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Eighty-five per cent of what? Discrepancies in the weight cut-off for anorexia nervosa substantially affect the prevalence of underweight

Published online by Cambridge University Press:  08 September 2008

J. J. Thomas ,
C. A. Roberto  and
K. D. Brownell
J. J. Thomas*
Affiliation:
Department of Psychology, Yale University, New Haven, CT, USA Klarman Eating Disorders Center, McLean Hospital, Harvard Medical School, MA, USA Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA
C. A. Roberto
Affiliation:
Department of Psychology, Yale University, New Haven, CT, USA
K. D. Brownell
Affiliation:
Department of Psychology, Yale University, New Haven, CT, USA
*
*Address for correspondence: J. J. Thomas, Ph.D., Eating Disorders Clinical and Research Program, Massachusetts General Hospital, WAC-816D, 15 Parkman St, Boston, MA 02114, USA. (Email: [email protected])
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Abstract

Background

DSM-IV cites <85% of expected body weight (EBW) as a guideline for the diagnosis of anorexia nervosa (AN) but does not require a specific method for calculating EBW. The purpose of the present study was to determine the degree to which weight cut-off calculations vary across studies, and to evaluate whether differential cut-offs lead to discrepancies in the prevalence of individuals who are eligible for the AN diagnosis.

Method

Two coders independently recorded the EBW calculation methods from 99 studies that either (a) compared individuals with AN to those with subclinical eating disorders or (b) conducted AN treatment trials. Each weight cut-off was applied to a nationally representative (n=12001) and treatment-seeking (n=189) sample to determine the impact of EBW calculation on the proportion who met the AN weight criterion.

Results

Coders identified 10 different EBW methods, each of which produced different weight cut-offs for the diagnosis of AN. Although only 0.23% of the national sample met the lowest cut-off, this number increased 43-fold to 10.10% under the highest cut-off. Similarly, only 48.1% of treatment seekers met the lowest cut-off, whereas 89.4% met the highest.

Conclusions

There is considerable variance across studies in the determination of the AN weight cut-off. Discrepancies substantially affect the proportion of individuals who are eligible for diagnosis, treatment and insurance reimbursement. However, differences may not be fully appreciated because the ubiquitous citation of the 85% criterion creates a sense of false consensus.

Keywords

Anorexia nervosaexpected body weightbody mass indexDSM-IV criteria for eating disordersCenters for Disease Control and Prevention (CDC)National Health and Nutrition Examination Survey (NHANES)
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 5 , May 2009 , pp. 833 - 843
Copyright
Copyright © Cambridge University Press 2008

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