Anorexia patients still restrict food after therapy

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."

Anorexia nervosa is an eating disorder in which a person limits eating, and weighs at least 15 percent less than her ideal weight. It usually is considered a female disorder because at least 90 percent of cases are in young women, but it can occur in men or in older people.

A person with this disorder fears being fat, and may be completely convinced that she is overweight despite what the scale shows or what other people say. To achieve or maintain leanness, she may exercise obsessively or use laxatives. Since a super-restrictive diet requires exquisite control, she may become quite careful, inhibited and controlled in other areas of life. For example, she may retreat from social contacts or may perform ritual behaviors.
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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.