Anorexia patients still restrict food after therapy

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Even though anorexic women show substantial weight gain and major reductions in psychological symptoms after three months of hospitalization, they continue to eat much smaller meals than women who have never had the disease, a new study shows.

While treating anorexia in the hospital often is successful, 30 percent to 70 percent of patients relapse when they go out into the real world, Robin Sysko of Rutgers University in Newark, New Jersey and colleagues report in the American Journal of Clinical Nutrition. Little is known, Sysko and her team add, about the actual eating behavior in anorexic patients and how treatment affects this behavior.

While patients can clearly eat normally during treatment, said Sysko, “when control is transferred back to them over their eating behavior, that’s when we seem to see the difficulty arising.”

Sysko and her team tested eating behavior among 12 anorexic patients and 12 normal individuals by having them consume a strawberry yogurt shake. The shake was placed in an opaque, popcorn bucket-sized container and participants drank it with a straw so it was not possible for them to see the food. Study participants were told the drink would be their lunch for the day, and that they could consume as much as they liked. They were not told what the meal consisted of or its calorie content.

The anorexic patients were tested upon entering the hospital, and 11 of them were re-tested after they had reached 90 percent of their ideal body weight. All had experienced significant improvement in levels of depression and disordered behavior.

When the anorexic patients were first tested, they consumed about 104 grams of the shake on average. After three months of treatment, they consumed an average 178 grams, compared to 490 grams for the healthy control patients. The shake was about one calorie per gram.

The anorexic patients found the study situation very difficult, Sysko noted, largely because the food was unknown and they had no idea how many calories it contained.

“It tends to be very anxiety-provoking at least by self report—patients found it quite uncomfortable to be in that situation,” she told. “They just experienced a lot of anxiety around not being able to see the food and not being able to see what was in the food.”

Sysko and her colleagues are hoping to develop interventions that will help to normalize patients’ eating behavior outside the hospital, for example by helping reduce the anxiety and fear they feel about eating unknown quantities of food.

“This might be just one area that would be important to address post-hospitalization,” she added. “Clearly we need additional strategies to help people once they’re leaving an intensive program, because that’s the period that’s fraught with all kinds of potential difficulties for patients.”

SOURCE: American Journal of Clinical Nutrition, August 2005.

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