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Restrictive eating disorders among adolescent inpatients
Melissa Whitelaw1, Heather Gilbertson2, Katherine J Lee3
1Department of Nutrition and Food Services, and Centre for Adolescent Health, The Royal Children's Hospital, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; and Murdoch Children's Research Institute, Melbourne, Australia melissa.whitelaw@rch.org.au.
Adolescents with Eating Disorder Not Otherwise Specified (EDNOS-Wt) show increasing hospital admissions and similar severe complications as anorexia nervosa (AN), despite not being underweight. This highlights the need for careful medical assessment in higher-weight adolescents with significant weight loss.
Area of Science:
- Pediatric Endocrinology
- Adolescent Medicine
- Eating Disorder Research
Background:
- Clinicians observe adolescents with severe weight loss and anorexia nervosa (AN) symptoms but not meeting AN diagnostic criteria due to weight.
- This group is classified as Eating Disorder Not Otherwise Specified (EDNOS-Wt).
Purpose of the Study:
- To describe the changing incidence of EDNOS-Wt compared to AN.
- To compare the characteristics of EDNOS-Wt and AN patients requiring hospitalization after weight loss.
Main Methods:
- A 6-year retrospective cohort study (2005-2010) of first admissions for adolescents aged 12-19.
- Patients were diagnosed with DSM-IV AN or EDNOS-Wt at a tertiary children's hospital.
- Clinical, biochemical, and nutritional data were collected within 28 days of admission.
Main Results:
- Ninety-nine adolescents were admitted: 73 with AN and 26 with EDNOS-Wt.
- The proportion of EDNOS-Wt admissions increased from 8% in 2005 to 47% in 2009.
- EDNOS-Wt patients experienced similar rates of hypophosphatemia (39%) and low pulse rates as AN patients.
Conclusions:
- There was a fivefold increase in EDNOS-Wt hospital admissions over 6 years.
- EDNOS-Wt patients, despite not being underweight, faced life-threatening complications similar to AN patients.
- Higher-weight adolescents with significant weight loss require thorough medical evaluation.