Weight Requirements for Catch-Up Growth in Adolescent Girls with Eating Disorders



Adolescent girls presenting with an eating disorder with onset of weight loss before menarche are at risk of being stunted by undernutrition. They have, however, considerable growth potential and will catch up in stature if adequately treated. In contrast to postmenarcheal teenagers the younger girls have an insidious onset of disease with an often long period of diminished weight gain and stunting of growth. Disturbed eating behaviour may be discrete and go unnoticed during the early stages of disease. Presentation is therefore usually delayed until weight loss makes the diagnosis evident. At presentation weight deficit may be considerable due to not only weight loss but also the absence of expected weight gain. There is a decrease in linear growth, which in some cases may have completely halted. Following start of treatment there may be considerable weight gain, especially during the first year of treatment. Resumption of linear growth is, however, delayed to the second year of treatment. Growth may then continue for several years at an age when girls usually have almost reached their final height. Catch-up growth is thus achieved by prolonging the growth period rather than growing at an increased rate. Catch-up can reach the growth trajectory of prepubertal growth, i.e. the growth channel before onset of the eating disorder. This level of catch-up growth is achieved if weight gain reaches the prepubertal weight curve. When catch-up in weight and height stabilises at this level, menarche ensues. Considerable catch-up growth is thus possible in eating disorders with onset before menarche. A prerequisite is rapid weight restoration, before growth potential is lost with age. Once weight gain is achieved full catch-up in stature and completion of puberty by menarche may take several years.


Weight Gain Eating Disorder Eating Disorder Bulimia Nervosa Standard Deviation Score 
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.



Body mass index


Eating disorder


Standard deviation score



Work by the author presented in this review was supported by HRH Crown princess Lovisa's Fund for Child Healthcare, the Swedish Society for Medical Sciences, the Gillbergska Foundation, the First of May Flower Annual Campaign and Uppsala University. No potential conflicts of interest are reported.


