High resting energy expenditure in normal-weight bulimics and its normalization with control of eating behaviour

Resting energy expenditure (REE) has been found to be lower in normal weight-bulimics (NWBs) than in controls and it was speculated that metabolic abnormalities might underlie bulimia. This study consisted of a longitudinal assessment of REE, body composition and energy intake before, during and after the control of eating behaviour, with comparisons between REEs in NWBs, those in controls, and estimated basal energy expenditure (EBEE). NWBs in acute phase of bulimia were assessed the 1st, 2nd, and last day of a one-week hospitalization that warranted compliance with normal diet. Assessments were then repeated after a six-week outpatient psychotherapy. Mean REE in NWBs was higher than that in controls and EBEE on admission. It decreased down to normal rate at discharge and at therapy termination. Fat-free mass (FFM) decreases slightly during hospitalization despite a weight-maintenance diet, but REE-FFM ratio also decreased significantly. Metabolic factors which might account for these results are discussed. Data suggest that: (1) caloric requirements in NWBs were higher than estimated weight-maintenance rations; (2) binge-eating increased REE; (3) control of eating behaviour decreased REE.