcare systems at both sites. It is noteworthy that these findings are similar to what has been reported in successful relapse prevention in depression -- early recurrence of symptoms is associated with long-term relapse.

This is the first paper to definitively show that early weight loss after weight restoration in adults with anorexia nervosa is a predictor of a more long-term poor outcome for people living with this disorder. According to Dr. Kaplan, the study results suggest that better treatment may be achieved if patients reach a higher normal weight during a structured treatment programs.  He explains that preventing weight loss immediately following discharge from such programs may also be key to effective long-term recovery

E-published October 8, 2008 in  Psychological Medicine, visit The slippery slope: prediction of successful weight maintenance in anorexia nervosa for a copy of the abstract. 

 

 

 

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