Body composition, eating disorder psychopathology, and psychological distress in anorexia nervosa: a longitudinal study. Does percent body fat predict outcome in anorexia nervosa? Changes in regional fat redistribution and the effects of estrogen during spontaneous weight gain in women with anorexia nervosa. An evaluation of family therapy in anorexia nervosa and bulimia nervosa. An open trial of fluoxetine in patients with anorexia nervosa. Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial.
BACKGROUND Although the effect of immediate weight restoration on body composition and body fat distribution has previously been studied in anorexia nervosa ( AN ) , its influence in women with AN on eating disorder psychopathology and psychological distress has not previously been investigated to our knowledge . OBJECTIVES We assessed body composition and fat mass distribution before and after body weight restoration and investigated any relation between changes in body fat patterns of patients with AN treated in a specialist inpatient unit and their eating disorder and psychological distress features . DESIGN Body composition was measured by using dual-energy X-ray absorptiometry in 50 female , adult patients with AN before and after complete weight restoration [ body mass index ( BMI ; in kg/m² ) ≥18.5 ] and 100 healthy control subjects matched by age and posttreatment BMI of study group participants . Eating disorder psychopathology and psychological distress were assessed in the AN group before and after weight restoration by using the Eating Disorder Examination interview and the Global Severity Index of the Brief Symptom Inventory ( BSI-GSI ) , respectively . RESULTS After the achievement of complete weight restoration , patients with AN had higher trunk ( P < 0.001 ) , and roid ( P < 0.001 ) , and gynoid ( P < 0.001 ) fat masses and lower arm ( P < 0.001 ) and leg ( P = 0.001 ) fat masses with respect to control subjects . No relation was shown between body-composition variables and eating disorder psychopathology in the AN group , and the only significant predictor of change in BSI-GSI was the baseline BSI-GSI score . CONCLUSION The normalization of body weight in patients with AN is associated with a preferential distribution of body fat in central regions , which does not , however , seem to influence either eating disorder psychopathology or psychological distress scores OBJECTIVE The goal of this study was to investigate the relationship of body composition and neuroendocrine levels with clinical outcome in women with anorexia nervosa in a relapse-prevention trial . METHOD Body composition and fasting cortisol and leptin levels were assessed before r and om assignment in 32 weight-recovered subjects with anorexia nervosa from the New York site of the Fluoxetine to Prevent Relapse in Women With Anorexia Nervosa trial . Clinical outcome at the end of study participation was defined using modified Morgan-Russell criteria ( full , good , fair , poor ) , then dichotomized into treatment " success " or " failure . " RESULTS In a binary logistic regression model examining the effect of percent body fat , body mass index , anorexia nervosa subtype , waist-to-hip ratio , and serum cortisol and leptin levels on treatment outcome , only percent body fat was significantly associated with outcome . CONCLUSIONS In recently weight-restored women with anorexia nervosa , lower percent body fat was associated with poor long-term outcome BACKGROUND Anorexia nervosa is a disease of severe acquired undernutrition with a high and increasing prevalence among young women in the United States . OBJECTIVE The objective was to investigate the effects of spontaneous outpatient weight recovery and estrogen administration on fat distribution in patients with anorexia nervosa . DESIGN Twenty-seven amenorrheic women aged 26.6 + /- 1.2 y with anorexia nervosa were identified through an outpatient study of bone loss and were r and omly assigned to receive or not receive estrogen without any dietary intervention other than calcium and multivitamin supplements .  Body composition was measured at baseline and at 6 and 9 mo and was compared with cross-sectional values obtained in 20 healthy , eumenorrheic , age-matched ( 25.4 + /- 0.5 y ) control subjects . RESULTS Twenty of the 27 patients with anorexia aged 27.0 + /- 1.3 y spontaneously gained weight ( 4.1 + /- 0.9 kg ) ; body mass index ( in kg/m(2 ) ) increased from 16.1 + /- 0.3 to 17.5 + /- 0.4 . Fat mass and lean mass accounted for 68 % and 32 % of the gain in total body mass , respectively . With spontaneous weight gain , there was a significant increase in the percentage of trunk fat from 32.4 + /- 1.3 % at baseline to 36.5 + /- 1.0 % at 9 mo ( P = 0.03 ) , which correlated with urinary free cortisol ( r = 0.66 , P = 0.003 ) . Estrogen treatment was not protective against the gain in trunk fat with spontaneous weight gain . CONCLUSIONS In women with anorexia nervosa , spontaneous weight gain is associated with a significant increase in trunk adiposity , and estrogen administration may