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J Adolesc Health. 2017 Jun;60(6):674-679. doi: 10.1016/j.jadohealth.2017.01.001. Epub 2017 Mar 8.

History of Overweight/Obesity as Predictor of Care Received at 1-year Follow-Up in Adolescents With Anorexia Nervosa or Atypical Anorexia Nervosa.

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Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychology, Florida State University, Tallahassee, Florida. Electronic address:
Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
Division of Adolescent Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan; Formerly at the Division of Adolescent Pediatrics, Beaumont Children's Hospital, Royal Oak, Michigan.
Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center, North Shore-Long island Jewish Health System, New Hyde Park, New York; Department of Pediatrics, Hofstra Northwell School of Medicine, Hempstead, New York.
Division of Adolescent Medicine and Eating Disorders, Penn State Children's Hospital, Hershey, Pennsylvania.
Division of Adolescent and Young Adult Health, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
Division of Adolescent Medicine, Stanford University School of Medicine, Stanford, California.
Division of Adolescent Medicine, University of California San Francisco, San Francisco, California.
Center for Adolescent Medicine, Department of General Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, Ohio.



Previous research has indicated that patients with anorexia nervosa (AN) or atypical AN with premorbid history of overweight/obesity have greater weight loss and longer illness duration than patients with no such history. However, little is known about the association of premorbid overweight/obesity and receiving inpatient medical care during treatment for an eating disorder.


Using logistic regression, we sought to determine if history of overweight/obesity was associated with receiving inpatient medical care in a sample of 522 patients (mean age 15.5 years, 88% female) with AN/atypical AN.


Binary results demonstrated greater percent weight loss (27.4% vs. 16.2%) and higher percent median body mass index (%mBMI, 99.8% vs. 85.2%) at presentation in those with a history of overweight/obesity (p < .001) but no difference in duration of illness (p = .09). In models adjusted for demographics and percent weight loss, history of overweight/obesity was associated with lower odds of receiving inpatient medical care (odds ratio .60 [95% confidence interval: .45-.80]) at 1-year follow-up. However, these associations were no longer significant after adjusting for %mBMI. Mediation results suggest that %mBMI fully mediates the relationship between history of overweight/obesity and inpatient medical care, in that those with a history of overweight/obesity are less likely to receive care due to presenting at a higher weight.


Our findings suggest that, despite greater degree of weight loss and no difference in duration of illness, participants with a history of overweight/obesity are less likely to receive inpatient medical care.


Adolescents; Anorexia nervosa; Atypical anorexia nervosa; Eating disorder; Inpatient medical care; Obesity; Overweight; Percent median body mass index; Percent weight loss

[Indexed for MEDLINE]

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