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Outcome in anorexia nervosa

2001; Elsevier BV; Volume: 358; Issue: 9285 Linguagem: Inglês

10.1016/s0140-6736(01)06056-1

1474-547X

Janice Russell, Suzanne Abraham, Stephan Zipfel, Wolfgang Herzog,

Eating Disorders and Behaviors

David Ben-Tovim and colleagues (April 21, p 1254)1Ben-Tovim DI Walker K Gilchrist P Freeman R Kalucy R Esterman A Outcome in patients with eating disorders: a 5-year study.Lancet. 2001; 357: 1254-1257Summary Full Text Full Text PDF PubMed Scopus (205) Google Scholar try to show that treatment is of doubtful efficacy in eating disorders, especially resource-intensive treatment in anorexia nervosa. Their data do not show this result at all when extended inpatient treatment is defined as more than 2 weeks of hospital care and extended outpatient treatment as more than three outpatient visits. Ben-Tovim and colleagues report that patients in all three diagnostic classifications were separated into groups according to whether they had spent 6 weeks or more in specialist units and achieved a safe body weight defined as a body-mass index of 16 kg/m2Practice guideline for the treatment of patients with eating disorders (revision).Am J Psychiatry. 2000; 157: 1-39Google Scholar. However, they make no further mention of this separation other than the anorexia nervosa patients who died had spent long periods of time in hospital. The researchers do not assess effects of what is generally thought to be an adequate treatment for anorexia nervosa according to published guidelines.2Practice guideline for the treatment of patients with eating disorders (revision).Am J Psychiatry. 2000; 157: 1-39Google Scholar The study is not a treatment outcome study. There is no form of randomisation or other process to control for treatment confounders. Most of the study sample seem to have disorders with chronic course and no previous treatment. The anorexia nervosa patients seem to have had unusually long duration of illness and mild clinical symptoms. This group should not be presumed to be representative of anorexia nervosa patients. The patients described would be expected to have had fairly minor symptomatology given that their mean body-mass index. Admission to hospital would be an unlikely recommendation in the absence of severe comorbidity. Nevertheless the death rate was similar to that in studies of severely ill patients with much longer follow up periods.3Zipfel S Lowe B Reas DL Deter H-C Herzog W Long-term prognosis in anorexia nervosa: lessons from a 21-year follow-up study.Lancet. 2000; 355: 721-722Summary Full Text Full Text PDF PubMed Scopus (440) Google Scholar We have reported on the relation of better bone and psychological outcomes to higher body-mass index after refeeding in anorexia nervosa patients whose body-mass indices were restored to a mean of 19 kg/m2Practice guideline for the treatment of patients with eating disorders (revision).Am J Psychiatry. 2000; 157: 1-39Google Scholar.4Gross G Russell JD Beumont PJV et al.Longitudinal study of patients with anorexia nervosa 6 to 10 years after evaluation.Ann N Y Acad Sci. 2000; 904: 614-616Crossref PubMed Scopus (21) Google Scholar, 5Russell JD Gross G Anorexia nervosa and body mass index.Am J Psychiatry. 2001; : 2060Google Scholar At age 15 years those patients' mean pretreatment body-mass index was much lower than that in Ben-Tovim and colleagues' cohort, but only one of 61 patients died. They received what would generally be judged adequate treatment. The Morgan-Russell-Hayward general outcome measure is generally thought limited, especially in patients with mild clinical syndromes. We agree that rating outcome in eating disorders should not be based on weight and one uncertain endocrine parameter. Reliable biological parameters are needed as much as the psychosocial factors. We agree with Ben Tovim and colleagues that more work needs to be done on outcome and efficacy of treatment in eating disorders. The area is difficult to research and we hope for more scientifically rigorous methods in the future. These workers' conclusion, apart from being unsubstantiated by the data presented and ungeneralisable, could be misused by health funding bodies to further limit treatment options for a vulnerable group of patients. Outcome in anorexia nervosaAuthors' reply Full-Text PDF