Body composition, eating disorder psychopathology, and psychological distress in anorexia nervosa: a longitudinal study. Does percent body fat predict outcome in anorexia nervosa? Changes in regional fat redistribution and the effects of estrogen during spontaneous weight gain in women with anorexia nervosa. An evaluation of family therapy in anorexia nervosa and bulimia nervosa. An open trial of fluoxetine in patients with anorexia nervosa. Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial. Percent body fat is a risk factor for relapse in anorexia nervosa: a replication study. Family and individual therapy in anorexia nervosa. A 5-year follow-up. The impact of social skills training within an established in-patient treatment programme for anorexia nervosa. Maintenance treatment for anorexia nervosa: a comparison of cognitive behavior therapy and treatment as usual. A pilot open case series of ethyl-EPA supplementation in the treatment of anorexia nervosa. The slippery slope: prediction of successful weight maintenance in anorexia nervosa. Follow-up of bone mineral density and body composition in adolescents with restrictive anorexia nervosa: role of dual-energy X-ray absorptiometry Randomized clinical trial comparing family-based treatment with adolescent-focused individual therapy for adolescents with anorexia nervosa. Ten-year follow-up of adolescent-onset anorexia nervosa: physical health and neurodevelopment. Double-blind placebo-controlled administration of fluoxetine in restricting- and restricting-purging-type anorexia nervosa The effectiveness of cognitive behavioral therapy on changing eating disorder symptoms and psychopathology of 32 anorexia nervosa patients at hospital discharge and one year follow-up. Pilot study of a graded exercise program for the treatment of anorexia nervosa. Implicit and explicit affect toward food and weight stimuli in anorexia nervosa. A double-blind, placebo-controlled study of risperidone for the treatment of adolescents and young adults with anorexia nervosa: a pilot study. Subcallosal Cingulate Connectivity in Anorexia Nervosa Patients Differs From Healthy Controls: A Multi-tensor Tractography Study A controlled study of the effect of therapies aimed at adolescent and family psychopathology in anorexia nervosa. Family Therapy versus Individual Therapy for Adolescent Females with Anorexia Nervosa
BACKGROUND Although the effect of immediate weight restoration on body composition and body fat distribution has previously been studied in anorexia nervosa ( AN ) , its influence in women with AN on eating disorder psychopathology and psychological distress has not previously been investigated to our knowledge . OBJECTIVES We assessed body composition and fat mass distribution before and after body weight restoration and investigated any relation between changes in body fat patterns of patients with AN treated in a specialist inpatient unit and their eating disorder and psychological distress features . DESIGN Body composition was measured by using dual-energy X-ray absorptiometry in 50 female , adult patients with AN before and after complete weight restoration [ body mass index ( BMI ; in kg/m² ) ≥18.5 ] and 100 healthy control subjects matched by age and posttreatment BMI of study group participants . Eating disorder psychopathology and psychological distress were assessed in the AN group before and after weight restoration by using the Eating Disorder Examination interview and the Global Severity Index of the Brief Symptom Inventory ( BSI-GSI ) , respectively . RESULTS After the achievement of complete weight restoration , patients with AN had higher trunk ( P < 0.001 ) , and roid ( P < 0.001 ) , and gynoid ( P < 0.001 ) fat masses and lower arm ( P < 0.001 ) and leg ( P = 0.001 ) fat masses with respect to control subjects . No relation was shown between body-composition variables and eating disorder psychopathology in the AN group , and the only significant predictor of change in BSI-GSI was the baseline BSI-GSI score . CONCLUSION The normalization of body weight in patients with AN is associated with a preferential distribution of body fat in central regions , which does not , however , seem to influence either eating disorder psychopathology or psychological distress scores OBJECTIVE The goal of this study was to investigate the relationship of body composition and neuroendocrine levels with clinical outcome in women with anorexia nervosa in a relapse-prevention trial . METHOD Body composition and fasting cortisol and leptin levels were assessed before r and om assignment in 32 weight-recovered subjects with anorexia nervosa from the New York site of the Fluoxetine to Prevent Relapse in Women With Anorexia Nervosa trial . Clinical outcome at