Abstract
BackgroundWeight suppression (WS), which is the difference between a patient’s highest and current weight, has been associated with bulimic symptom severity in adults with bulimia nervosa (BN). However, the impact of WS on eating disorder psychopathology in youth with BN is unknown.MethodsParticipants included 85 youth with DSM-5 BN who presented for outpatient treatment. Current WS was calculated as the difference between highest and current body mass index z-score (BMIz), while greatest WS was the difference between highest and lowest BMIz, both assessed at participants’ current height. Separate multivariable linear regressions were conducted to determine if current or greatest WS was significantly associated with frequency of binge eating, compensatory behaviors, or dietary restraint. A secondary analysis was conducted on youth ages 16 and older, given the limitation of assessing WS at current height in younger participants with greater height instability.ResultsYouth with higher levels of greatest WS (but not current WS) were older, had a longer duration of illness, and reported greater weight and shape concern. When adjusting for BMIz, neither current nor greatest WS was significantly associated with bulimic behaviors or dietary restraint in the full sample. However, in the subset of youth ages 16 and older, current WS moderated the effect of BMIz on binge eating and compensatory behaviors. For youth with high WS, those with a high current BMIz engaged in more frequent binge eating than those with low current BMIz, and the negative impact of BMIz on compensatory behaviors became weaker.ConclusionsOur findings suggest that WS is clinically relevant in the presentation of youth with BN, and that it may need to be addressed as one important factor in BN psychopathology. Future studies using growth charts to determine historically highest and lowest BMIz may help to further elucidate the link (or lack thereof) between WS and BN psychopathology in youth.
Highlights
Weight suppression (WS), which is the difference between a patient’s highest and current weight, has been associated with bulimic symptom severity in adults with bulimia nervosa (BN)
Current WS was calculated as the difference between highest body mass index z-score (BMIz) and current BMIz, using weight and height measured at the assessment
This may reflect the fact that youth with BN who have low current BMIz or low historical BMIz engage in weight loss behaviors developmentally earlier or more effectively than those with higher BMIz, resulting in greater current or historical weight loss, whereas those with higher BMIz may not yet have effectively engaged in behaviors that lead to WS, regardless of possible efforts to do so
Summary
Weight suppression (WS), which is the difference between a patient’s highest and current weight, has been associated with bulimic symptom severity in adults with bulimia nervosa (BN). Theoretical models of BN in adults posit that dietary restraint contributes to binge eating and purging [1, 2]. BMI might moderate the WS-binge eating association, such that women with high WS and low BMI display the highest levels of binge eating [3] This interaction may be the result of individuals with high WS and low BMI being more metabolically or biologically predisposed to engage in binge eating than those with high WS and a higher BMI, a profile which may instead increase attempts at dietary restraint and use of compensatory behaviors. Research suggests that the effects of historical WS may be longlasting, with greatest WS predicting binge eating frequency and its interaction with BMI predicting purging frequency [3] as well as predicting long-term weight gain [7]
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