Most individuals with anorexia nervosa will enter eating disorder therapy many months or even years after they have continuously struggled with restrictive eating, purging, and binging; depending on the specific subtype. Usually, by the time an individual with anorexia nervosa enters treatment, there are already medical complications that need to be addressed. One of the major admission criteria for higher levels of care including inpatient treatment, residential treatment, and partial hospitalization is a weight upon admission. Insurance companies will often approve or deny coverage based upon this one “important” number. The anorexia definition characterizes this eating disorder by the intense fear of gaining weight, a distorted body image, inability to maintain a minimally normal weight and extreme dietary habits that prevent weight gain. Therefore many insurance companies and treatment centers believe that an individual must weigh under the minimal normal weight for their age and development to be considered for treatment.

A study published in the Journal of Adolescent Health found that teenagers with eating disorders who presented with higher recent weight loss, regardless of weight at the time of admission, had more complications from their disease. The majority of individuals with anorexia nervosa who enter treatment are usually teenagers or adolescents. The lead study author, Melissa Whitelaw, believes that although being underweight is a requirement for the diagnosis of anorexia nervosa, atypical anorexia nervosa meets all the criteria for anorexia nervosa without the low weight. This particular study found that these clients represented 31% of hospital admissions in teenagers over 9 years and that there was a 5-fold increase in these cases over the study period. Whitelaw says the research revealed that greater total weight loss and recent weight loss, not the degree of underweight, were associated with life-threatening low pulse rates. Low pulse rates, known as bradycardia, is a serious and well-known cardiovascular complication seen in individuals with anorexia nervosa. This complication, like many others, stems from weight loss and not actual weight. An individual that was once considered “obese” would be more at risk for cardiovascular complications if they underwent significant weight loss as a result of starvation and malnutrition compared to an underweight individual who did not experience weight loss. Severe weight loss results in electrolyte disturbance, body storage shifts and fluid loss, which can create much strain on the heart.

Healthcare practitioners, school therapists, parents, and eating disorder therapists should be concerned about recent weight loss and weight trends and should ask about his during an initial assessment, rather than just documenting the actual weight on the scale. Many professionals believe that weight history and weight loss should be included in the diagnostic criteria for anorexia nervosa.

“The study shows that bradycardia during refeeding was more often predicted by recent weight loss rather than by weight at the time of hospitalization, highlighting the need to reconsider clinical management of these clients, Garber says. The traditional clinical approach for anorexia has been to use presentation weight as the best indicator for risk” she adds.