Anthropometry and Nutritional Rehabilitation in Underweight Eating Disorders

  • Giulio Marchesini
  • Laura Maria Ricciardi
  • Nicola Villanova
  • Riccardo Dalle Grave


The restoration of a normal body weight is a key strategy in the treatment of eating disorders, in order to eliminate the adverse effects of starvation on health and on the eating disorder psychopathology. Unfortunately, weight regain is frequently hindered by changes in body shape, in particular a protrusion of the abdomen, which may lead underweight patients to stop their nutritional rehabilitation program. In adult patients with underweight eating disorders, studies using dual-energy X-ray absorptiometry, skinfold thickness, dual photon absorptiometry and circumference measurements found a preferential accumulation of body fat in the central regions rather than the extremities during the process of weight regain. These data, however, were not confirmed in adolescents and in young adults with eating disorders. To date, the mechanism(s) implicated in the preferential accumulation of abdominal fat (e.g., low level of estrogens, fast rate of weight regain) have not been settled by experimental research, nor is it settled whether the preferential accumulation is a transient phenomenon or it persists after complete and stable weight restoration. Available data indicate that weight regain produces an increase in bone mineral density, initially greater in the hip than in the spine, but in the long-term bone recovery is never complete, especially whenever the eating disorder starts during adolescence and peak bone mass has not been attained. As lack of exercising may contribute to decrease bone mass, to increase the risk for atherosclerosis and to decrease compliance with the program, clinicians tend to incorporate healthy and social exercising in the nutritional rehabilitation. Preliminary findings indicate that this procedure helps patients get out of the isolation of their disease, overcome the urge to exercise, accept weight gain and changes in shape, and increase lean body mass, while it does not reduce the short-term gain of body fat or BMI.


Obesity Depression Urea Estrogen Osteoporosis 
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


