Clinical Practice of Body Composition Assessment in Female Subjects with Anorexia Nervosa

  • Michel Probst
  • Marina Goris


Anorexia Nervosa (AN) is characterised by a refusal to maintain a minimally normal body weight and by the distorted perception of one’s own body (weight, size, shape) as a negative interpretation of their appearance as too fat, resulting in the intense fear of weight gain, even when severely underweight. Both from a physiological and psychological viewpoint, weight, weight restoration and body composition are crucial elements for the treatment of AN. AN patients have unrealistic ideas about body fat and the influence of food intake and dieting on body weight and shape. Over the last ten years, body composition in female anorexia nervosa has become an important topic in treatment as well as in research. Increasingly, body composition is integrated into the assessment of the evolution of AN in patients. A wide variety of methods have been used to measure body composition in anorexia nervosa. The skinfold measurements and the bio impedance analysis are most often used in clinical practices. However, clinicians have to be careful with the use of the bio impedance analysis BIA for the estimate of body fat in AN. Additionally, the body mass index (BMI) does not predict the body composition or reveal the change in body composition. There are a number of available equations to estimate the percentage of body fat from the available body density. The Siri-Formula (In: Lawrence JH, Tobias CA, editors. Advances in biological and medical physics. New York: Academic Press, p. 239–280, 1956) is recommended, with some restrictions. A weight gain program for patients with anorexia nervosa lead to a significant increase in body weight and body fat. More than half (55%) of the weight increase is attributed to the increase of fat mass. The body composition results had to be communicated and explained to the AN patients in psycho-education sessions. Here, guidelines for a standard protocol of anthropometric assessments in the clinical practice are proposed. Despite an increase in knowledge about the body composition of patients with anorexia nervosa, more fundamental research is necessary in regard to the limitations of the techniques and equations for these specific group of underweight patients.


Body Composition Anorexia Nervosa Eating Disorder Skinfold Thickness Measure Body Composition 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Anorexia nervosa


