Anorexia nervosa: differences and similarities between adolescents with and without a history of obesity Anorexia nerviosa: diferencias y similitudes entre adolescentes con y sin antecedentes de obesidad

The aim of this study was to evaluate clinical differences and similarities between anorexia nervosa (AN) patients with and without a history of obesity. We evaluated 108 patients (10-18 years old) with the restricting or purging subtype of AN, treated at a public referral facility in Brazil. To evaluate clinical characteristics, we used a standardized psychiatric interview, the Development and Well-Being Assessment, the Children’s Global Assessment Scale, the Eating Disorder Examination Questionnaire (EDE-Q), and body mass index (BMI)-for-age percentile. The mean age was 14.8±2.5 years, and 95 (88.0%) of the patients were female. Of the 108 patients evaluated, 78 (72.2%) had restrictive AN and 23 (21.3%) had a history of obesity. Patients with and without a history of obesity were similar in terms of age at onset, time from symptom onset to treatment, duration of treatment, impact of the disease on global functioning, and comorbidities. At treatment initiation, those with a history of obesity were at a higher BMI-for-age percentile and scored higher on the Weight Concern subscale of the EDE-Q. We conclude that severe cases of AN can occur in patients with and without a history of obesity with no differences in terms of the baseline characteristics and the duration of treatment. The significantly higher BMI-for-age percentiles amongst patients with a history of obesity (at treatment initiation) suggests that the urge for treatment shouldn’t be based on BMI percentile only. Resumen El objetivo de este estudio fue identificar las diferencias clinicas entre pacientes con anorexia nerviosa (AN) con y sin antecedentes de obesidad. Se evaluaron 108 pacientes (10-18 anos de edad) con AN del subtipo restrictivo o purgativo, tratados en un centro publico de referencia en Brasil. Para evaluar las caracteristicas clinicas, se utilizaron una entrevista estandarizada psiquiatrica, el Development and Well-Being Assessment, la Children’s Global Assessment Scale, el Eating Disorder Examination Questionnaire (EDE-Q), y el percentil del indice de masa corporal (IMC) para la edad. La edad media fue de 14.80±2, anos, y 95 (88.00%) de los pacientes eran del sexo femenino. De los 108 pacientes, 78 (72.20%) tenian AN restrictiva y 23 (21.30%) tenian antecedentes de obesidad. Los pacientes con y sin antecedentes de obesidad eran similares en terminos de edad de inicio de la enfermedad, tiempo desde el inicio de los sintomas hasta el inicio del tratamiento, duracion del tratamiento, impacto de la enfermedad en el funcionamiento general y comorbilidades. Al inicio del tratamiento, los pacientes con antecedentes de obesidad estaban en un percentil mas alto de IMC para la edad y puntuaron mas alto en la subescala preocupacion por el peso del EDE-Q. En conclusion, casos graves de AN pueden ocurrir en pacientes con y sin antecedentes de obesidad.