Incremental validity of weight suppression in predicting clinical impairment in bulimic syndromes

Research has shown that weight suppression (WS; the difference between a person's highest and current body weight in pounds) is a robust predictor of weight gain and eating‐disorder (ED) symptoms among individuals with bulimic syndromes. Given the important prognostic role that WS plays in ED course and outcome, we hypothesized that WS would represent a clinically useful indicator of impairment for bulimic syndromes. We further posited that WS would demonstrate incremental validity above‐and‐beyond other proposed indicators in explaining clinical impairment in bulimic syndromes. Participants were community‐recruited adults (N = 101; 80.2% female) with full‐threshold (n = 51) or subthreshold (n = 50) bulimia nervosa. Other indicators of impairment included body mass index, frequency of inappropriate compensatory behaviors, lifetime history of any internalizing disorder, and multiple purging. Clinical impairment was assessed with the clinical impairment assessment (CIA). Hierarchical linear regression tested whether WS added to the explanation of CIA score variance above‐and‐beyond other indicators of bulimic‐syndrome impairment. WS was significantly associated with clinical impairment (p = .011), but did not demonstrate incremental validity over other independent variables in predicting CIA scores. WS explained an additional 1.7% of the variance in CIA scores above‐and‐beyond other variables and the independent effect of WS on CIA scores represented a medium‐sized effect (Cohen's d = 0.521). Results suggested that WS may be an indicator of ED‐related clinical impairment. Inquiring about WS could be an informative component of routine bulimic‐syndrome assessment, given that WS explains some of the variance in clinical impairment in bulimic syndromes.     

Metoclopramide and unintended weight gain

OBJECTIVE: This paper describes the case of a 19-year-old female with anorexia nervosa (restricting type) who was prescribed metoclopramide (Reglan, Robins, Richmond, VA) for delayed gastric emptying. She subsequently experienced dramatic and unintended weight gain. RESULTS: The initial treatment of delayed gastric emptying with metoclopramide did not result in a significant change in body weight. However, an increase in the dose resulted in a 20% increase in the patient's body weight over a 2-month period. DISCUSSION: The risks of weight gain that accompany the administration of metoclopramide are discussed, as well as the postulated etiology and psychological implications for the patient.     

Changes in weight and body image over time in women with eating disorders

BACKGROUND: This study examined the changes in body image and weight in young women with an adolescent eating disorder, relative to women without an eating disorder (noED). METHOD: Three diagnostic groups, anorexia nervosa (AN; n = 10), bulimia nervosa (BN; n = 27), and binge eating disorder (BED; n = 42) and three comparison groups (noED; n = 659 each) were compared on body mass index (BMI) and self-reported current body size, ideal body size, and weight dissatisfaction. Dependent variables were examined 2 and 1 year before the onset, the onset year, and 1 and 2 years after the onset of the eating disorder in a model that was adjusted for ethnicity and BMI. RESULTS: BMI was lower in the AN group at all time points except 2 years before onset. AN girls evidenced a significantly stronger relation between BMI and current self-ratings and weight dissatisfaction than noED girls. BMI did not differ between the BN group and the noED group. Girls with BN reported larger current body sizes and greater weight dissatisfaction across all time points. The BED group had higher BMI than the noED group across time. BED girls reported greater current body size ratings and weight dissatisfaction than the noED girls. Girls with AN, BN, or BED did not differ from the noED girls on body ideal ratings. DISCUSSION: Body weight seems to influence perception of body size more so for girls with AN than for noED girls. No support was found for an accelerated weight gain over time for BN. Weight may increase over time for the BED group relative to the noED group, but larger studies are needed. Across all three groups, ideal body size appears to be unrelated to diagnostic status. Rather, the risk for developing an eating disorder appears to arise from size overestimation and related weight dissatisfaction.     

Sleep variables in anorexia nervosa: evolution with weight restoration

OBJECTIVE: Studies on sleep patterns in anorexia nervosa (AN) have yielded inconsistent results. Therefore, we have studied the evolution of subjective and objective sleep characteristics in AN patients before and after weight restoration. METHOD: Thirty-four severely underweight AN inpatients of the restrictive subtype had a polysomnographic sleep registration at the time of admission and after weight restoration. Subjective sleep quality was also measured with self-report instruments. RESULTS: Objective sleep variables did not change with weight restoration, whereas subjective quality of sleep did improve. Percentage of underweight at admission and amount of slow wave sleep were predictors of the length of time required for weight restoration. DISCUSSION: The finding that weight restoration does not affect polysomnographic sleep variables in AN patients seems to contradict previous studies.