Excessive weight loss in the athletic adolescent. A diagnostic dilemma

Differentiating anorexia nervosa (AN) from excessive weight loss in the otherwise healthy, athletic adolescent may be difficult. We report the maximal work capacity, hormonal secretory patterns, and psychological assessment of a 14-year-old male runner who induced excessive weight loss and partially recovered. At 17% below previous body weight (28% below ideal weight for height), he had significant resting bradycardia (38 bmp), low maximal heart rate (167 bpm), depressed VO2 max, and prepubertal 24-hour LH and testosterone secretory patterns in the presence of late pubertal genital development. The diagnostic dilemma of excess weight loss due to food aversion in the normal athlete versus anorexia nervosa with running as a symptom was resolved by psychiatric evaluation. A disturbed body image, marked feelings of inadequacy, and depression were discovered, which are findings consistent with AN. Diagnostic criteria of AN and the possible implications of a subnormal maximal heart rate are reviewed.