the end of study participation was defined using modified Morgan-Russell criteria ( full , good , fair , poor ) , then dichotomized into treatment " success " or " failure . " RESULTS In a binary logistic regression model examining the effect of percent body fat , body mass index , anorexia nervosa subtype , waist-to-hip ratio , and serum cortisol and leptin levels on treatment outcome , only percent body fat was significantly associated with outcome . CONCLUSIONS In recently weight-restored women with anorexia nervosa , lower percent body fat was associated with poor long-term outcome BACKGROUND Anorexia nervosa is a disease of severe acquired undernutrition with a high and increasing prevalence among young women in the United States . OBJECTIVE The objective was to investigate the effects of spontaneous outpatient weight recovery and estrogen administration on fat distribution in patients with anorexia nervosa . DESIGN Twenty-seven amenorrheic women aged 26.6 + /- 1.2 y with anorexia nervosa were identified through an outpatient study of bone loss and were r and omly assigned to receive or not receive estrogen without any dietary intervention other than calcium and multivitamin supplements .  Body composition was measured at baseline and at 6 and 9 mo and was compared with cross-sectional values obtained in 20 healthy , eumenorrheic , age-matched ( 25.4 + /- 0.5 y ) control subjects . RESULTS Twenty of the 27 patients with anorexia aged 27.0 + /- 1.3 y spontaneously gained weight ( 4.1 + /- 0.9 kg ) ; body mass index ( in kg/m(2 ) ) increased from 16.1 + /- 0.3 to 17.5 + /- 0.4 . Fat mass and lean mass accounted for 68 % and 32 % of the gain in total body mass , respectively . With spontaneous weight gain , there was a significant increase in the percentage of trunk fat from 32.4 + /- 1.3 % at baseline to 36.5 + /- 1.0 % at 9 mo ( P = 0.03 ) , which correlated with urinary free cortisol ( r = 0.66 , P = 0.003 ) . Estrogen treatment was not protective against the gain in trunk fat with spontaneous weight gain . CONCLUSIONS In women with anorexia nervosa , spontaneous weight gain is associated with a significant increase in trunk adiposity , and estrogen administration may not protect against the accumulation of central fat with weight gain A controlled trial comparing family therapy with individual supportive therapy in anorexia nervosa and bulimia nervosa was undertaken . Eighty patients ( 57 with anorexia nervosa ; 23 with bulimia nervosa ) were first admitted to a specialized unit to restore their weight to normal . Before discharge , they were r and omly allocated to family therapy or the control treatment ( individual supportive therapy ) . After one year of psychological treatment , they were reassessed , using body weight , menstrual function , and ratings on the Morgan and Russell scales . Family therapy was found to be more effective than individual therapy in patients whose illness was not chronic and had begun before the age of 19 years . A more tentative finding was the greater value of individual supportive therapy in older patients . To our knowledge , this is the first controlled trial of family therapy in anorexia nervosa and clarifies the specific indications for this treatment BACKGROUND Anorexia nervosa is a disorder of unknown etiology with a high rate of relapse and no known treatment . Because anorexia nervosa shares some similarities with obsessive compulsive disorder , we hypothesized that a serotonin-specific medication might be useful in the treatment of this illness . METHOD We administered an open trial of fluoxetine to 31 patients with DSM-III-R anorexia nervosa . Most anorexics were started on fluoxetine treatment after inpatient weight restoration and then discharged from the hospital and followed up as out patients . RESULTS At the time of follow-up ( 11 + /- 6 months on fluoxetine ) , 29 of the 31 patients had maintained their weight at or above 85 % average body weight ( 97 % + /- 13 % average body weight for the group ) . We judged response as good in 10 , partial in 17 , and poor in 4 anorexics as measured by improvements in eating behavior , mood , and obsessional symptoms . Restrictor anorexics responded significantly better than bulimic and /or purging-type anorexics . CONCLUSION This open trial suggests that fluoxetine may help patients with anorexia nervosa maintain a healthy body weight as out patients . The reasons for the positive effects of fluoxetine are uncertain , but the agent may help by improving eating behavior and /or reducing obsessionality , depression , and anxiety . It is important to emphasize that this was not a double-blind , placebo-controlled study . Thus we can not be certain of the efficacy of fluoxetine and caution that