Eating Disorders Publications

  • Decreased caloric intake in normal-weight patients with bulimia:
    comparison with female volunteers
    Harry E. Gwirtsman, Walter H. Kaye, Eva Obarzanek, David T. George, David C. Jimerson, and Michael H. Ebert

    ABSTRACT: Patients with bulimia (binge-purge syndrome) frequently complain that they consume a very restrictive diet to avoid gaining weight. To investigate this claim, 23 hospitalized bulimic patients were assessed daily for body weight, caloric intake, macronutrient diet content, activity measures, and body composition estimates during weight-stable periods. Bulimic patients ate fewer kilocalories per kilogram body weight (22.1 + 4.6 kcal/kg) than did age-matched normal women (29.7 + 6.5 kcal/kg) but had similar activity levels and body composition. Clinical variables, such as history of laxative abuse, anorexia, or obesity, and physiological characteristics, such as body weight, activity level, or dietary content, could not account for this difference in caloric consumption. Bulimic patients tended to eat a diet lower in fat and higher in protein than did control subjects. These results agree with observations of increased efficiency of caloric utilization in obese patients and support patient complaints of a tendency to gain weight easily. Am J Clin Nutr 1989;49:86-92. Download PDF of article

  • Caloric intake necessary for weight maintenance in anorexia nervosa: nonbulimics require greater caloric intake than bulimics
    Walter H. Kaye, MD, Harry E. Gwirtsman, MD, Eva Obarzanek, PhD, Ted George, MD, David C. Jimerson, MD and Michael H. Ebert, MD

    ABSTRACT: In the past decade, patients with anorexia nervosa have been subdivided by the presence or absence of bingeing-and-purging behavior. Psychologic, physiologic, and premorbid weight differences have also been discovered between these subgroups. We now report that nonbulimic anorectics required 30-50% more caloric intake than bulimic anorectics to maintain a stable weight. This difference in caloric intake was independent of phase of illness; it was present at low weight and at intervals after weight restoration. Subjects were closely supervised on an inpatient hospital ward so that they could not binge or purge. Motor activity did not appear to explain these alterations in caloric requirements. Such differences in caloric intake could be trait related or a consequence of many years of starving or bingeing behavior. These findings are clinically relevant for advising eating disorder patients of caloric requirements necessary to maintain a normal weight. Am J Clin Nutr 1986;44:435-443 Download PDF of article

  • Relative importance of calorie intake needed to gain weight and level of physical activity in anorexia nervosa
    Walter H. Kaye, MD, Harry E. Gwirtsman, MD, Eva Obarzanek, Ph.D., and David T. George, MD

    ABSTRACT: We assessed whether level of physical activity of anorexia nervosa patients could influence caloric consumption needed to gain weight during hospitalization. Seventy-three percent of patients with anorexia nervosa had higher levels of motor activity than did healthy female volunteers. Anorectics required 8301 + 2272 kcal (mean + SD) to gain 1 kg body wt. Activity levels and caloric consumption needed to gain 1 kg were significantly correlated; the most active patients needed to consume more calories to gain weight. A median split of anorectic patients by level of activity showed that the group with lower activity levels gained 1 kg every 5.1 + 1.2 d, whereas the group with higher activity levels gained 1 kg every 7.2 + 1.9 d. These data suggest that the rate of weight gain can be accelerated, and the cost of hospitalization decreased, by restricting exercise in anorectics during refeeding. Am J Clin Nutr 1988;47:987-94 Download PDF of article

  • Caloric Consumption and Activity Levels After Weight Recovery in Anorexia Nervosa: A Prolonged Delay in Normalization
    Walter H. Kaye, MD, Harry Gwirtsman, MD, Ted George, MD, Michael H. Ebert, MD, Rosemary Petersen, RD

    ABSTRACT: In the 2 to 6 weeks after completion of refeeding and termination of a weight restoration program, patients with anorexia nervosa required greater than normal caloric intake to maintain a stable weight and had elevated levels of activity. By contrast, such patients studied 6 months or longer after weight recovery had normal caloric intake and activity levels. The prolonged delay in normalization of caloric intake and activity is mirrored by the slow resolution to normal of the neuroendocrine dysregulation that characterizes this disorder. This suggests that treatment for weight maintenance in anorexia nervosa should be extended aggressively for months after the return of a healthy weight so as to restore normal neuroendocrine function and thereby enhance the likelihood of permanent recovery. Int J Eat Dis 1986:Vol 5, No. 3:489-502 Download PDF of article

  • Abnormal Caloric Requirements for Weight Maintenance in Patients with Anorexia and Bulimia Nervosa
    Theodore E. Weltzin, MD, Madelyn H. Fernstrom, PhD, Donna Hansen, RD, Claire McConaha, RN, BSN, and Walter H. Kaye, MD

    Objective: This study tested previous findings that patients with eating disorders who attain normal weight have abnormal caloric requirements for maintaining weight. Method: Fifty-three female patients meeting the DSM-III-R criteria for anorexia nervosa and/or bulimia nervosa were divided into four subgroups, and their daily caloric intake was measured over a weight-stable period. Patients with anorexia nervosa (restricting and bulimic subtypes) were studied 4 weeks after refeeding and weight gain, when they had attained 95% of average body weight. Patients with normal-weight bulimia (previously anorexic or never previously anorexic) were studied 1-4 weeks after admission to an inpatient unit. Results: After weight restoration, restricting anorexic patients required significantly more calories per day to maintain weight than did bulimic anorexic patients, as measured with corrections for weight, body surface area, and fat-free mass. Previously anorexic normal-weight bulimic patients required significantly more calories per day to maintain weight than never-anorexic normal-weight bulimic patients, as measured with correction for weight but not with the other factors used to correct caloric intake. Conclusions: To maintain stable weight after weight restoration, restricting anorexic patients require a significantly higher caloric intake than do bulimic anorexic patients. Differences in caloric needs between normal-weight bulimic patients with and without histories of anorexia may depend on the methods used to correct caloric requirements. Body surface area may be the most precise correction factor across different subgroups of eating disorder patients. Elevated caloric requirements, when coupled with reduced food intake, may particularly contribute to relapse in anorexic patients. Am J Psychiatry 1991; 148:1675-1682 Download PDF of article.