Prevalence of a history of overweight and obesity in adolescents with restrictive eating disorders
J Adolesc Health.
, In press; doi:

Investigators from multiple institutions conducted a study to examine the relationship between a history of overweight or obesity and eating disorders characterized by dietary restriction or weight loss. The researchers retrospectively reviewed data on new patients aged 9–22 years who were diagnosed with anorexia nervosa or an eating disorder (not otherwise specified) with weight loss and/or dietary restriction at the Mayo Clinic eating disorder clinic in Rochester, MN between 2007 and 2013.

Data extracted from the medical records included historical body mass index (BMI) information, BMI at the time of the eating disorder intake, BMI decrease at the time of eating disorder intake, number of months between first-reported eating disorder symptom and eating disorder intake, and number of physical symptoms. Eating disorder severity at intake was assessed using the Eating Disorder Examination-Questionnaire. The investigators compared weight loss, duration of symptoms, and severity of symptoms in patients with a history of BMI above the 85th percentile for age and gender on CDC growth charts (overweight or obese group) to those below the 85th percentile (average-weight group).

Data on 179 adolescents were analyzed; the majority (85%) of participants were female. Of the 179 patients, 36.7% had a history of a BMI above the 85th percentile (17.7% between 85th and 95th percentile; 19.0% >95th percentile). Patients with a history of overweight or obesity had a larger BMI decrease at eating disorder intake (5.37 kg/m2) compared to the average-weight group (3.57 kg/m2; P < .0001). Historically overweight or obese patients also had a longer duration of illness before presentation (19.9 vs 11.1 months; P < .0001). No differences were detected between groups in the number of physical symptoms or eating disorder severity.

The investigators conclude that a substantial proportion of adolescents seeking treatment for restrictive eating disorders have a history of overweight or obesity and that these adolescents experience a delay in eating disorder diagnosis. Increasing earlier detection of eating disorders in adolescents who have been overweight or obese may minimize the consequences on patients’ overall health and well-being.

Dr Wong has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

With the increased focus on screening children and adolescents for obesity, pediatricians are identifying more overweight and obese patients and counseling them on strategies for weight loss or reaching a “healthy” weight range. The findings of this study indicate that overweight and obese adolescents are not exempt from having or developing an eating disorder. They not only represented a substantial group of the patients seeking treatment at the study’s eating disorder clinic but also were at higher risk for delayed detection and treatment.

The delay in diagnosis or misdiagnosis of eating disorders...

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