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Media release: Eating disorders not exclusive to those who are underweight

Adolescents who are not underweight but have lost a significant amount of weight can still be suffering from life-threatening complications associated with anorexia nervosa, a new research study has found.

Over a six year period from 2005 to 2010, researchers found more than a fivefold increase in the incidence of hospitalised adolescents who, apart from not being underweight, met all of the criteria for the diagnosis of anorexia nervosa. 

These adolescents required admission to hospital as they were suffering from acute, life-threatening medical complications of weight loss, despite not meeting the low weight criteria of anorexia nervosa. 

Professor Susan Sawyer said the research highlights that higher-weight adolescents who have lost a large amount of weight require careful medical assessment.

“Eating disorders can emerge at any weight. Clinicians need to have a high level of suspicion about a possible restrictive eating disorder in all patients who have rapidly lost weight or lost a significant amount of weight - even if the young person is not underweight at the time they present.”  

“There is poor understanding by health professionals, teachers and families of the risks of rapid, severe weight loss – at all weight. Most health professionals think ‘underweight’ when they think of anorexia. It is therefore not surprising that many of these adolescents were very unwell by the time they were eventually admitted to hospital.”

Lead researcher, Melissa Whitelaw, believes the dramatic increase in the proportion of adolescents admitted to hospital who were not yet underweight reflects increasing rates of obesity in adolescents.

“Obesity and eating disorders used to be considered as distinct health concerns with little overlap in patient populations. These data suggest that we need to be much more aware of the risks of eating disorders emerging in adolescents who are overweight.”

The research showed that while some of the patients had been advised by a health professional to lose weight, none were being professionally supported to lose weight at the time they presented with an eating disorder. Researchers said this highlights the need for supervision of appropriate weight loss efforts in overweight adolescents. 

“Regardless of their actual weight, clinicians consulting with adolescents who have lost a large amount of weight should, among other tasks, review the patient’s weight loss strategies to ensure they are sustainable and safe. They should also carefully assess the patient’s cardiovascular health. For those adolescents who have rapidly lost a large amount of weight, anorexia nervosa should be considered” said Professor Sawyer.   

Researchers said that due to a combination of factors including the nature of eating disorders, lack of parent awareness, lack of training in health professionals, and delays in accessing specialist services, there are often significant delays in making the diagnosis of anorexia nervosa, even in adolescents who are very underweight.

Both researchers are part of The Royal Children’s Hospital Specialist Eating Disorder program. The research was done in collaboration between Murdoch Children's Research Institute, The Royal Children’s Hospital and the University of Melbourne.