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Weight Suppression in Eating Disorders: a Research and Conceptual Update

  • Eating Disorders (S Wonderlich and JM Lavender, Section Editors)
  • Published:
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Abstract

Purpose of Review

Weight suppression, the discrepancy between an individual’s highest past weight at adult height and his or her current weight, is related to many characteristics of individuals with eating disorders. This paper reviews research findings from the past 5 years, draws several implications regarding the mechanism underlying these effects, and proposes new approaches to measuring weight suppression.

Recent Findings

Studies were reviewed under the categories of anorexia nervosa, bulimia nervosa, and mixed or miscellaneous samples, with more studies falling into the last category than in the first two. Recent findings have continued to show that weight suppression is related to a wide variety of biological and behavioral features in both diagnosed and sub-clinical samples.

Summary

Weight suppression promotes weight gain which is anathema to individuals with eating disorders, putting them in a biobehavioral bind that appears to prolong their disorder. Priorities for future research are to understand the mechanisms underlying the effects of weight suppression, evaluate new ways of defining weight suppression, and study its implications for modifying treatment.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major Importance

  1. Butryn ML, Lowe MR, Safer DL, Agras WS. Weight suppression is a robust predictor of outcome in the cognitive-behavioral treatment of bulimia nervosa. J Abnorm Psychol. 2006;115(1):62–7.

    Article  PubMed  Google Scholar 

  2. Lowe MR. The effects of dieting on eating behavior: a three-factor model. Psychol Bull. 1993;114(1):100–21.

    Article  CAS  PubMed  Google Scholar 

  3. Lowe MR. Weight suppression. In: Brownell KD, Walsh BT, editors. Eating disorders and obesity: a comprehensive handbook. 3rd ed. New York: Guilford Publications; 2017. p. 116–20.

    Google Scholar 

  4. Lowe MR, Davis W, Lucks D, Annunziato R, Butryn M. Weight suppression predicts weight gain during inpatient treatment of bulimia nervosa. Physiol Behav. 2006;87(3):487–92.

    Article  CAS  PubMed  Google Scholar 

  5. Stice E, Durant S, Burger KS, Schoeller DA. Weight suppression and risk of future increases in body mass: effects of suppressed resting metabolic rate and energy expenditure. Am J Clin Nutr. 2011;94(1):7–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Butryn ML, Juarascio A, Lowe MR. The relation of weight suppression and BMI to bulimic symptoms. Int J Eat Disord. 2011;44(7):612–7.

    Article  PubMed  Google Scholar 

  7. •• Berner LA, Shaw JA, Witt AA, Lowe MR. The relation of weight suppression and body mass index to symptomatology and treatment response in anorexia nervosa. J Abnorm Psychol. 2013;122(3):694–708. One of several studies showing that the impact of weight suppression on eating disorder symptoms is moderated by current BMI.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dulloo AG, Jacquet J, Montani J-P. How dieting makes some fatter: from a perspective of human body composition autoregulation. Proc Nutr Soc. 2012;71(3):379–89.

    Article  PubMed  Google Scholar 

  9. Keys A, Brozek J, Henschel A, Mickelsen O, Taylor H. The biology of human starvation. University of Minnesota Press; 1950.

  10. Rosenbaum M, Hirsch J, Gallagher DA, Leibel RL. Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. Am J Clin Nutr. 2008;88(4):906–12.

    Article  CAS  PubMed  Google Scholar 

  11. Doucet E, Imbeault P, St-Pierre S, Alméras N, Mauriège P, Richard D, et al. Appetite after weight loss by energy restriction and a low-fat diet–exercise follow-up. Int J Obes. 2000;24(7):906–14.

    Article  CAS  Google Scholar 

  12. Carter FA, McIntosh VV, Joyce PR, Bulik CM. Weight suppression predicts weight gain over treatment but not treatment completion or outcome in bulimia nervosa. J Abnorm Psychol. 2008;117(4):936–40.

    Article  PubMed  Google Scholar 

  13. Lowe MR, Thomas JG, Safer DL, Butryn ML. The relationship of weight suppression and dietary restraint to binge eating in bulimia nervosa. Int J Eat Disord. 2007;40(7):640–4.

    Article  PubMed  Google Scholar 

  14. •• Keel PK, Heatherton TF. Weight suppression predicts maintenance and onset of bulimic syndromes at 10-year follow-up. J Abnorm Psychol. 2010;119(2):268–75. This study shows that weight suppression has a very-long-term impact on bulimic symptoms in a large, nonclinical sample.

    Article  PubMed  PubMed Central  Google Scholar 

  15. • Herzog DB, Thomas JG, Kass AE, Eddy KT, Franko DL, Lowe MR. Weight suppression predicts weight change over 5 years in bulimia nervosa. Psychiatry Res. 2010;177(3):330–4. This is one of many studies showing that weight suppression predicts weight gain over the short and long term. Given that individuals with eating disorders greatly fear weight gain, it appears that weight suppression keeps them stuck in a “biobehavioral bind.”

