Closer attention to height and weight for anorexia?

Hilary Trevelyan writes.
Anorexia Nervosa (AN) has the highest fatality rate of mental disorders, at 10 per cent. It predominantly affects adolescents between 13–19, although children as young as six report shape and weight thought distortions. Excessive food restriction induces a physiological-psychological feedback loop as the body and brain are starved, impacting physical development as well as effective decision making and cognition due to biological brain changes. Anorexia is often associated with social phobia and anxiety, but it can be unclear whether these follow or precede the impact of starvation on the brain.
 
So is weight loss the chicken or the egg? Can anorexic thoughts and cognitions be triggered by low BMI and failure to follow a developmental weight trajectory, rather than vice versa?
 
My own recent MSc study, conducted at the University of East London, indicated that only 4 per cent of 101 carers realised their child was not developing according to their trajectory before becoming concerned about AN. This is supported by a US survey of adolescents (1999–2013, n = 113,542) which found adolescents could diet and over-exercise for months or years prior to diagnosis, reaching very low BMIs  without their family noticing as so few kept track of their child’s weight.
 
Over 80 per cent of parents in our study were concerned about social phobia and/or anxiety in their child either before or after AN symptom onset. However, the data suggested a stronger association between the age that development slowed or ceased with AN diagnosis than between age that social phobia and anxiety were noted with AN diagnosis. Development ceased or slowed on average 2.27 years prior to diagnosis, representing a significant delay as treatment should begin within three years to maximise the possibility of a full recovery.
 
UK parents are issued with a Red Book containing their child’s weight and height developmental chart up to the age of 20. These books are often not used after the age of five, when measurements are understood to be happening at school. Following my son’s diagnosis aged 13, I had to ring our previous GP surgeries to plot his weight. It seemed he had only been weighed three times since the age of five. When he was weighed in 2014, 19 months before diagnosis, he had dropped from between the 65th – 75th to below the 50th percentile. I was not informed of this and presume the GP did not notice or realise any possible significance.
 
Eating disorders represent a significant cost to the NHS, and BEAT recently estimated an annual economic cost of 15 billion. Amongst adolescents, around 50 per cent with AN require expensive inpatient treatment due to late diagnosis, sometimes for over a year. In 2019 The Royal Society of Psychiatrists called for better preventive treatment for adolescents with Anorexia. Perhaps closer attention to height and weight trajectory by parents, GPs and schools, in addition to other associated factors such as family and individual history of anxiety, social phobia or OCD, may help to identify those young people vulnerable to developing this dangerous illness before it becomes so entrenched and difficult to treat.
 
Hilary Trevelyan
Wivenhoe
Essex

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