not protect against the accumulation of central fat with weight gain A controlled trial comparing family therapy with individual supportive therapy in anorexia nervosa and bulimia nervosa was undertaken . Eighty patients ( 57 with anorexia nervosa ; 23 with bulimia nervosa ) were first admitted to a specialized unit to restore their weight to normal . Before discharge , they were r and omly allocated to family therapy or the control treatment ( individual supportive therapy ) . After one year of psychological treatment , they were reassessed , using body weight , menstrual function , and ratings on the Morgan and Russell scales . Family therapy was found to be more effective than individual therapy in patients whose illness was not chronic and had begun before the age of 19 years . A more tentative finding was the greater value of individual supportive therapy in older patients . To our knowledge , this is the first controlled trial of family therapy in anorexia nervosa and clarifies the specific indications for this treatment BACKGROUND Anorexia nervosa is a disorder of unknown etiology with a high rate of relapse and no known treatment . Because anorexia nervosa shares some similarities with obsessive compulsive disorder , we hypothesized that a serotonin-specific medication might be useful in the treatment of this illness . METHOD We administered an open trial of fluoxetine to 31 patients with DSM-III-R anorexia nervosa . Most anorexics were started on fluoxetine treatment after inpatient weight restoration and then discharged from the hospital and followed up as out patients . RESULTS At the time of follow-up ( 11 + /- 6 months on fluoxetine ) , 29 of the 31 patients had maintained their weight at or above 85 % average body weight ( 97 % + /- 13 % average body weight for the group ) . We judged response as good in 10 , partial in 17 , and poor in 4 anorexics as measured by improvements in eating behavior , mood , and obsessional symptoms . Restrictor anorexics responded significantly better than bulimic and /or purging-type anorexics . CONCLUSION This open trial suggests that fluoxetine may help patients with anorexia nervosa maintain a healthy body weight as out patients . The reasons for the positive effects of fluoxetine are uncertain , but the agent may help by improving eating behavior and /or reducing obsessionality , depression , and anxiety . It is important to emphasize that this was not a double-blind , placebo-controlled study . Thus we can not be certain of the efficacy of fluoxetine and caution that fluoxetine should not be used as the sole treatment of anorexia nervosa at this time CONTEXT Antidepressant medication is frequently prescribed for patients with anorexia nervosa . OBJECTIVE To determine whether fluoxetine can promote recovery and prolong time-to-relapse among patients with anorexia nervosa following weight restoration . DESIGN , SETTING , AND PARTICIPANTS R and omized , double-blind , placebo-controlled trial . From January 2000 until May 2005 , 93 patients with anorexia nervosa received intensive inpatient or day-program treatment at the New York State Psychiatric Institute or Toronto General Hospital . Participants regained weight to a minimum body mass index ( calculated as weight in kilograms divided by the square of height in meters ) of 19.0 and were then eligible to participate in the r and omized phase of the trial . INTERVENTIONS Participants were r and omly assigned to receive fluoxetine or placebo and were treated for up to 1 year as out patients in double-blind fashion . All patients also received individual cognitive behavioral therapy . MAIN OUTCOME MEASURES The primary outcome measures were time-to-relapse and the proportion of patients successfully completing 1 year of treatment . RESULTS Forty-nine patients were assigned to fluoxetine and 44 to  placebo . Similar percentages of patients assigned to fluoxetine and to placebo  maintained a body mass index of at least 18.5 and remained in the study for 52 weeks ( fluoxetine , 26.5 % ; placebo , 31.5 % ; P = .57 ) . In a Cox proportional hazards analysis , with prer and omization body mass index , site , and diagnostic subtype as covariates , there was no significant difference between fluoxetine and placebo in time-to-relapse ( hazard ratio , 1.12 ; 95 % CI , 0.65 - 2.01 ; P = .64 ) . CONCLUSIONS This study failed to demonstrate any benefit from fluoxetine in the treatment of patients with anorexia nervosa following weight restoration . Future efforts should focus on developing new models to underst and the persistence of this illness and on exploring new psychological and pharmacological treatment approaches . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00288574
First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat .
Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females .
Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls .
Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults .
Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .
The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .