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Anorexia Nervosa

Extreme anorexia nervosa: medical findings outcomes, and inferences from a retrospective cohort

Journal of Eating Disorders
By Philip S. Mehler, MD, FACP, FAED, CEDS Dennis Gibson, MD, FACP, CEDS Jeana Cost, MS, LPC, CEDS

Gibson D, Watters A, Cost J, Mascolo M, Mehler PS. Extreme anorexia nervosa: medical findings outcomes, and inferences from a retrospective cohort. J of Eating Disorders. 8:25-36, 2020.

Background

Extreme anorexia nervosa (AN) is defined as a BMI < 15 kg/m2 in those meeting DSM-V diagnostic criteria for AN. This study seeks to define the frequency of medical complications in this group of patients in order to help inform the care of individuals < 65% ideal body weight who seek treatment for their extreme eating disorders.

Methods

Through retrospective chart review and computerized data collection, we obtained the baseline characteristics and medical findings of 281 adult patients, with AN restricting and binge-purge subtypes, admitted to the ACUTE unit for medical stabilization between May 2013 and August 2018.

Results

In this population, with a mean admitting BMI of 12.1 kg/m2 (range = 7.5–15.7), 56% admitted with bradycardia, 45% demonstrated increased liver function tests (LFTs) on admission, 64% admitted with leukopenia, 47% with anemia, and 20% presented with thrombocytopenia. During admission, 38% developed hypoglycemia, 35% developed refeeding hypophosphatemia, nearly 33% of patients developed edema, and low bone mineral density was diagnosed in almost 90% of the patients. Highly elevated LFTs (>3x upper limits of normal) predicted hypoglycemia, and low BMI predicted refeeding hypophosphatemia (p = .001).

Conclusions

Although conclusions drawn from the findings presented in this descriptive study must be tempered by relevant clinical judgement, these findings showcase that patients with extreme AN are at significantly increased risk for many serious medical complications secondary to their state of malnutrition and also with initial refeeding.

Plain English summary

Extreme anorexia nervosa (AN) is defined as a BMI < 15 kg/m2 in those meeting DSM-5 diagnostic criteria for AN. However, the frequency of medical complications specific to those meeting this greatest amount of weight loss is unknown. This retrospective study seeks to better define the frequency of medical complications in individuals < 65% ideal body weight admitting to an inpatient medical stabilization unit. We found that patients with extreme AN present with similar medical complications, although at a more frequent occurrence, to those at higher percent ideal body weights. Low bone mineral density is an almost universal finding in this population, with 45% of individuals presenting with osteopenia and 43% with osteoporosis. 35% of individuals developed hypophosphatemia and 38% developed hypoglycemia in this population, both more frequent in the restricting than binge-purge subtype of AN. Elevated liver function tests predict the development of hypoglycemia. Patients with extreme AN are at a significantly increased risk for many serious medical complications secondary to their state of malnutrition and also with initial refeeding.

Written by

Jeana Cost, MS, LPC, CEDS

Jeana Cost is the Vice President of Operations and Clinical Services of the ACUTE Center for Eating Disorders & Severe Malnutrition, and brings more than 15 years mental health experience to ACUTE, including extensive experience in pre-admission patient assessment, treatment recommendations and collaboration with families and outpatient teams.

ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

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