fluoxetine should not be used as the sole treatment of anorexia nervosa at this time CONTEXT Antidepressant medication is frequently prescribed for patients with anorexia nervosa . OBJECTIVE To determine whether fluoxetine can promote recovery and prolong time-to-relapse among patients with anorexia nervosa following weight restoration . DESIGN , SETTING , AND PARTICIPANTS R and omized , double-blind , placebo-controlled trial . From January 2000 until May 2005 , 93 patients with anorexia nervosa received intensive inpatient or day-program treatment at the New York State Psychiatric Institute or Toronto General Hospital . Participants regained weight to a minimum body mass index ( calculated as weight in kilograms divided by the square of height in meters ) of 19.0 and were then eligible to participate in the r and omized phase of the trial . INTERVENTIONS Participants were r and omly assigned to receive fluoxetine or placebo and were treated for up to 1 year as out patients in double-blind fashion . All patients also received individual cognitive behavioral therapy . MAIN OUTCOME MEASURES The primary outcome measures were time-to-relapse and the proportion of patients successfully completing 1 year of treatment . RESULTS Forty-nine patients were assigned to fluoxetine and 44 to  placebo . Similar percentages of patients assigned to fluoxetine and to placebo  maintained a body mass index of at least 18.5 and remained in the study for 52 weeks ( fluoxetine , 26.5 % ; placebo , 31.5 % ; P = .57 ) . In a Cox proportional hazards analysis , with prer and omization body mass index , site , and diagnostic subtype as covariates , there was no significant difference between fluoxetine and placebo in time-to-relapse ( hazard ratio , 1.12 ; 95 % CI , 0.65 - 2.01 ; P = .64 ) . CONCLUSIONS This study failed to demonstrate any benefit from fluoxetine in the treatment of patients with anorexia nervosa following weight restoration . Future efforts should focus on developing new models to underst and the persistence of this illness and on exploring new psychological and pharmacological treatment approaches . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00288574 OBJECTIVE We aim ed to replicate and extend our previous findings of an association between percent body fat in recently weight-restored patients with Anorexia Nervosa ( AN ) and clinical outcome in the year following treatment . METHOD Twenty-two hospitalized , weight-restored women with AN underwent  whole body MRI to determine percent adipose tissue . Following hospital discharge , patients were contacted regularly , and at the end of the year , clinical outcome was determined using modified Morgan-Russell ( MR ) criteria : full , good , fair or poor . Identical to our previous study , outcome was dichotomized into " full , good or fair " and " poor " groups . RESULTS Data from 21 subjects were available for analysis . Percent body fat was significantly lower in the poor outcome group ( 22 % ± 5 % ) compared to the " full , good or fair " outcome group ( 27 % ± 4%)(p < 0.035 ) . To further examine the relationship , we combined data from the current study with data from the 26 subjects on whom we had previously reported . Univariate analysis of variance ( ANOVA ) demonstrated a significant difference in percent adipose tissue across the four MR outcome groups ( F = 3.416 , df = 3 , p<0.03 ) . DISCUSSION Lower percent adipose tissue after short-term weight normalization is associated with poor clinical outcome in the year following inpatient treatment . These findings may be important in the assessment of risk for relapse in patients with AN BACKGROUND There is evidence that specific psychological treatments are effective in patients with eating disorders . Our goal was to determine by means of a controlled trial whether psychological treatments , previously found to be effective in anorexia nervosa , gave rise to enduring benefits . METHODS A 5-year follow-up was conducted on patients who had participated in a previous trial of family therapy for anorexia and bulimia nervosa .  