  1. Bryant-Waugh RJ, Lask BD, Shafran RL, Fosson AR. Do doctors recognise eating disorders in children? Arch Dis Child. 1992;67:103–5.PubMedCrossRefGoogle Scholar
  2. Caragero L, Favaro A, Santonastaso P, Alberino F, DiPascoli L, Nardi M, Favaro S, Gatta A. Insulin-like growth factor 1 (IGF-1), a nutritional marker in patients with eating disorders. Clin Nutr. 2001;20:251–7.CrossRefGoogle Scholar
  3. Danziger Y, Mukamel M, Zeharia A, Dinari G, Mimouni M. Stunting of growth in anorexia nervosa during the prepubertal and pubertal period. Isr J Med Sci. 1994;30:581–4.PubMedGoogle Scholar
  4. Eliakim A, Brasel JA, Mohan S, Barstow TJ, Berman N, Cooper DM. Physical fitness, endurance training, and the growth hormone-insulin-like growth factor I system in adolescent females. J Clin Endocrinol Metab. 1996;81:3986–92.PubMedCrossRefGoogle Scholar
  5. Favaro A, Tenconi E, Degortes D, Soave M, Zanetti T, Nardi MT, Caragero L, Santonastaso P. Association between low height and eating disorders: Cause or effect? Int J Eat Disord. 2007;40:549–53.PubMedCrossRefGoogle Scholar
  6. Gelander L, Blum WF, Larsson L, Rosberg S, Albertsson-Wikland K. Monthly measurements of insulin-like growth factor I (IGF-I) and IGF-binding protein-3 in healthy prepubertal children: characterization and relationship with growth: the 1-year growth study. Pediatr Res. 1999;45:377–83.PubMedCrossRefGoogle Scholar
  7. Georgopoulos N, Markou K, Theodoropoulou A, Paraskevopoulou P, Varaki L, Kazantzi Z, Leglise M, Vagenakis AG. Growth and pubertal development in elite female rhythmic gymnasts. J Clin Endocrinol Metab. 1999;84:4525–30.PubMedCrossRefGoogle Scholar
  8. Georgopoulos NA, Markou KB, Theodoropoulou A, Vagenakis GA, Benardot D, Leglise M, Dimopoulos JCA, Vagenakis AG. Height velocity and skeletal maturation in elite female rhythmic gymnasts. J Clin Endocrinol Metab. 2001;86:5159–64.PubMedCrossRefGoogle Scholar
  9. Higgs JF, Goodyer IM, Birch J. Anorexia nervosa and food avoidance emotional disorder. Arch Dis Child. 1989;64:346–51.PubMedCrossRefGoogle Scholar
  10. Jahreis G, Kauf E, Fröhner G, Schmidt HE. Influence of intensive exercise on insulin-like growth factor I, thyroid and steroid hormones in female gymnasts. Growth Regul. 1991;1:95–9.PubMedGoogle Scholar
  11. Joughin N, Varsou E, Gowers S, Crisp AH. Relative tallness in anorexia nervosa. Int J Eat Disord. 1991;12:195–207.CrossRefGoogle Scholar
  12. Karwautz A, de Zwaan M, Wöber-Bingöl C, Wöber C, Friedrich MH. Awareness of earlyonset anorexia nervosa. Eat Weight Disord. 1997;2:138–43.PubMedGoogle Scholar
  13. Lacey JH, Crisp AH, Hart G, Kirkwood BA. Weight and skeletal maturation – a study of radiological and chronological age in an anorexia nervosa population. Postgrad Med J. 1979;55:381–5.PubMedCrossRefGoogle Scholar
  14. Lai KY, de Bruyn R, Lask B, Bryant-Waugh R, Hankins M. Use of pelvic ultrasound to monitor ovarian and uterine maturity in childhood onset anorexia nervosa. Arch Dis Child. 1994;71:228–31.PubMedCrossRefGoogle Scholar
  15. Lantzouni E, Frank GR, Golden NH, Shenker RI. Reversibility of growth stunting early onset anorexia nervosa: a prospective study. J Adolesc Health. 2002;31:162–5.PubMedCrossRefGoogle Scholar
  16. Martorell R, Kettel Khan L, Schroeder DG. Reversibilty of stunting: epidemiological findings in children from developing countries. Eur J Clin Nutr. 1994;48 Suppl 1:S45–57.PubMedGoogle Scholar
  17. Modan-Moses D, Yaroslavski A, Novikov I, Segev S, Toledano A, Miterany E, Stein D. Stunting of growth as a major feature of anorexia nervosa in male adolescents. Pediatrics. 2003;111:270–6.PubMedCrossRefGoogle Scholar
  18. Nussbaum M, Baird D, Sonnenblick M, Cowan K, Shenker IR. Short stature in anorexia nervosa. J Adolesc Health. 1985;6:453–4558.CrossRefGoogle Scholar
  19. Ogg EC, Millar HR, Pusztai EE, Thom AS. General practice consultation patterns preceding the diagnosis of an eating disorder. Int J Eat Disord. 1997;22:89–93.PubMedCrossRefGoogle Scholar
  20. Prabhakaran R, Misra M, Miller KK, Kruczek K, Sundaralingam S, Herzog DB, Katzman DK, Klibanski A. Determinants of height in adolescent girls with anorexianervosa. Pediatrics. 2008;121:e1517–23.PubMedCrossRefGoogle Scholar
  21. Pugliese MT, Lifshitz F, Grad G, Fort P, Marks-Katz M. Fear of obesity. A cause of short stature and delayed puberty. N Engl J Med. 1983;309:513–8.PubMedCrossRefGoogle Scholar
  22. Reindollar RH, Byrd JR, McDonough PG. Delayed sexual development: a study of 252 patients. Am J Obstet Gynecol. 1981;140:371–80.PubMedGoogle Scholar
  23. Root AW, Powers PS. Anorexia nervosa presenting as growth retardation in adolescents. J Adolesc Health Care. 1983;4:25–30.PubMedCrossRefGoogle Scholar
  24. Russel GFM. Premenarcheal anorexia nervosa and its sequele. J Psychiatr Res. 1985;19:363–9.CrossRefGoogle Scholar
  25. Schachter M, Shoham Z. Amenorrhea during the reproductive years – is it safe? Fertil Steril. 1994;62:1–16.PubMedGoogle Scholar
  26. Suikkari AM, Sane T, Seppälä M, Yki-Järvinen H, Karonen SL, Koivisto VA. Prolonged exercise increases serum insulin-like growth factor-binding protein concentrations. J Clin Endocrinol Metab. 1989;68:141–4.PubMedCrossRefGoogle Scholar
  27. Swenne I. Heart risk associated with weight loss in anorexia nervosa and eating disorders: electrocardiographic changes during the early phases of refeeding. Acta Paediatr. 2000;89:447–52.PubMedCrossRefGoogle Scholar
  28. Swenne I. Changes in body weight and body mass index (BMI) in teenage girls prior to the onset and diagnosis of an eating disorder. Acta Paediatr. 2001;90:677–81.PubMedCrossRefGoogle Scholar
  29. Swenne I. Weight requirements for catch-up growth in girls with eating disorders and onset of weight loss before menarche. Int J Eat Disord. 2005;38:340–5.PubMedCrossRefGoogle Scholar
  30. Swenne I. Weight and growth requirements for menarche in teenage girls with eating disorders, weight loss and primary amenorrhea. Horm Res. 2008;69:146–51.PubMedCrossRefGoogle Scholar
  31. Swenne I, Thurfjell B. Chinical onset and diagnosis of eating disorders in premenarcheal girls is preceded by inadequate weight gain and growth retardation. Acta Paediatr. 2003;92:1133–7.PubMedCrossRefGoogle Scholar
  32. Swenne I, Stridsberg M, Thurfjell B, Rosling A. Insulin-like growth factor-1 as an indicator of nutrition during treatment of adolescent girls with eating disorder. Acta Paediatr. 2007;96:1203–8.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of Women’s and Children’s HealthUppsala UniversityUppsalaSweden

Personalised recommendations