A History of Overweight and Obesity and Development of Restrictive Eating A sizeable number of teens may take drastic weight control measures.

Reprinted from Eating Disorders Review
January/February Volume 26, Number 1
©2015 IAEDP

Prior obesity or overweight is common among treatment-seeking adolescents with restrictive eating disorders. A history of overweight/obesity likely delays case finding, and thus may worsen prognosis for these young patients, according to a team from the Mayo Clinic and the University of Miami Miller School of Medicine (J Adolesc Health. 2015; 56:19).

According to Jocelyn Lebow, PhD, and her colleagues, healthcare professionals are more likely to identify and refer clearly malnourished adolescents than teens who are obese or overweight, and may not recognize that obese adolescents’ attempts at weight loss carry a risk for developing an eating disorder. Obesity itself is a significant risk for the development of eating disorders, and stigma and weight-based teasing may add to the likelihood of disordered eating. One population-based sample of teenaged girls showed that approximately 25% of the obese girls were currently using extreme weight-control behaviors, such as fasting or smoking (Am J Prev Med.2007; 33:359).

The researchers conducted a chart review of consecutive patients 9 to 22 years of age presenting over 6 ½ years for an eating disorder intake evaluation. A body mass index (BMI, kg/m²) history was collected, and teens completed the Eating Disorder Examination Questionnaire (EDE-Q). The results were used to assess dietary restraint, weight, shape, and eating concerns.

Approximately 36% of teens presenting for treatment for a restrictive eating disorder had a weight history above the 85th percentile for age and gender. In this subgroup, 17% had a history of being overweight and a further 19% had a history of obesity. Another finding was that adolescents with a history of overweight or obesity experienced a significantly greater drop in BMI, and the time from the onset of their eating disorder to evaluation took approximately 10 months. While there was no significant difference between the two groups on the EDE-Q subscales for Restraint or Weight Concerns or Eating Concerns, there was a trend toward a difference between the two groups on the Shape Concerns subscale, with the overweight history group having higher scores.

According to the authors, clinicians should remain vigilant for disordered eating in young patients presenting at all BMIs. Early detection of eating disorders will be helped by eliminating the “faulty assumption” that obesity and restrictive eating disorders cannot co-occur.