Food choice and diet variety in weight-restored patients with anorexia nervosa.
Schebendach, J.E., Mayer, L.E., Devlin, M.J., Attia, E., Conteno, I.R., Wolf, R.I., & Walsh, T.B. (2011). New England Journal of Medicine, 360(9), 859-873.
Limited diet variety is associated with decreased energy intake and it may lead to food monotony, or lack of variety and interest in other foods, often seen as routine eating of the same foods. Patients with anorexia nervosa generally consume a limited number of less palatable (i.e., pleasant to taste) foods and simultaneously avoid foods that are generally more palatable. Previous research has shown that limited diet variety has been associated with worse outcomes during a one-year period following inpatient weight restoration in patients with anorexia nervosa.
This study sought to expand upon those findings and provide a detailed description of the types of foods that patients were restricting from their diets. Forty-one women with anorexia nervosa between the ages of 18 and 45 participated in the study. All of the participants had previously been hospitalized at the Eating Disorders Service of the New York State Psychiatric Institute (NYSPI) and restored to a minimum body weight corresponding to a BMI of about 20 kg/m2. Using the modified Morgan-Russell (MR) criteria, 29 patients were included in the treatment success group (MR criteria were met for a full, good, or fair outcome), and 12 patients were included in the treatment failure group (MR criteria were met for a poor outcome).
The failure group consumed significantly less total fat than the success group and the percentage of energy from fat was significantly lower in the failure group compared to the success group. The success group selected a greater variety of foods than the failure group following treatment. Specifically, the success group selected a different food 71% of the time, while the failure group selected a different food only 58% of the time. Additionally, the failure group had significantly less variety from the added fat group, the caloric beverage group, the added sugars group, the miscellaneous foods group (e.g., pasta sauce) and the carbohydrate group (e.g., rice, pasta, potato).
Although the sample size for this study was small and the diet variety groups were based on NYSPI’s menu planning protocol, these results suggest an association between diet variety and treatment outcomes.
What we know about recovery from women who have recovered
Thus far, only one study has asked women who have recovered from eating disorders about their experiences of achieving or maintaining recovery; men were not included. Federici and Kaplan (2008) interviewed 15 women who had successfully completed treatment for AN and maintained their weight at one-year follow-up (defined as a BMI of at least 19). The women identified six core areas that helped them in their recovery:
- internal motivation for change;
- perception of recovery as a “work in progress;”
- valuing of the treatment experience (i.e., as a way to address issues of importance);
- the development of supportive relationships (i.e., the availability, support, non-judgmental stance of friends and family following treatment);
- awareness and tolerance of negative emotion; and
- self-validation (i.e., cultivating a sense of personal worth).
Collection of qualitative information from a greater number of recovered persons may provide new and valuable insights into recovery and its maintenance.
Federici, A., & Kaplan, A. S. (2008). The patient's account of relapse and recovery in anorexia nervosa: A qualitative study. European Eating Disorders Review, 16(1), 1-10.
How many people recover?
Rates of recovery show substantial variation across studies. However, Fichter and Quadflieg (2007) assessed 311 female patients with anorexia nervosa (AN), bulimia nervosa (BN), or binge eating disorder (BED). At the 12 year follow-up, 89 patients with AN, 162 with BN, and 60 with BED were available.
Among patients with AN, 49.4% had recovered, 18% had AN, 15.7% had an eating disorder not otherwise specified, 9% had BN, and 7.9% had died.
Among patients with BN, 69.7% had recovered, 13.6% had an eating disorder not otherwise specified, 10.5% had BN, 1.8% had AN, and 1.9% had BED.
Among patients with BED, 66.7% had recovered, 13.3% had EDNOS, 10% had BN, 6.7% had BED, and 3.3% had died.
Fichter, M. M., & Quadflieg, N. (2007). Long-term stability of eating disorder diagnoses. International Journal of Eating Disorders, 40(Supl), S61-S66.