Bioelectric Impedance Analysis


Bone Mineral Content


Bone Mineral Density


Body Mass Index


Dual-Energy X-Ray Absorptiometry


Diagnostic and Statistical Manual of Mental Disorders


Eating Disorder Not Otherwise Specified


Fat Mass


Lean body mass


  1. American Psychiatry Association. Book diagnostic and statistical manual of mental disorders. Washington, DC: American Psychiatry Association; 2000.Google Scholar
  2. Bertoli S, Corradi E, Vangeli V, Tarlarini P, Salvatori GC, Gentile MG, Testolin G, Battezzati A. Time course of total and distrectual weight gain after refeeding in anorexia nervosa. Acta Diabetol. 2004;41:18–24.PubMedCrossRefGoogle Scholar
  3. Compston JE, McConachie C, Stott C, Hannon RA, Kaptoge S, Debiram I, Love S, Jaffa A. Changes in bone mineral density, body composition and biochemical markers of bone turnover during weight gain in adolescents with severe anorexia nervosa: a 1-year prospective study. Osteoporos Int. 2006;17:77–84.PubMedCrossRefGoogle Scholar
  4. Dalle Grave R, Bohn K, Hawker D, Fairburn CG. Inpatient, day patient and two forms of outpatient CBT-E. In: Fairburn CG, editor. Cognitive behavior therapy and eating disorders. New York: The Guilford Press; 2008a. p. 231–244.Google Scholar
  5. Dalle Grave R, Calugi S, Marchesini G. Compulsive exercise to control shape or weight in eating disorders: prevalence, associated features, and treatment outcome. Compr. Psychiatry. 2008b;49:346–52.PubMedCrossRefGoogle Scholar
  6. Dalle Grave R, Di Pauli D, Sartirana M, Calugi S, Shafran R. The interpretation of symptoms of starvation/severe dietary restraint in eating disorder patients. Eat Weight Disord. 2007;12:108–13.PubMedGoogle Scholar
  7. de Alvaro MT, Munoz-Calvo MT, Barrios V, Martinez G, Martos-Moreno GA, Hawkins F, Argente J. Regional fat distribution in adolescents with anorexia nervosa: effect of duration of malnutrition and weight recovery. Eur J Endocrinol. 2007;157:473–9.PubMedCrossRefGoogle Scholar
  8. Dominguez J, Goodman L, Sen Gupta S, Mayer L, Etu SF, Walsh BT, Wang J, Pierson R, Warren MP. Treatment of anorexia nervosa is associated with increases in bone mineral density, and recovery is a biphasic process involving both nutrition and return of menses. Am J Clin Nutr. 2007;86:92–9.PubMedGoogle Scholar
  9. Espeland MA, Stefanick ML, Kritz-Silverstein D, Fineberg SE, Waclawiw MA, James MK, Greendale GA. Effect of postmenopausal hormone therapy on body weight and waist and hip girths. Postmenopausal Estrogen-Progestin Interventions Study Investigators. J Clin Endocrinol Metab. 1997;82:1549–56.PubMedCrossRefGoogle Scholar
  10. Fairburn CG. Book cognitive behavior therapy and eating disorders. New York: The Guildford Press; 2008.Google Scholar
  11. Forbes GB, Kreipe RE, Lipinski BA, Hodgman CH. Body composition changes during recovery from anorexia nervosa: comparison of two dietary regimes. Am J Clin Nutr. 1984;40:1137–45.PubMedGoogle Scholar
  12. Goldner EM, Birmingham CL. Treatment of anorexia nervosa. In: Alexander-Mott L, Lumsden DB, editors. Understanding eating disorders. Washington, DC: Taylor & Francis; 1994.Google Scholar
  13. Grinspoon S, Thomas L, Miller K, Pitts S, Herzog D, Klibanski A. Changes in regional fat redistribution and the effects of estrogen during spontaneous weight gain in women with anorexia nervosa. Am J Clin Nutr. 2001;73:865–9.PubMedGoogle Scholar
  14. Haarbo J, Marslew U, Gotfredsen A, Christiansen C. Postmenopausal hormone replacement therapy prevents central distribution of body fat after menopause. Metabolism. 1991;40:1323–6.PubMedCrossRefGoogle Scholar
  15. Iketani T, Kiriike N, Nagata T, Yamagami S. Altered body fat distribution after recovery of weight in patients with anorexia nervosa. Int J Eat Disord. 1999;26:275–82.PubMedCrossRefGoogle Scholar
  16. Kerruish KP, O’Connor J, Humphries IR, Kohn MR, Clarke SD, Briody JN, Thomson EJ, Wright KA, Gaskin KJ, Baur LA. Body composition in adolescents with anorexia nervosa. Am J Clin. Nutr. 2002;75:31–7.PubMedGoogle Scholar
  17. Keys A, Brozek J, Henschel A, Mickelsen O, Taylor H. Book the biology of human starvation. Minneapolis: The University of Minnesota Press; 1950.Google Scholar