Family therapy or individual supportive therapy had been administered to 80 out patients for 1 year beginning on discharge from hospital after weight restoration . The 80 patients had been subdivided into 4 prognostically homogeneous groups of which 2 turned out to be the most important : patients with early onset and short history of anorexia nervosa , and patients with late-onset anorexia nervosa . At the 5-year follow-up , the efficacy of the outpatient therapies was again assessed by the maintenance of weight , and the categories of general outcome and dimensions of clinical functioning defined by the Morgan-Russell scales . RESULTS Significant improvements were found in the group of 80 patients as a whole , mainly attributable to the natural outcome of anorexia nervosa , and most evident in the early onset and short history group , as expected . Within 2 of the prognostic groups , significant benefits attributable to previous psychological treatments were still evident , favoring family therapy for patients with early onset and short history of anorexia nervosa and favoring individual supportive therapy for patients with late-onset anorexia nervosa . CONCLUSIONS Much of the improvements found at a 5-year follow-up can be attributed to the natural outcome of the illness . Nevertheless , it was still possible to detect long-term benefits of psychological therapies completed 5 years previously There are no controlled studies of the long term impact of treatment on the evolution of anorexia nervosa , although it is clear that life can sometimes be saved in the short term and that a variety of pharma cological and behavioural approaches can have a short term and limited effect on the low body weight control mechanisms of the patient . During the past 20 years , the second author has run an established in patient combined  behaviour and psychotherapeutic treatment programme  for patients with anorexia nervosa involving restoration of body weight to matched population levels coupled with individual and family psychotherapy ( Crisp , 1967 ) . He believes that this approach does have an impact on the course of the disorder ( Crisp , 1980 ) . However , it is difficult to evaluate it in total in a controlled experimental fashion since , in the event , it is impossible to deny any patient a treatment which almost always has the short term . effect of her gaining weight back to normal adult levels . In recent years , therefore , an alternative strategy has developed in the unit in which specific treatments ( e.g. the impact of tricyclic drugs ( Lacey and Crisp , 1980 ) are experimentally superimposed on the basic treatment programme . This paper reports the impact of a social skills programme exhibited on this basis . Two case reports ( Lang , 1965 and Argyle et a ! , 1974a ) describe the efficacy of behavioural social anxiety treatment  for anorexia nervosa . These studies are limited in diag nostic detail . Wolpe ( 1975 ) advocates the value of the comprehensiveness of a behavioural analysis in treating anorexianervosathatwould includean assessment of the symptom of social anxiety within the clinical condition . A controlled study by Argyle et a ! ( 1974b ) indicates the efficiency of  social skills treat ment as well as brief psychotherapy in positively influencing social ease in a patient population . How ever , no experimental studies are reported on the impact of a behaviourally orientated treatment for social anxiety  on the course of recovery for anorexia nervosa . This treatment was introduced because anorectics are known to be socially isolated and to have low self-esteem ( Crisp , 1970 ; Pillay and Crisp , 1977 ) . Furthermore , previous follow-up studies have revealed that those who have recovered often become socially anxious despite their involvement in psycho therapy directed at this area of difficulty ( Stonehill and Crisp , 1977 ; Crisp , 1980 ) . The hypothesis was that social skills training within the established in-patient treatment programme would lead to a greater degree of recovery from anorexia nervosa at one year follow-up as measured by the percentage matched population mean weight of the patients , and furthermore that these patients would be less socially anxious than those who had not received suchtreatment OBJECTIVE The aim of this study was to compare two maintenance treatment conditions for weight-restored anorexia nervosa ( AN ) :  individual cognitive behavior therapy ( CBT ) and maintenance treatment as usual ( MTAU ) . METHOD This study was a nonr and omized clinical trial . The participants were 88 patients with AN who had achieved a minimum body mass index ( BMI ) of 19.5 and control of binge eating and purging symptoms after completing a specialized hospital-based program . Forty-six patients received 1 year of manualized individual CBT and 42 were in an assessment -only control condition ( i.e. , MTAU ) for 1 year . This condition was intended to mirror follow-up care as usual . Participants in both the conditions were assessed at 3-month intervals during the 1-year study . The main outcome variable was time to relapse . RESULTS When relapse was defined as a BMI < or= 17.5 for 3 months or the resumption of regular binge eating and /or purging behavior for 3 months , time to relapse was significantly longer in the CBT condition when compared with MTAU . At 1 year , 65 % of the CBT group and 34 % of the MTAU group had not