Weight regain in anorexia nervosa results in abnormal fat redistribution

Anorexia nervosa is a psychiatric illness of girls and young women that culminates in severe undernutrition with mortality rates as high as 21%. Because the patient’s self-perceived body image is an important component of successful recovery, the pattern of weight regain may have psychological significance. In research published in the American Journal of Clinical Nutrition, Grinspoon et al. studied 27 women with anorexia nervosa who were involved in an outpatient recovery program. Among the 20 patients who gained weight, body fat was increased to 37% in the trunk region, significantly higher than the 34% of the normal-weight control group.

During the 9-month study, the participants were randomly assigned to receive or not receive estrogen in the form of birth control pills. Of the 20 women who gained weight, 10 were taking estrogen and 10 were not; each group gained an average of 4.1 kg each to attain a mean BMI of 17.5. There were no differences in weight gain and body fat distribution patterns as a result of estrogen use. The significant central fat accumulation relative to the extremities was accompanied by increased urinary cortisol secretion. One explanation for the abnormal distribution of weight regain may be that excess cortisol leads to increased trunk fat accumulation, which was highest in those patients with the greatest urinary free cortisol concentrations.

In an accompanying editorial, Dr. Mayer points out that the phenomenon of disproportionate fat regain in the abdomen appears to have a biological basis, yet its psychological connotations for anorexic patients could hamper the recovery process. Future research should address the issue of whether abnormal weight redistribution occurs only in early recovery or whether it persists in the long term, in which case cardiovascular complications could occur.

Grinspoon, Steven K. et al. Changes in regional fat redistribution and the effects of estrogen during spontaneous weight gain in women with anorexia nervosa. Am J Clin Nutr 2001;73:865-9.

Mayer, Laurel. Body composition and anorexia nervosa: does physiology explain psychology? Am J Clin Nutr 2001;73:851-2.

This media release is provided by The American Society for Clinical Nutrition Inc., to provide current information on nutrition-related research. This information should not be construed as medical advice. If you have a medical concern, consult your doctor. To see the complete text of this article and the editorial, please go to:

http://faseb.org/ajcn/May/12198-Grinspoon.pdf
http://faseb.org/ajcn/May/12637-Mayer.pdf

For more information, please contact: sgrinspoon@partners.org or lsm16@columbia.edu