    Article  PubMed  PubMed Central  Google Scholar 

  16. Lowe MR, Berner LA, Swanson SA, Clark VL, Eddy KT, Franko DL, et al. Weight suppression predicts time to remission from bulimia nervosa. J Consult Clin Psychol. 2011;79(6):772–6.

    Article  PubMed  Google Scholar 

  17. •• Wildes JE, Marcus MD. Weight suppression as a predictor of weight gain and response to intensive behavioral treatment in patients with anorexia nervosa. Behav Res Ther. 2012;50(4):266–74. The first of several papers showing the weight suppression’s effects extend from bulimia nervosa to anorexia nervosa.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Berner LA, Feig EH, Witt AA, Lowe MR. Menstrual cycle loss and resumption among patients with anorexia nervosa spectrum eating disorders: is relative or absolute weight more influential? Int J Eat Disord. 2017;50(4):442–6.

    Article  PubMed  Google Scholar 

  19. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). 5th ed. American Psychiatric Publishing; 2013.

  20. • Bodell LP, Keel PK. Weight suppression in bulimia nervosa: associations with biology and behavior. J Abnorm Psychol. 2015;124(4):994–1002. Individuals with bulimia nervosa showed lower levels of leptin and greater reinforcing value of food.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Accurso EC, Lebow J, Murray SB, Kass AE, Le Grange D. The relation of weight suppression and BMIz to bulimic symptoms in youth with bulimia nervosa. J Eat Disord. 2016;4(1):21.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Hagan KE, Clark KE, Forbush KT. Incremental validity of weight suppression in predicting clinical impairment in bulimic syndromes. Int J Eat Disord. 2017;50(6):672–8.

    Article  PubMed  Google Scholar 

  23. Keel PK, Bodell LP, Haedt-Matt AA, Williams DL, Appelbaum J. Weight suppression and bulimic syndrome maintenance: preliminary findings for the mediating role of leptin. Int J Eat Disord. 2017;50(12):1432–6.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Zanetti T, Santonastaso P, Sgaravatti E, Degortes D, Favaro A. Clinical and temperamental correlates of body image disturbance in eating disorders. Eur Eat Disord Rev. 2013;21(1):32–7.

    Article  PubMed  Google Scholar 

  25. Van Son GE, van der Meer PA, Van Furth EF. Correlates and associations between weight suppression and binge eating symptomatology in a population-based sample. Eat Behav. 2013;14(2):102–6.

    Article  PubMed  Google Scholar 

  26. Cook BJ, Steffen KJ, Mitchell JE, Otto M, Crosby RD, Cao L, et al. A pilot study examining diagnostic differences among exercise and weight suppression in bulimia nervosa and binge eating disorder. Eur Eat Disord Rev. 2015;23(3):241–5.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Davis HA, Holland LA, Keel PK. A preliminary examination of a nonpurging compensatory eating disorder. Int J Eat Disord. 2014;47(3):239–43.

    Article  PubMed  Google Scholar 

  28. Lavender JM, Shaw JA, Crosby RD, Feig EH, Mitchell JE, Crow SJ, et al. Associations between weight suppression and dimensions of eating disorder psychopathology in a multisite sample. J Psychiatr Res. 2015;69:87–93.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Forney KJ, Brown TA, Holland-Carter LA, Kennedy GA, Keel PK. Defining “significant weight loss” in atypical anorexia nervosa. Int J Eat Disord. 2017;50(8):952–62.

    Article  PubMed  Google Scholar 

  30. Stice E, Telch CF, Rizvi SL. Development and validation of the Eating Disorder Diagnostic Scale: a brief self-report measure of anorexia, bulimia, and binge-eating disorder. Psychol Assess. 2000;12(2):123–31.

    Article  CAS  PubMed  Google Scholar 

  31. Goodman EL, Baker JH, Peat CM, Yilmaz Z, Bulik CM, Watson HJ. Weight suppression and weight elevation are associated with eating disorder symptomatology in women age 50 and older: results of the gender and body image study. Int J Eat Disord 2018.

  32. Burnette CB, Simpson CC, Mazzeo SE. Exploring gender differences in the link between weight suppression and eating pathology. Eat Behav. 2017;27:17–22.

    Article  PubMed  Google Scholar 

  33. Burnette CB, Simpson CC, Mazzeo SE. Relation of BMI and weight suppression to eating pathology in undergraduates. Eat Behav. 2018;30:16–21.

    Article  PubMed  Google Scholar 

  34. Carter FA, Boden JM, Jordan J, McIntosh VV, Bulik CM, Joyce PR. Weight suppression predicts total weight gain and rate of weight gain in outpatients with anorexia nervosa. Int J Eat Disord. 2015;48(7):912–8.

    Article  PubMed  Google Scholar 

  35. Bodell LP, Racine SE, Wildes JE. Examining weight suppression as a predictor of eating disorder symptom trajectories in anorexia nervosa. Int J Eat Disord. 2016;49(8):753–63.

    Article  PubMed  Google Scholar 

  36. • Witt AA, Berkowitz SA, Gillberg C, Lowe MR, Råstam M, Wentz E. Weight suppression and body mass index interact to predict long-term weight outcomes in adolescent-onset anorexia nervosa. J Consult Clin Psychol. 2014;82(6):1207–11. This study shows that weight suppression predicts degree of weight gain in individuals with anorexia up to 18 years later, often in interaction with starting BMI.