Bio impedance analysis


Body mass index


Control subjects




Dual energy X-ray absorptiometry


Diagnostic statistical manual


Fat free mass


Fat mass


Not mentioned


Percentage body fat


Correlation coefficient


Skinfold thickness


Total body water


Underwater weighing


  1. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. Washington, DC: A.P.A. Press; 1994.Google Scholar
  2. Birmingham CL, Jones PJ, Orphanidou S, Bakan R, Cleator I, Goldner E, Phang PT. Int J Eat Disord. 1996;19:311–5.PubMedCrossRefGoogle Scholar
  3. Casper RC, Schoeller DA, Kushner R, Hnilicka J, Gold ST. Am J Clin Nutr. 1991;53:1143–50.PubMedGoogle Scholar
  4. Charest-Lilly P, Sherill C, Rosentsweig J. Adapt Phys Activ Q. 1987;4:126–36.Google Scholar
  5. Deurenberg P, Westrate JA. Am J Clin Nutr. 1989;50:1104–15.PubMedGoogle Scholar
  6. Durnin JV, Womersley J. Br J Nutr. 1974;32:77–96.PubMedCrossRefGoogle Scholar
  7. Grinspoon S, Thomas L, Miller K, Pitts S, Herzog D, Klibanski A. Am J Clin Nutr. 2001;73:865–9.PubMedGoogle Scholar
  8. Haas V, Onur S, Paul T, Nutzinger D, Bosy Westphal A, Hauer M, Brabant G, Kleo, H, Muller MJ. Am J Clin Nutr. 2005;81:889–96.PubMedGoogle Scholar
  9. Haas V, Kohn MR, Clarke SD, Allen JR, Madden S, Muller MJ, Gaskin KJ. Am J Clin Nutr. 2009;89:1005–10.PubMedCrossRefGoogle Scholar
  10. Hannan WJ, Cowen SJ, Freeman CP, Wrate M. Eur J Clin Nutr. 1993;47:741–6.PubMedGoogle Scholar
  11. Heymsfield SB, Allison DB, Heshka S, Pierson RN. In: Allison DB, editor. Handbook of assessment methods for eating behaviors and weight related problems. London: Sage Publications; 1995). p. 515–560.Google Scholar
  12. Heyward VH, Stolarczyk LM. Applied body composition assessment. Leeds: Human Kinetics; 1996.Google Scholar
  13. Iacopino I, Siani V, Melchiorri G, Orlandi C, De Luna A, Cervellil V, Andreoli A. Acta Diabetol. 2003;40:180–2.CrossRefGoogle Scholar
  14. Jackson AS, Pollock ML, Ward A. Med Sci Sports Exerc. 1980;12:175–82.PubMedGoogle Scholar
  15. Kerruish KP, O’Connor J, Humphries IRJ, Kohn MR, Clarke SD, Briody JN, Thomson EJ, Wright KA, Gaskin KJ, Baur LA. Am J Clin Nutr. 2002;75:31–7.PubMedGoogle Scholar
  16. Lohman TG. Pediatr Exerc Sci. 1989;1:19–30.Google Scholar
  17. Mayer L, Walsh T, Pierson R, Heymsfield SB, Gallagher D, Wang J, Parides M, Leibel R, Warren M, Killory E, Glasofer D. Am J Clin Nutr. 2005;81:1286–91.PubMedGoogle Scholar
  18. Mayo-Smith W, Hayes CW, Biller B, Klibanski A, Rosenthal H, Rosenthal D. Radiology. 1989;170:515–8.PubMedGoogle Scholar
  19. Mazess RB, Barden SH, Ohlrich ES.. Am J Clin Nutr. 1990;52:438–41.PubMedGoogle Scholar
  20. Misra M, Katzman DK, Cord J, Manning SJ, Mickley D, Herzog DB, Miller KK, Klibanski A. Am J Clin Nutr. 2008;88:1478–84.PubMedCrossRefGoogle Scholar
  21. Moreno M, Djamal-Dine D, Jaffrin M. Med Eng Phys. 2008;30:783–91.PubMedCrossRefGoogle Scholar
  22. Nicholls D, Wells JC, Stanhope R. Eur J Clin Nutr. 2002;56:857–65.PubMedCrossRefGoogle Scholar
  23. Orphanidou CI, McCargar LJ, Birmingham CL, Belzberg AS. Am J Clin Nutr. 1997;65:1034–41.PubMedGoogle Scholar
  24. Pagliato E, Corradi E, Gentile M, Testolin G. Ann NY Acad Sci. 2000;904:617–20.PubMedCrossRefGoogle Scholar
  25. Polito A, Cuzzolaro M, Raguzzini A, Censi L, Ferro-Luzzi A. Eur J Clin Nutr. 1998;52:655–62.PubMedCrossRefGoogle Scholar
  26. Probst M, Goris M, Vandereycken W, Van Coppenolle H. Br J Nutr. 1996;76:639–47.PubMedCrossRefGoogle Scholar
  27. Probst M, Goris M, Vandereycken W, Van Coppenolle H. Am J Clin Nutr. 2001;73:190–7.PubMedGoogle Scholar
  28. Probst M, Goris M, Vandereycken W, Pieters G. Int J Eat Disord. 2008;41:180–3.PubMedCrossRefGoogle Scholar
  29. Russell D, Prendergast PJ, Darby PL, Garfinkel PE, Whitewell JR, Jeejeebhoy KN. Am J Clin Nutr. 1983;38:229–37.PubMedGoogle Scholar
  30. Russell JD, Mira M, Allen BJ, Stawart PM, Vizzard J, Arthur B, Beumont PJV. Am J Clin Nutr. 1994;59:98–102.PubMedGoogle Scholar
  31. Scalfi L, Polito A, Bianchi L, Marra M, Caldaro A, Nicloai L, Contaldo F. Eur J Clin Nutr. 2002;56:15–20.PubMedCrossRefGoogle Scholar
  32. Siri WE. In: Lawrence JH, Tobias CA, editors. Advances in biological and medical physics. New York: Academic Press; 1956. p. 239–280.Google Scholar
  33. Slaughter ME, Lohman TG, Boileau RA. Hum Biol. 1988;60:709–23.PubMedGoogle Scholar
  34. Soh NL, Touyz S, Dobbins T, Clarke S, Kohn M, Lee E, Leow V, Ung K, Walter G. Eur Eat Disord Rev. 2009;17:31–9.PubMedCrossRefGoogle Scholar
  35. Trocki O, Shepherd R. J Nutr. 2000;100:457–60.Google Scholar
  36. Vaisman N, Corey M, Rossi MF, Goldberg E, Pencharz P. J Pediatr. 1988;113:925–9.PubMedCrossRefGoogle Scholar
  37. Vaisman N, Rossi M, Corey M, Clarke R, Goldberg E, Pencharz B. Eur J Clin Nutr. 1991;45:527–37.PubMedGoogle Scholar
  38. Wilmore JH, Behnke AR. Am J Clin Nutr. 1970;23:267–74.PubMedGoogle Scholar
  39. Yamashita S, Kawai K, Yamaka T, Inoo T, Yokayama H, Morita C, Takii M, Kubo C. Int J Eat Disord. 2010;43:365–71.Google Scholar

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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Rehabilitation Sciences, Faculty of Kinesiology and Rehabilitation Sciences, K.U. LeuvenUniversity Psychiatric Centre-K.U. LeuvenLeuvenBelgium
  2. 2.University Psychiatric Centre-K.U. LeuvenKortenbergBelgium

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