A significant proportion of adolescents with anorexia nervosa (AN) or atypical anorexia nervosa (AAN) experience premorbid overweight/obesity, yet distinct characteristics among this subset of patients remain unclear. This study examined eating disorder (ED) symptom severity, psychological morbidity, and weight stigma in patients with premorbid overweight/obesity as compared to patients with premorbid normal weights.
Participants included adolescents with AN or AAN (aged 12–18) who received multidisciplinary treatment at a pediatric medical center in the United States. ED symptoms, anxiety, and depression were compared among patients with premorbid overweight/obesity (n = 43) and premorbid normal weights (n = 63). Associations between weight stigma, ED severity, and psychological morbidity were also examined.
Patients with premorbid overweight/obesity reported greater ED severity (p = 0.04), anxiety (p < 0.003), depression (p = 0.02), and a higher frequency of weight-based teasing by peers (p = 0.003) and parent weight talk about their own weights (p < 0.001). Weight-based teasing was positively associated with ED symptoms, anxiety, and depression for all patients, regardless of premorbid weight status.
Adolescents with AN or AAN and a history of overweight/obesity may present with greater ED symptom severity and psychological morbidity than patients with normal weight histories. Distinct prevention and treatment interventions for adolescents with AN or AAN and premorbid overweight/obesity may be warranted.
Level of evidence
Level III, case–control analytic study.
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The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Funding for this study was provided by a Clinical Outcomes Research Enhancement award funded through the Division of Behavioral Medicine and Clinical Psychology at Cincinnati Children’s Hospital Medical Center.
Conflict of interest
The authors declare that they have no conflicts of interest or competing interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Cincinnati Children’s Hospital Medical Center Institutional Review Board, Study ID 2017–2569) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Written informed consent was obtained from the parents of all individual participants included in this study.
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Matthews, A., Kramer, R.A. & Mitan, L. Eating disorder severity and psychological morbidity in adolescents with anorexia nervosa or atypical anorexia nervosa and premorbid overweight/obesity. Eat Weight Disord 27, 233–242 (2022). https://doi.org/10.1007/s40519-021-01168-7