Moving Beyond “Skinniness”: Presentation Weight Is Not Sufficient to Assess Malnutrition in Patients With Restrictive Eating Disorders Across a Range of Body Weights

Garber presents an editorial on the study of Whitelaw et al that examined weight loss as a marker of illness severity in adolescents with restrictive eating disorders. The study participants were 171 adolescents age 12 to 19 on their first admission to hospital with malnutrition secondary to anorexia nervosa (AN) or atypical anorexia nervosa (AAN). The authors utilized changes in body mass index (BMI) z-score to account for potential changes in linear height during adolescence and allow weight changes to be compared across age and sex. They found that greater total and recent weight loss were stronger predictors of aberrant vital signs than admission weight. This finding has major healthcare implications, given that these vital signs comprise the hospitalization criteria for adolescents with restrictive eating disorders. They found that total weight loss predicted risk for the refeeding syndrome and longer hospital admission.