relapsed . DISCUSSION The current findings provide preliminary evidence that CBT may be helpful in improving outcome and preventing relapse in weight-restored AN Anorexia nervosa ( AN ) carries the highest risk of morbidity and mortality amongst psychiatric disorders . The efficacy of current treatment approaches is limited . Despite the fat-phobic nature of the disease , poly-unsaturated fatty acids ( PUFAs ) have not received much research attention . Patients who consume western diet , which is rich in n-6 PUFAs and trans-fatty acids , are likely to develop severe n-3 PUFA deficiency during self-induced starvation . Re-feeding programmes do not take into consideration n-3 EFA intake , possibly leading to further n-3 PUFA deficiency during weight restoration , and this might contribute to the maintenance of the disorder . To test this hypothesis , we carried out a systematic case series of E-EPA supplementation in the treatment of AN . Seven young patients received 1g/day E-EPA in addition to st and ard treatment , and were followed up for 3 months . Three of them recovered and four improved . R and omised controlled trials are warranted to examine the effectiveness of E-EPA  in AN further BACKGROUND Previous research has found that many patients with anorexia nervosa ( AN ) are unable to maintain normal weight after weight restoration . The objective of this study was to identify variables that predicted successful weight maintenance among weight-restored AN patients . METHOD Ninety-three patients with AN treated at two sites ( Toronto and New York ) through in-patient or partial hospitalization achieved a minimally normal weight and were then r and omly assigned to receive fluoxetine or placebo along with cognitive behavioral therapy ( CBT ) for 1 year . Clinical , demographic and psychometric variables were assessed after weight restoration prior to r and omization and putative predictors of successful weight maintenance at 6 and 12 months were examined . RESULTS The most powerful predictors of weight maintenance at 6 and 12 months following weight restoration were pre-r and omization body mass index ( BMI ) and the rate of weight loss in the first 28 days following r and omization . Higher BMI and lower rate of weight loss were associated with greater likelihood of maintaining a normal BMI at 6 and 12 months . An additional predictor of weight maintenance was site ; patients in Toronto fared better than those in New York . CONCLUSIONS This study found that the best predictors of weight maintenance in weight-restored AN patients over 6 and 12 months were the level of weight restoration at the conclusion of acute treatment and the avoidance of weight loss immediately following intensive treatment . These results suggest that outcome might be improved by achieving a higher BMI during structured treatment programs and on preventing weight loss immediately following discharge from such programs Background / Objectives : Restrictive Anorexia nervosa ( ANR ) is an eating disorder ( ED ) characterized by a low bone mineral content ( BMC ) and by an alteration in body composition ( reduction and abnormal distribution of fat mass — FM and lean mass — LM ) . The aim of our study was to address whether bone and body composition changes could be influenced by hormonal status and sport in female adolescents with restrictive anorexia nervosa-ANR.Subjects/ Methods : Prospect i ve study on 79 adolescents with ANR su bmi tted to Dual Energy X-Ray Absorptiometry — DXA at baseline-T0  and after 12 months-T12 . Among the 46/79—58.2 % patients that completed the study , we evaluated total and regional FM and LM% , as well as lumbar bone mineral density ( BMD ) and Z-score , linking them to clinical variables : menarche/amenorrhea/hormonal therapy and physical activity . Results : At T0 : body mass index ( BMI ) = 16.4±1.4 kg/m2 with low levels of FM% ( 21.7±5.7 ) low BMC in 12/46—26.0 % ( mean Z-score : −1.21±1.27 , with higher values related to physical activity — P=0.001 ) . At T12 : a significant increase in BMI —P=0.001 , with LM reduction and FM increase ( more evident in the trunk — P<0.001 ) ; regarding bone , no significant changes were observed , though a tendency in terms of improvement associated with resumption of menses . Conclusions : After 1 year , weight recovery was not associated with a reestablishment of bone values ; by contrast , it was associated with an increase and a distortion in FM distribution , more evident in trunk region ( potential and adjunctive risk factor for the relapse of the psychiatric condition ) . The complexity of these clinical findings suggested DXA , a low-dose and low-cost technique , in long-term monitoring of ANR patients CONTEXT Evidence -based treatment