    Article  PubMed  Google Scholar 

  37. Dawkins H, Watson HJ, Egan SJ, Kane RT. Weight suppression in bulimia nervosa: relationship with cognitive behavioral therapy outcome. Int J Eat Disord. 2013;46(6):586–93.

    Article  PubMed  Google Scholar 

  38. Hessler JB, Diedrich A, Greetfeld M, Schlegl S, Schwartz C, Voderholzer U. Weight suppression but not symptom improvement predicts weight gain during inpatient treatment for bulimia nervosa. Eur Eat Disord Rev. 2018;26(2):146–9.

    Article  PubMed  Google Scholar 

  39. Swenne I, Parling T, Ros HS. Family-based intervention in adolescent restrictive eating disorders: early treatment response and low weight suppression is associated with favourable one-year outcome. BMC Psychiatry. 2017;17(1):333.

    Article  PubMed  PubMed Central  Google Scholar 

  40. •• Bodell LP, Brown TA, Keel PK. Weight suppression predicts bulimic symptoms at 20-year follow-up: the mediating role of drive for thinness. J Abnorm Psychol. 2017;126(1):32–7. This study demonstrates that weight suppression predicts bulimic symptoms 20 years later and that drive for thinness at 10 years mediates this relationship.

    Article  PubMed  Google Scholar 

  41. Berner L, Shaw J, Witt A, Lowe M. Interaction of weight suppression and body mass index in the prediction of symptomatology and outcome in anorexia nervosa. J Abnorm Psychol. 2013;122:694–708.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Solmi M, Gallicchio D, Collantoni E, Meneguzzo P, Zanetti T, Degortes D, et al. The impact of weight suppression and weight loss speed on baseline clinical characteristics and response to treatment. Int J Eat Disord. 2018;51(6):542–8. https://doi.org/10.1002/eat.22861.

    Article  PubMed  Google Scholar 

  43. Seetharaman S, Golden NH, Halpern-Felsher B, Peebles R, Payne A, Carlson JL. Effect of a prior history of overweight on return of menses in adolescents with eating disorders. J Adolesc Health. 2017;60(4):469–71.

    Article  PubMed  Google Scholar 

  44. Schaumberg K, Anderson LM, Reilly EE, Gorrell S, Anderson DA, Earleywine M. Considering alternative calculations of weight suppression. Eat Behav. 2016;20:57–63.

    Article  PubMed  Google Scholar 

  45. Favaro A, Caregaro L, Tenconi E, Bosello R, Santonastaso P. Time trends in age at onset of anorexia nervosa and bulimia nervosa. J Clin Psychiatry. 2009;16(12):1715–21.

    Article  Google Scholar 

  46. Wade TD, Bergin JL, Martin NG, Gillespie NA, Fairburn CG. A transdiagnostic approach to understanding eating disorders. J Nerv Ment Dis. 2006;194(7):510–7. https://doi.org/10.1097/01.nmd.0000225067.42191.b0.

    Article  PubMed  Google Scholar 

  47. Ochner CN, Barrios DM, Lee CD, Pi-Sunyer FX. Biological mechanisms that promote weight regain following weight loss in obese humans. Physiol Behav. 2013;120:106–13.

    Article  CAS  PubMed  Google Scholar 

  48. Greenway F. Physiological adaptations to weight loss and factors favouring weight regain. Int J Obes. 2015;39(8):1188–96.

    Article  CAS  Google Scholar 

  49. Hintze LJ, Mahmoodianfard S, Auguste CB, Doucet É. Weight loss and appetite control in women. Curr Obes Rep. 2017;6(3):334–51.

    Article  PubMed  Google Scholar 

  50. • Juarascio A, Lantz EL, Muratore AF, Lowe MR. Addressing weight suppression to improve treatment outcome for bulimia nervosa. Cogn Behav Pract. 2018;25(3):391–401. This is the first paper to consider how treatment might be modified given the literature on weight suppression in eating disorders.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Drexel University, Philadelphia, USA

    Michael R. Lowe, Amani D. Piers & Leora Benson

  2. Department of Psychology, Drexel University, 3141 Chestnut St., Room 119, Philadelphia, PA, 19104, USA

    Michael R. Lowe

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  1. Michael R. Lowe
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  2. Amani D. Piers
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  3. Leora Benson
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Correspondence to Michael R. Lowe.

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Conflict of Interest

Amani D. Piers and Leora Benson declare no conflict of interest. Michael R. Lowe is a member of the Clinical Excellence Board and a research consultant at the Renfrew Center for eating disorders.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Eating Disorders

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Lowe, M.R., Piers, A.D. & Benson, L. Weight Suppression in Eating Disorders: a Research and Conceptual Update. Curr Psychiatry Rep 20, 80 (2018). https://doi.org/10.1007/s11920-018-0955-2

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  • DOI: https://doi.org/10.1007/s11920-018-0955-2

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