Anorexia Nervosa and Body Fat Distribution: A Systematic Review

Abstract: The aim of this paper was to conduct a systematic review of body fat distribution before and after partial and complete weight restoration in individuals with anorexia nervosa. Literature searches, study selection, method development and quality appraisal were performed independently by two authors, and data was synthesized using a narrative approach. Twenty studies met the inclusion criteria and were consequently analyzed. The review had five main findings. First, during anorexia nervosa adolescent females lose more central body fat, while adult females more peripheral fat. Second, partial weight restoration leads to greater fat mass deposition in the trunk region than other body regions in adolescent females. Third, after short-term weight restoration, whether partial or complete, adults show a central adiposity phenotype with respect to healthy age-matched controls. Fourth, central fat distribution is associated with increased insulin resistance, but does not adversely affect eating disorder psychopathology or cause psychological distress in female adults. Fifth, the abnormal central fat distribution seems to normalize after long-term maintenance of complete weight restoration, indicating that preferential central distribution of body fat is a transitory phenomenon. However, a discrepancy in the findings has been noted, especially between adolescents and adults; besides age and gender, these appear to be related to differences in the methodology and time of body composition assessments.

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Alex’s Notes: Anorexia is an eating disorder most commonly known for its obsession with becoming thin. Those who suffer from it have an irrational fear of weight gain and extreme body dysmorphia that drives them into starvation-like eating practices. Given that body image is such a keystone aspect of anorexia, there is great clinical importance in knowing how weight-regain during treatment affects the psychological wellbeing of the patients. Surprisingly, no studies to date have acknowledged this, and thus the current study set out to systematically review the published literature addressing body fat distribution in adolescent and adult patients with anorexia nervosa before and after partial or complete weight restoration.

All studies that evaluated body fat distribution were taken into consideration, with the exception of non-original studies, editorials, and letters to editors. Overall, 20 articles (5 non-controlled longitudinal, 6 cross-sectional, and 9 controlled longitudinal studies) were included in the systematic review.

Beginning with weight loss, it appears that adolescent females tend to lose more trunk and visceral fat than peripheral and subcutaneous fat, while one study examining boys found a preferential fat loss in the extremities, which the authors attribute to the hypogonadal status brought about by anorexic practices. Conversely, adult females follow the exact opposite fat-loss pattern but maintain their body fat distribution ratios (android/gynoid).

During treatment, when weight is being regained, DXA confirmed results in adolescents suggest that there is a normalization of body fat distribution with no increases to central adiposity. In other words, weight regain in children leads to a “normalization” of body weight and fat status without any apparent long-term consequences, at least for 2-years after complete weight restoration. Unfortunately for the adult counterparts, both partial and complete weight regain leads to an accumulation of trunk fat in the short-term, but within a year it appears that there is a normalization of body fat distribution. The reason for the “unfortunately” in the previous sentence is simply because it is these transient body changes that can easily discourage a recovering anorexic.

Now, there is a second motive for my sharing of this study. The bottom line is that in females (and I can’t say this holds true for males because there are not any studies except the one addressing this) severe weight loss and starvation diets do not lead to unrepairable damage. After 1-2 years of weight regain, everything normalized; it just took time and dedication. So going beyond eating disorders, this information should be seen as a light at the end of the tunnel for those of us who have done years of yo-yo and starvation dieting. Our bodies are not static, and provided the tools necessary are present, our bodies will heal themselves.

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