Changes in Grip Strength, Depression, and Cognitive Functioning During Medical Stabilization for Anorexia Nervosa: Exploring the Utility of Grip Strength as a Marker of Severity

Abstract

Objective: It is not uncommon for individuals with anorexia nervosa (AN) to attempt to appear healthier than the reality, underscoring the value of establishing objective markers of AN severity to guide effective treatment. Grip strength has been proposed as one such objective marker, and the purpose of this prospective study was to explore associations in grip strength, depression, and cognitive functioning in extreme AN, including those at the lowest body weight, as these factors are associated in other populations.
Method: Forty-nine patients with extreme AN completed a standard grip strength assessment, the Beck Depression Inventory-2 (BDI-2), the Massachusetts General Hospital Cognitive and Physical Functioning Questionnaire (CPFQ), and the Coding subtest of the Wechsler Adult Intelligence Test, 4th edition, at admission and discharge from an inpatient medical stabilization unit for eating disorders. Paired-samples t-tests were used to examine admission-discharge change. Pearson correlations were used to examine associations among assessments.
Results: At admission, only 4-10% of patients exhibited normal grip strength, depending on the hand tested. Patients scored in the severely depressed range on the BDI-2 and reported markedly diminished cognitive functioning. For most patients, measures improved from admission to discharge. Among the most low-weighted patients (body mass index (BMI) ≤ 12.41 vs. higher), grip strength and depression were correlated with each other and were extraordinarily severe.
Discussion: Results indicate that positive physical, psychological, and cognitive changes can be possible within weeks of hospitalization for severe AN. Among the most low-weighted patients, depression and grip strength may function as “bedfellows.” 
Conclusion: Utilization of grip strength assessments may offer a quick, objective marker of severity of AN and may lend credence to providers’ treatment recommendations.