Clinical onset and diagnosis of eating disorders in premenarcheal girls is preceded by inadequate weight gain and growth retardation.

ABSTRACT

AIM: To study growth and weight changes before the presentation of an eating disorder (ED) with premenarcheal onset. METHODS: Growth charts from the school health services were obtained for 45 girls assessed during the period 1990-2000 at Uppsala University Children's Hospital. Measurements of weight and height from the charts and at presentation were recalculated into standard deviation scores (SDS). RESULTS: At their maximal weight the girls were 12.5 +/- 1.7 (mean +/- SE) y old. They were then lighter, shorter and leaner than the general population mean, as evidenced by SDS below zero for weight (-0.43 +/- 1.08; mean +/- SD), height (-0.45 +/- 1.01) and body mass index (BMI) (-0.35 +/- 1.07). At presentation approximately 1 y later they had lost 5.8 +/- 4.3 kg and were considerably underweight (weight SDS -2.27 +/- 1.33) and further stunted (height SDS -0.76 +/- 0.97). The point on the growth curves with the highest SDS for weight was observed at 8.5 +/- 1.4 y of age. The girls were then heavier (weight SDS 0.35 +/- 0.93) and less lean (BMI SDS 0.42 +/- 0.97) than the population average. A tendency to track down through weight and height curves before the onset of weight loss was thus observed. Total weight deficit was as much as 31 +/- 10% of expected body weight. Analyses of weight and height deficits indicated that two-thirds of the weight deficit and 60% of the height deficit was generated before the onset of weight loss. CONCLUSION: Girls with eating disorders presenting before menarche may have a long history of poor weight gain and growth retardation before the onset of weight loss. This is in contrast to older girls, who commonly start weight loss at an above-average weight without prior poor weight gain. Since the psychopathology of ED in young girls may be different and less evident compared with older teenagers it is important to be aware that poor weight gain and growth retardation may be associated with early-onset ED.