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Greater rate of weight loss predicts paediatric hospital admission in adolescent typical and atypical anorexia nervosa

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Abstract

Hospital admissions for eating disorders (ED) are rapidly increasing. Limited research exists evidencing the factors that lead to hospital admissions or their outcomes. The current study aimed to identify predictors of hospital admission in adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN). Prospective observational study including participants (n = 205) aged 11–18 and diagnosed with AN or AAN at initial ED assessment, across eight London clinics. Physical health parameters at assessment, including heart rate, blood pressure, temperature and rate of weight loss, were compared between adolescents who were admitted to a paediatric ward following assessment and those who were not admitted. The mean rate of weight loss prior to assessment was significantly higher, and mean energy intake significantly lower, in the admitted vs not admitted groups (1.2 vs 0.6kg/week, p < 0.001 and 565 kcal/day vs 857 kcal/day, p < 0.001), independent of degree of underweight. No significant differences were identified between groups in all other parameters of physical risk. Underweight adolescents with AN were equally likely to be admitted as non-underweight adolescents with AAN.

  Conclusion: This study provides evidence on predictors of hospital admission, from a sample representing the London area. The assessment of weight loss speed, duration and magnitude are recommended as priority parameters that inform the risk of deterioration and the likelihood of hospital admission in adolescent AN and AAN. Further research investigating outcomes of these hospital admission is needed.

What is Known:

• Hospital admissions for eating disorders (ED) are rapidly increasing.

• Limited research exists evidencing the factors that lead to hospital admissions, or their outcomes.

What is New:

• This study provides evidence on predictors of hospital admission in young people with typical and atypical anorexia nervosa.

• Weight loss speed, duration, and magnitude are recommended as priority parameters that inform the risk of deterioration and the likelihood of hospital admission in this patient group.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, CB.

Abbreviations

AN:

Anorexia nervosa

AAN:

Atypical anorexia nervosa

ANOVA:

Analysis of variance

ED:

Eating disorders

NHS:

National Health Service

MDT:

Multidisciplinary team

MEED:

Medical of Emergencies in Eating Disorders

NICE:

National Institute for Clinical and care Excellence

%mBMI:

Percentage median body mass index

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Acknowledgements

We acknowledge Suzy Oakley, Annie Stevenson, Ellie Bishop, Jessica Polykarpou and Eloise Saglio for their support with the study.

Author information

Authors and Affiliations

  1. South London and Maudsley NHS Trust, London Metropolitan University, London, UK

    Cliona Brennan

  2. East London NHS Foundation Trust, Kings College London, University College London, London, UK

    Erica Cini

  3. London Metropolitan University, London, UK

    Sarah Illingworth & Dee Bhakta

  4. South London and Maudsley NHS Trust, Kings College Hospital London, London, UK

    Simon Chapman

  5. South London and Maudsley NHS Trust, London, UK

    Mima Simic

  6. Central Northwest London NHS Trust, Imperial College London, London, UK

    Dasha Nicholls

  7. Royal Free Hospital NHS Trust, London, UK

    Victoria Chapman, Ellen Hayes & Nicola Tweedy

  8. West London NHS Trust, London, UK

    Conor Simms

  9. Northamptonshire NHS Trust, Northamptonshire, UK

    Sarah Fuller

  10. Northeast London Foundation Trust, London, UK

    Jade Orpwood

  11. East London NHS Foundation Trust, London, UK

    Tahmida Baksh

  12. Central Northwest London NHS Trust, London, UK

    Emma Astaire

  13. The Michael Rutter Centre, De Crespigny Park, Camberwell, London, SE5 8AZ, UK

    Cliona Brennan

Authors
  1. Cliona Brennan
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  2. Erica Cini
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  3. Sarah Illingworth
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  15. Dee Bhakta
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Contributions

CB was responsible for conception and design of the study, recruitment of participants, data collection and analysis and preparation of drafts and final versions of the manuscript and associated tables and documents. DB contributed to the conception, design, and supervision of the study, and editing of the draft and final manuscript and tables. MS, SI, EC, SC, DN and VC contributed to the design and supervision of the study, and the editing of the final manuscript. CS, EH, SF, JO, NC, TB and EA were responsible for the recruitment of participants, collection of study data and editing the final draft of the manuscript. Cliona Brennan wrote the first draft of the manuscript.

Corresponding author

Correspondence to Cliona Brennan.

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The authors declare no competing interests.

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Communicated by Peter de Winter

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Brennan, C., Cini, E., Illingworth, S. et al. Greater rate of weight loss predicts paediatric hospital admission in adolescent typical and atypical anorexia nervosa. Eur J Pediatr 183, 1789–1799 (2024). https://doi.org/10.1007/s00431-024-05436-3

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  • DOI: https://doi.org/10.1007/s00431-024-05436-3

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