trials for adolescents with anorexia nervosa are few . OBJECTIVE To evaluate the relative efficacy of family-based treatment ( FBT ) and adolescent-focused individual therapy ( AFT ) for adolescents with anorexia nervosa in full remission . DESIGN R and omized controlled trial . SETTING Stanford University and The University of Chicago ( April 2005 until March 2009 ) . PARTICIPANTS One hundred twenty-one participants , aged 12 through 18 years , with DSM-IV diagnosis of anorexia nervosa excluding the amenorrhea requirement . Intervention Twenty-four outpatient hours of treatment over 12 months of FBT or AFT . Participants were assessed at baseline , end of treatment ( EOT ) , and 6 months ' and 12 months ' follow-up posttreatment . MAIN OUTCOME MEASURES Full remission from anorexia nervosa defined as normal weight ( ≥95 % of expected for sex , age , and height ) and mean global Eating Disorder Examination score within 1 SD of published means . Secondary outcome measures included partial remission rates ( > 85 % of expected weight for height plus those who were in full remission ) and changes in body mass index percentile and eating-related psychopathology . RESULTS There were no differences in full remission between treatments at EOT . However , at both the 6- and 12-month follow-up , FBT was significantly superior to AFT on this measure . Family-based treatment was significantly superior for partial remission at EOT but not at follow-up . In addition , body mass index percentile at EOT was significantly superior for FBT , but this effect was not found at follow-up . Participants in FBT also had greater changes in Eating Disorder Examination score at EOT than those in AFT , but there were no differences at follow-up . CONCLUSION Although both treatments led to considerable improvement and were similarly effective in producing full remission at EOT , FBT was more effective in facilitating full remission at both follow-up points . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00149786 To study the development of physical health and some neuromotor functions in anorexia nervosa ( AN ) 51 individuals ( 48 females , three males ) with a mean AN onset of 14 years , recruited after community screening , were followed prospect ively together with 51 age- , sex- , and school-matched individuals without AN ( controls ) . About 10 years after AN onset , all individuals were examined in respect of physical health and neurodevelopment . There were no deaths . Weight and height had normalised , except in three participants with persistent AN . Significantly more participants with AN had a physical complaint/disorder , including hirsutism . This might be a long-term complication in weight restored AN . Dysdiadochokinesis occurred almost exclusively among individuals with former AN in accordance with our previous studies BACKGROUND Anorexia nervosa is an often chronic disorder with high morbidity and mortality . Many people relapse after weight restoration . This study was design ed to determine whether a selective serotonin reuptake inhibitor would improve outcome and reduce relapse after weight restoration by contributing to maintenance of a healthy normal weight and a reduction of symptoms . METHODS We administered a double-blind placebo-controlled trial of fluoxetine to 35 patients with restricting-type anorexia nervosa . Anorexics were r and omly assigned to fluoxetine ( n = 16 ) or a placebo ( n = 19 ) after inpatient weight gain and then were observed as out patients for 1 year . RESULTS Ten of 16 ( 63 % ) subjects remained on fluoxetine for a year , whereas only three of 19 ( 16 % ) remained on the placebo for a year ( p = .006 ) . Those subjects remaining on fluoxetine for a year had reduced relapse as determined by a significant increase in weight and reduction in symptoms . CONCLUSIONS This study offers preliminary evidence that fluoxetine may be useful in improving outcome and preventing relapse of patients with anorexia nervosa after weight restoration BACKGROUND This study aims to assess changes in core eating disorder psychopathology ( Eating Attitudes Test , EAT ; Eating Disorders Inventory-2 , EDI-2 ) , depression ( Hamilton Rating Scale , HRSD ; Beck Depression Inventory , BDI ) and general psychopathology ( MMPI-2 ) after inpatient treatment and one-year follow-up among patients diagnosed with anorexia . METHODS Thirty-two patients were treated for anorexia nervosa on an inpatient unit , and were assessed before and after treatment . The inpatient milieu was design ed to use cognitive therapy as the primary therapeutic intervention , along with weight restoration . RESULTS At discharge , all patients displayed significant change in core eating disorder psychopathology in their depressive