title: History of Overweight/Obesity as Predictor of Care Received at 1-year Follow-Up in Adolescents With Anorexia Nervosa or Atypical Anorexia Nervosa.
abstract: OBJECTIVE
  Previous research has indicated that patients with anorexia nervosa (AN) or atypical AN with premorbid history of overweight/obesity have greater weight loss and longer illness duration than patients with no such history. However, little is known about the association of premorbid overweight/obesity and receiving inpatient medical care during treatment for an eating disorder.
  
  
  METHODS
  Using logistic regression, we sought to determine if history of overweight/obesity was associated with receiving inpatient medical care in a sample of 522 patients (mean age 15.5 years, 88% female) with AN/atypical AN.
  
  
  RESULTS
  Binary results demonstrated greater percent weight loss (27.4% vs. 16.2%) and higher percent median body mass index (%mBMI, 99.8% vs. 85.2%) at presentation in those with a history of overweight/obesity (p < .001) but no difference in duration of illness (p = .09). In models adjusted for demographics and percent weight loss, history of overweight/obesity was associated with lower odds of receiving inpatient medical care (odds ratio .60 [95% confidence interval: .45-.80]) at 1-year follow-up. However, these associations were no longer significant after adjusting for %mBMI. Mediation results suggest that %mBMI fully mediates the relationship between history of overweight/obesity and inpatient medical care, in that those with a history of overweight/obesity are less likely to receive care due to presenting at a higher weight.
  
  
  CONCLUSIONS
  Our findings suggest that, despite greater degree of weight loss and no difference in duration of illness, participants with a history of overweight/obesity are less likely to receive inpatient medical care.
authors.affiliation: Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Psychology, Florida State University, Tallahassee, Florida. Electronic address: kennedy@psy.fsu.edu.
authors.forename: Grace A
authors.initials: GA
authors.lastname: Kennedy
authors.affiliation: Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Sara F
authors.initials: SF
authors.lastname: Forman
authors.affiliation: Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Woods
authors.affiliation: Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas.
authors.forename: Albert C
authors.initials: AC
authors.lastname: Hergenroeder
authors.affiliation: Division of Adolescent Medicine, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan; Formerly at the Division of Adolescent Pediatrics, Beaumont Children's Hospital, Royal Oak, Michigan.
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Mammel
authors.affiliation: Division of Adolescent Medicine, Steven and Alexandra Cohen Children's Medical Center, North Shore-Long island Jewish Health System, New Hyde Park, New York; Department of Pediatrics, Hofstra Northwell School of Medicine, Hempstead, New York.
authors.forename: Martin M
authors.initials: MM
authors.lastname: Fisher
authors.affiliation: Division of Adolescent Medicine and Eating Disorders, Penn State Children's Hospital, Hershey, Pennsylvania.
authors.forename: Rollyn M
authors.initials: RM
authors.lastname: Ornstein
authors.affiliation: Division of Adolescent and Young Adult Health, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: S Todd
authors.initials: ST
authors.lastname: Callahan
authors.affiliation: Division of Adolescent Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Neville H
authors.initials: NH
authors.lastname: Golden
authors.affiliation: Division of Adolescent Medicine, Stanford University School of Medicine, Stanford, California.
authors.forename: Cynthia J
authors.initials: CJ
authors.lastname: Kapphahn
authors.affiliation: Division of Adolescent Medicine, University of California San Francisco, San Francisco, California.
authors.forename: Andrea K
authors.initials: AK
authors.lastname: Garber
authors.affiliation: Center for Adolescent Medicine, Department of General Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, Ohio.
authors.forename: Ellen S
authors.initials: ES
authors.lastname: Rome
authors.affiliation: Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Tracy K
authors.initials: TK
authors.lastname: Richmond
mesh_terms: D000293:Adolescent; D000856:Anorexia Nervosa / Q000453:epidemiology*; D015992:Body Mass Index; D005260:Female; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D012189:Retrospective Studies; D015431:Weight Loss / Q000502:physiology
keywords: Adolescents; Anorexia nervosa; Atypical anorexia nervosa; Eating disorder; Inpatient medical care; Obesity; Overweight; Percent median body mass index; Percent weight loss