  18. Lapidus L, Bengtsson C, Larsson B, Pennert K, Rybo E, Sjostrom L. Distribution of adipose tissue and risk of cardiovascular disease and death: a 12 year follow up of participants in the population study of women in Gothenburg, Sweden. Br Med J (Clin Res Ed.) 1984;289:1257–61.CrossRefGoogle Scholar
  19. Mayer L, Walsh BT, Pierson RN, Jr., Heymsfield SB, Gallagher D, Wang J, Parides MK, Leibel RL, Warren MP, Killory E, Glasofer D. Body fat redistribution after weight gain in women with anorexia nervosa. Am J Clin Nutr. 2005;81:1286–91.PubMedGoogle Scholar
  20. Mika C, Herpertz-Dahlmann CB, Heer M, Holtkamp K. Improvement of nutritional status as assessed by multifrequency BIA during 15 weeks of refeeding in adolescent girls with anorexia nervosa. J Nutr. 2004;134:3026–30.PubMedGoogle Scholar
  21. Miller KK, Lee EE, Lawson EA, Misra M, Minihan J, Grinspoon SK, Gleysteen S, Mickley D, Herzog D, Klibanski A. Determinants of skeletal loss and recovery in anorexia nervosa. J Clin Endocrinol Metab. 2006;91:2931–7.PubMedCrossRefGoogle Scholar
  22. Misra M, Soyka LA, Miller KK, Grinspoon S, Levitsky LL, Klibanski A. Regional body composition in adolescents with anorexia nervosa and changes with weight recovery. Am J Clin Nutr. 2003;77:1361–7.PubMedGoogle Scholar
  23. Moreno MV, Djeddi DD, Jaffrin MY. Assessment of body composition in adolescent subjects with anorexia nervosa by bioimpedance. Med Eng Phys. 2008;30:783–91.PubMedCrossRefGoogle Scholar
  24. Orphanidou CI, McCargar LJ, Birmingham CL, Belzberg AS. Changes in body composition and fat distribution after short-term weight gain in patients with anorexia nervosa. Am J Clin Nutr. 199;65:1034–41.Google Scholar
  25. Probst M, Goris M, Vandereycken W, Van Coppenolle H. Body composition of anorexia nervosa patients assessed by underwater weighing and skinfold-thickness measurements before and after weight gain. Am J Clin Nutr. 2001;73:190–7.PubMedGoogle Scholar
  26. Probst M, Van Coppenolle H, Vandereycken W. Body experience in anorexia nervosa patients: an overview of therapeutic approaches. Eating Disord J Treat Rev. 1995;3:186–98.Google Scholar
  27. Russell DM, Prendergast PJ, Darby PL, Garfinkel PE, Whitwell J, Jeejeebhoy KN. A comparison between muscle function and body composition in anorexia nervosa: the effect of refeeding. Am J Clin Nutr. 1983;38:229–37.PubMedGoogle Scholar
  28. Russell GF, Mezey AG. An analysis of weight gain in patients with anorexia nervosa treated with hirh calorie diets. Clin Sci. 1962;23:449–61.PubMedGoogle Scholar
  29. Scalfi L, Polito A, Bianchi L, Marra M, Caldara A, Nicolai E, Contaldo F. Body composition changes in patients with anorexia nervosa after complete weight recovery. Eur J Clin Nutr. 2002;56:15–20.PubMedCrossRefGoogle Scholar
  30. Soyka LA, Grinspoon S, Levitsky LL, Herzog DB, Klibanski A. The effects of anorexia nervosa on bone metabolism in female adolescents. J Clin Endocrinol Metab. 1999;84:4489–96.PubMedCrossRefGoogle Scholar
  31. Thien V, Thomas A, Markin D, Birmingham CL. Pilot study of a graded exercise program for the treatment of anorexia nervosa. Int J Eat Disord. 2000;28:101–6.PubMedCrossRefGoogle Scholar
  32. Tothill P, Laskey MA, Orphanidou CI, van Wijk M. Anomalies in dual energy X-ray absorptiometry measurements of total-body bone mineral during weight change using Lunar, Hologic and Norland instruments. Br J Radiol. 1999;72:661–9.PubMedGoogle Scholar
  33. Valtuena S, Di Mattei V, Rossi L, Polito A, Cuzzolaro M, Branca F. Bone resorption in anorexia nervosa and rehabilitated patients. Eur J Clin Nutr. 2003;57:260–5.PubMedCrossRefGoogle Scholar
  34. Viapiana O, Gatti D, Dalle Grave R, Todesco T, Rossini M, Braga V, Idolazzi L, Fracassi E, Adami S. Marked increases in bone mineral density and biochemical markers of bone turnover in patients with anorexia nervosa gaining weight. Bone. 2007;40:1073–7.PubMedCrossRefGoogle Scholar
  35. Zamboni M, Armellini F, Turcato E, Todisco P, Gallagher D, Dalle Grave R, Heymsfield S, Bosello O. Body fat distribution before and after weight gain in anorexia nervosa. Int J Obes Relat Metab Disord. 1997;21:33–6.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Giulio Marchesini
    • 1
  • Laura Maria Ricciardi
  • Nicola Villanova
  • Riccardo Dalle Grave
  1. 1.Clinical Dietetics“Alma Mater Studiorum” UniversityBolognaItaly

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