Dimensions within 24 weight history indices and their association with inpatient treatment outcome in adults with anorexia nervosa: analysis of routine data

Sandra Schlegl,Martin Greetfeld,Johannes Baltasar Hessler,Ulrich Voderholzer

doi:10.1186/s40337-019-0249-z

Abstract

ObjectiveNext to weight suppression (WS), there are a range of less often examined weight history indices, and improvements to the WS construct have been proposed. We aimed to examine redundancy and overlap between 24 weight history indices in order to identify suitable constructs for further investigation.MethodAnalysis of routine data of 770 female adult inpatients treated for AN. Twenty-four indices based on highest, lowest, and current weight, as well as developmental aspects were calculated and employed in correlational and factor analyses. The indices’ ability to predict core outcomes of inpatient treatment was investigated with regression analyses.ResultsFive factors emerged: “WS and highest weight”, “weight elevation (i.e., difference between current and lowest weight since puberty)”, “lowest weight”, “age at past highest or lowest weight”, and “years since past highest or lowest weight”. The constructs within these factors showed high correlations. Most indices related to change in weight, ED psychopathology, as well as behavioral aspect of AN. While measures of WE related more to weight gain and general ED Psychopathology, indices including lowest weight were stronger predictors of changes in slimness ideal and inappropriate compensatory behaviors.ConclusionMany proposed weight history indices are closely related and the amount of additional information in complex indices appears questionable. While highest weight seems to dominate indices of WS, WE may rely on current weight. These findings highlight that different aspects of weight history may relate to different aspects of current ED symptoms and their amenability to change under specialized treatment.

Highlights

The physiological and psychological core symptoms of anorexia nervosa (AN) revolve around weight and low weight is the cardinal diagnostic criterion
Most indices related to change in weight, Eating disorders (ED) psychopathology, as well as behavioral aspect of AN
These findings highlight that different aspects of weight history may relate to different aspects of current ED symptoms and their amenability to change under specialized treatment

Summary

Introduction

The physiological and psychological core symptoms of anorexia nervosa (AN) revolve around weight and low weight is the cardinal diagnostic criterion. The concept of weight suppression (WS), which describes the difference between In their conceptual review, Lowe and colleagues conclude that the constituents of WS are understudied and that the operationalization as applied above may not be fully adequate, as it does not relate the extent of WS to the highest weight or the expected weight for a certain (2019) 7:19 demographic group [2]. Lowe and colleagues conclude that the constituents of WS are understudied and that the operationalization as applied above may not be fully adequate, as it does not relate the extent of WS to the highest weight or the expected weight for a certain (2019) 7:19 demographic group [2] As a consequence, they suggest that more detailed analyses of weight history should be conducted, including, for example, the age at the highest lifetime weight. Studies employing the standard operationalization of WS paint a mixed picture for the association between WS and highest weight (see Lowe and colleagues for an overview [2])

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Discussion

Conclusion