Overvaluation of shape and weight in adolescents with anorexia nervosa: does shape concern or weight concern matter more for treatment outcome?

Catherine E Byrne,Daniel Le Grange,Setareh O’Brien,Andrea E Kass,James Lock,Alexandria Goodyear,Erin C Accurso,Sarah Fischer

doi:10.1186/s40337-015-0086-7

Abstract

BackgroundOvervaluation of shape and weight is a key diagnostic feature of anorexia nervosa (AN); however, limited research has evaluated the clinical utility of differentiating between weight versus shape concerns. Understanding differences in these constructs may have important implications for AN treatment given the focus on weight regain. This study examined differences in treatment outcome between individuals whose primary concern was weight versus those whose primary concern was shape in a randomized controlled trial of treatment for adolescent AN.MethodsData were drawn from a two-site randomized controlled trial that compared family-based treatment and adolescent focused therapy for AN. Chi-square tests and logistic regression analyses were conducted.ResultsThirty percent of participants presented with primary weight concern (n = 36; defined as endorsing higher Eating Disorder Examination (EDE) Weight Concern than Shape Concern subscale scores); 60 % presented with primary shape concern (n = 72; defined as endorsing higher EDE Shape Concern than Weight Concern scores). There were no significant differences between the two groups in remission status at the end of treatment. Treatment did not moderate the effect of group status on achieving remission.ConclusionsResults suggest that treatment outcomes are comparable between adolescents who enter treatment for AN with greater weight concerns and those who enter treatment with greater shape concerns. Therefore, treatment need not be adjusted based on primary weight or primary shape concerns.

Highlights

Overvaluation of shape and weight is a key diagnostic feature of anorexia nervosa (AN); limited research has evaluated the clinical utility of differentiating between weight versus shape concerns
Byrne et al Journal of Eating Disorders (2015) 3:49 analyses have generally failed to discriminate between a shape concern factor and weight concern factor on the Eating Disorder Examination (EDE) and EDE-Questionnaire (EDE-Q; the self-report questionnaire of the EDE), suggesting that separating shape and weight concerns may not be a meaningful distinction for many people [4, 5]
Results of this study revealed there were no differences in demographics, weight, or eating disorder pathology between adolescents who presented to treatment with primary weight concern versus with primary shape concern, nor was there a significant difference in clinical outcomes at the end of treatment

Summary

Introduction

Overvaluation of shape and weight is a key diagnostic feature of anorexia nervosa (AN); limited research has evaluated the clinical utility of differentiating between weight versus shape concerns. Understanding differences in these constructs may have important implications for AN treatment given the focus on weight regain. Individuals with AN appear to misperceive their own body shape as larger than the body shape of healthy controls, and perceive certain body shapes as more desirable than others These perceptions are associated with unique regions of neural activation, indicating that concerns about ‘shape’ itself are important to patients with AN, and that these misperceptions occur regardless of the actual body weight of the individual [7, 8]

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