Examining Diagnostic Criteria for Atypical Anorexia Nervosa Post Metabolic Bariatric Surgery
Eva Conceição, Ricarda Schmidt, Ben Schreglmann, James E. Mitchell, Thomas Mansfeld, Johannes Sander, Florian Seyfried, Stefan Kaiser, Christine Stroh, Arne Dietrich, Anja HilbertABSTRACT
Objective
To examine the applicability of current diagnostic criteria for atypical anorexia nervosa (AAN) to patients 1 year post Metabolic Bariatric Surgery (MBS).
Method
This prospective ongoing cohort study included patients from the multicenter Psychosocial Registry of Obesity Surgery assessed before surgery and 1 year‐post‐MBS. From a consecutive sample of 1117 volunteers with planned MBS, 985 received surgery, 721 had the 1 year‐post‐MBS assessment and were eligible for the study. DSM‐5 criteria for AAN 1 year‐post‐MBS were assessed using diagnostic items of the Eating Disorder Examination (EDE) interview. Main outcomes were percentage of total weight loss (%TWL), body mass index (BMI) 1 year‐post‐MBS, and eating disorder (ED) psychopathology (EDE questionnaire; pre‐ and 1 year‐post‐MBS).
Results
Of the 721 patients [490 (66.7%) female; mean(SD) age 46.72 (11.52)], 65.6% ( n = 469) reported EDE item “Maintained low weight” (DSM‐5 Criterion A), and 61.1% ( n = 440) reported “Importance of shape and/or weight” (Criterion C). EDE item “Dietary restriction” (Criterion A) and “Fear of weight gain” (Criterion B) were reported by 4.1% ( n = 29) and 4.6% ( n = 33) of patients, respectively. Only 1.8% ( n = 13) engaged in “Extreme weight control behaviors” (Criterion B). Following a DSM‐5‐based coding scheme, 3.9% (95% CI. 2.7–5.6; n = 28) of patients had AAN 1 year‐post‐MBS. AAN and non‐EDs patients did not differ on %TWL/BMI. All EDE diagnostic items, except “Dietary restriction,” significantly explained ED psychopathology ( F (7,586) = 28.97, p < 0.001, R 2 = 0.26) with “Fear of weight gain” and “Extreme weight control behaviors” being associated with the highest variance explained.
Conclusion
While BMI and %TWL did not distinguish AAN from non‐ED, “Fear of weight gain” and “Extreme weight control behaviors” may be a better indicator of these problems among patients 1 year‐post‐MBS.