symptoms , as well as in general aspects of psychopathology . At one-year follow-up , changes in some areas of core eating disorder psychopathology and depressive symptoms continued to be significantly different than from admissions . CONCLUSIONS The combination of CBT and weight restoration can significantly reduce eating disorder symptoms , depression , and general psychopathology during hospitalization , with some sustained benefit over a one year period . Future research is needed to identify the effect of CBT on anorexia nervosa during a wide variety of treatment setting s. Also , research must focus on the influence of outpatient treatment in the outcome of anorexia nervosa OBJECTIVE To determine whether a grade d exercise program used in the treatment of anorexia nervosa improves quality of life and does not decrease the rate of gain of body fat . METHODS A r and omized controlled trial with outcome measures : change in percent body fat , body mass index ( BMI ) , and Medical Outcomes Survey Short Form 36-item Quality of Life question naire . RESULTS Fifteen females and one male meeting the DSM-IV criteria for the diagnosis of anorexia nervosa were r and omized . There was no difference in change in BMI or percent body fat at 3 months . Quality of life outcomes improved from baseline in the experimental group compared with the control group . However , this difference was not statistically significant . DISCUSSION Incorporation of a grade d exercise program may increase compliance with treatment , but it did not reduce the short-term rate of gain of body fat or BMI . Longer studies with more subjects are necessary to determine the usefulness of a grade d exercise program in anorexia nervosa We know strikingly little about the core affective processes that drive the development and maintenance of , and recovery from anorexia nervosa ( AN ) . To partially address this knowledge gap , we measured implicit and explicit affect toward pleasant , neutral , unpleasant , food-relevant , and weight-relevant images in three groups : in patients with acute AN , individuals recovered from AN , and healthy controls with no history of AN . Compared with the other two groups , acutely ill AN participants displayed significantly greater implicit positive affect toward pleasant images and significantly greater implicit negative affect toward unpleasant , high-calorie food , and overweight body type images .  Recovered participants did not differ significantly from controls on any implicit affect measure . Explicit affective patterns were similar to implicit , but explicit measures yielded much smaller effect sizes and failed to detect certain group differences . Overall , negative implicit affect toward high-calorie foods and overweight body types may represent core affective processes that are operative during acute AN OBJECTIVE The purpose of this double-blind , placebo-controlled exploratory pilot study was to evaluate the safety and efficacy of risperidone for the treatment of anorexia nervosa . METHOD Forty female subjects 12 to 21 years of age ( mean , 16 years ) with primary anorexia nervosa in an eating disorders program were r and omized to receive risperidone ( n = 18 ) or placebo ( n = 22 ) . Subjects completed the Eating Disorder Inventory 2 , Color-A-Person Test , Body Image Software , and Multidimensional Anxiety Scale for Children at baseline and regular intervals . Weight , laboratory values , and electrocardiograms were monitored . Study medication was started at 0.5 mg daily and titrated upward weekly in 0.5-mg increments to a maximum dose of 4 mg until the subject reached a study endpoint . RESULTS The mean dose for the risperidone group was 2.5 mg and for the placebo group was 3 mg for a mean duration of 9 weeks . Subjects taking risperidone had a significant decrease on the Eating Disorder Inventory 2 Drive for Thinness subscale over the first 7 weeks ( effect size , 0.88 ; p = .002 ) , but this difference was not sustained to the end of the study ( p = .13 ) . The Eating Disorder Inventory 2 Interpersonal Distrust subscale decreased significantly more in subjects taking risperidone ( effect size , 0.60 ; p = .03 ) . Subjects taking risperidone had increased prolactin levels ( week 7 ; p = .001 ) . There were no significant differences between groups at baseline or the end of the study for the other rating scales , change in weight , or laboratory measurements . CONCLUSIONS This study does not demonstrate a benefit for the addition of risperidone in adolescents with anorexia nervosa during the weight-restoration phase of care . Clinical trial registration information-A Double-Blind , Placebo-Controlled Study of Risperidone for the Treatment of Anorexia Nervosa , http://www . clinical trials.gov , NCT00140426 BACKGROUND Anorexia nervosa is characterized by extreme low body weight and alterations in affective processing . The subcallosal cingulate regulates affect through wide-spread white matter connections and is implicated in the pathophysiology of anorexia nervosa . OBJECTIVES We examined whether those with treatment refractory anorexia nervosa undergoing deep brain stimulation ( DBS ) of the subcallosal white matter ( SCC ) show : ( 1 ) altered anatomical SCC connectivity compared to healthy controls , ( 2 ) white matter microstructural changes , and ( 3 ) microstructural changes associated with clinical ly-measured affect . METHODS Diffusion magnetic resonance imaging ( dMRI ) and deterministic multi-tensor tractography were used to compare anatomical connectivity and microstructure in SCC-associated white matter tracts . Eight women with treatment-refractory anorexia nervosa were compared to 8 age- and sex-matched healthy controls . Anorexia nervosa patients also completed affect-related clinical assessment s presurgically and 12 months post-surgery . RESULTS ( 1 ) Higher ( e.g. , left parieto-occipital cortices ) and lower ( e.g. , thalamus ) connectivity in those with anorexia nervosa compared to controls . ( 2 ) Decreases in fractional anisotropy , and alterations in axial and radial diffusivities , in the left fornix crus , anterior limb of the internal capsule ( ALIC ) , right anterior cingulum and left inferior fronto-occipital fasciculus . ( 3 ) Correlations between dMRI metrics and clinical assessment s , such as low pre-surgical left fornix and right ALIC fractional anisotropy being related to post-DBS improvements in quality -of-life and depressive symptoms , respectively . CONCLUSIONS We identified widely-distributed differences in SCC connectivity in anorexia nervosa patients consistent with heterogenous clinical disruptions , although these results should be considered with caution given the low number of subjects . Future studies should further explore the use of affect-related connectivity and behavioral assessment s to assist with DBS target selection and treatment outcome Ninety patients with severe anorexia nervosa fulfilling DSM-III-R criteria were assessed in depth in terms of their family developmental psychopathology and then r and omly allocated to either one of three treatment groups or to no treatment . In three treatment regimes , a behavioural approach to diet and weight gain was coupled with individual and family psychotherapy directed at the adolescent maturational problems . All three treatment regimes were highly significantly effective at one year in terms of weight gain , return of menstruation , and aspects of social and sexual adjustment . Body weights above those at pubertal onset were achieved for the group mean maximum and one-year follow-up weights for all three treatment groups but not the control group Behavioral family systems therapy ( BFST ) was compared with ego-oriented individual therapy ( EOIT ) in a controlled , r and om-assignment investigation involving 22 young adolescents with anorexia nervosa . Each adolescent and her parents received approximately 16 months of outpatient therapy along with a common medical and dietary regimen . BFST emphasized parental control over eating and weight gain , coupled with cognitive restructuring and problem-solving communication training . EOIT emphasized building ego strength , adolescent autonomy , and insight into the emotional blocks to eating . BFST produced greater change on body-mass index than did EOIT , but both treatments produced comparable improvements on eating attitudes , body shape dissatisfaction , interoceptive awareness , depression/internalizing psychopathology , and eating-related family conflict . The implication s of these results for the clinician who treats adolescents with anorexia nervosa are discussed . J Dev Behav Pediatr 15:111–116 , 1994 . Index terms : anorexia nervosa , adolescents , family therapy , individual therapy
First , during anorexia nervosa adolescent females lose more central body fat , while adult females more peripheral fat .
Second , partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females .
Third , after short-term weight restoration , whether partial or complete , adults show a central adiposity phenotype with respect to healthy age-matched controls .
Fourth , central fat distribution is associated with increased insulin resistance , but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults .
Fifth , the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration , indicating that preferential central distribution of body fat is a transitory phenomenon .
The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa .