Am J Psychiatry 1991; 148:1675-1682
Copyright © 1991 by American Psychiatric Association
Abnormal caloric requirements for weight maintenance in patients with anorexia and bulimia nervosa
TE Weltzin, MH Fernstrom, D Hansen, C McConaha and WH Kaye
Department of Psychiatry, University of Pittsburgh School of Medicine, PA.
OBJECTIVE: This study tested previous findings that patients with eating
disorders who attain normal weight have abnormal caloric requirements for
maintaining weight. METHOD: Fifty-three female patients meeting the
DSM-III-R criteria for anorexia nervosa and/or bulimia nervosa were divided
into four subgroups, and their daily caloric intake was measured over a
weight-stable period. Patients with anorexia nervosa (restricting and
bulimic subtypes) were studied 4 weeks after refeeding and weight gain,
when they had attained 95% of average body weight. Patients with
normal-weight bulimia (previously anorexic or never previously anorexic)
were studied 1-4 weeks after admission to an inpatient unit. RESULTS: After
weight restoration, restricting anorexic patients required significantly
more calories per day to maintain weight than did bulimic anorexic
patients, as measured with corrections for weight, body surface area, and
fat-free mass. Previously anorexic normal-weight bulimic patients required
significantly more calories per day to maintain weight than never- anorexic
normal-weight bulimic patients, as measured with correction for weight but
not with the other factors used to correct caloric intake. CONCLUSIONS: To
maintain stable weight after weight restoration, restricting anorexic
patients require a significantly higher caloric intake than do bulimic
anorexic patients. Differences in caloric needs between normal-weight
bulimic patients with and without histories of anorexia may depend on the
methods used to correct caloric requirements. Body surface area may be the
most precise correction factor across different subgroups of eating
disorder patients. Elevated caloric requirements, when coupled with reduced
food intake, may particularly contribute to relapse in anorexic patients.
