Anorexia may stunt growth in young women, study highlights importance of early diagnosis and treatment
In the current study, it was shown that growth impairment is a prominent feature of anorexia in adolescent females, resulting in decreased adult height compared to the normal population
Girls with anorexia, an eating disorder, can have stunted growth and may not reach their full height potential, according to a new study. The findings emphasize the importance of early and intensive intervention aiming at normalization of body weight, which may result in improved growth and allow patients to reach their full height potential, says the study’s corresponding author, Dr Dalit Modan-Moses, from the Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, in Tel Hashomer, Israel.
"We suggest that height impairment is a marker for other complications of anorexia nervosa affecting the person's overall health in several aspects: bone health, cognitive function, and problems with pregnancy and childbirth later in life. Early diagnosis and treatment could prevent, or at least reduce, the risk of these complications," writes Dr Modan-Mose in the analysis published in the Endocrine Society’s Journal of Clinical Endocrinology & Metabolism.
According to experts, eating disorders are serious and often fatal illnesses that are associated with severe disturbances in people’s eating behaviors and related thoughts and emotions. Preoccupation with food, body weight, and shape may also signal an eating disorder. The American Psychiatric Association says that eating disorders affect several million people at any given time, most often women between the ages of 12 and 35. The National Association of Anorexia Nervosa and Associated Disorders (ANAD) says that at least 30 million people of all ages and genders suffer from an eating disorder in the US. Common eating disorders include anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Anorexia nervosa — often simply called anorexia — is characterized by abnormally low body weight. It is a condition in which a person loses an unhealthy amount of weight on purpose by dieting, sometimes along with excessive exercise, binge eating, and/or purging behaviors. Anorexia is diagnosed when patients weigh at least 15% less than the normal healthy weight expected for their height.
People with anorexia nervosa have an intense fear of gaining weight and a disturbed body image, such as thinking they are fat even when they are dangerously very underweight. According to Mayo, anorexia is not really about food. Instead, it is an extremely "unhealthy and sometimes life-threatening way to try to cope with emotional problems" and a person often equates thinness with self-worth. "People with anorexia nervosa typically weigh themselves repeatedly, severely restrict the amount of food they eat, often exercise excessively, and/or may force themselves to vomit or use laxatives to lose weight. Anorexia nervosa has the highest mortality rate of any mental disorder. While many people with this disorder die from complications associated with starvation, others die of suicide," says the National Institute of Mental (NIMH).
In the current study, the research team studied 255 girls, around 15 years old, who were hospitalized for anorexia nervosa between January 1, 2000, and May 31, 2015. The investigators measured their height at the time of admission, discharge, and at adult height and found it was lower than expected. "After discharge, patients were followed in an outpatient clinic biweekly during the first two months, monthly for the next four months, and thereafter every three months until reaching the age of 18 years," the team explains.
Adult height was significantly shorter than expected when compared to the genetic potential according to the average of the patient’s mother and father’s heights. The analysis reveals that on average, at adult height, patients were 2.1 cm shorter than that of the normal population, and 1.6 cm shorter compared to their mid-parental target height. In most patients, weight rehabilitation did not result in an improvement in linear growth. "In the current study, we have shown that growth impairment is a prominent feature of anorexia in adolescent females, resulting in decreased adult height compared to the normal population as well as to the patients’ mid-parental target height," write authors.
They add, "Our findings also suggest that once growth impairment occurs, constant, robust and long-term efforts to improve and accelerate weight rehabilitation during inpatient treatment, aiming for target weight corresponding to premorbid height, may not suffice to induce adequate linear growth and to achieve optimal adult height."
According to researchers, the decreased height of the patients at the time of admission as well as at adult height can be viewed as a )clinical biomarker of disease burden” in adolescent females with anorexia. "Bone health is of particular concern, as 35% of the total adult bone mass accumulates during adolescence, bone mineral accretion is related to growth in the size of the skeleton, and height is correlated with bone mineral content and density. Thus, anorexia nervosa-induced growth impairment could result in decreased bone mass and impaired bone quality, predisposing to future osteoporosis and fracture," warns the team.
The findings may have implications for the management of malnutrition in adolescents with other chronic diseases to achieve optimal adult height and bone health, the authors suggest. "Our findings emphasize the importance of early detection and initiation of treatment of Anorexia nervosa in adolescents. They further highlight the need for continuous and longstanding weight gain over an extended period to achieve catch-up growth up to the full potential and to prevent irreversible tissue damage with long-term implications. Our findings may also have implications for the management of malnutrition in adolescents with chronic diseases such as inflammatory bowel disease and cystic fibrosis in order to achieve optimal adult height and bone health in these populations," say the researchers.