Rienecke, Renee D.

Accessible summaryWhat is known on the subject? Weight suppression (WS) has been suggested to predict outcome following psychological treatment for an eating disorder (ED). Some findings are contradictory and have not been considered systematically. What the paper adds to existing knowledge? The review suggests that weight gain at post‐treatment is reliably predicted by pretreatment WS, but findings regarding other outcomes (e.g., treatment dropout) are less consistent. Approximate effect sizes for observed relationships are identified, alongside support for biobehavioural theories of metabolic adaptation to weight loss. What are the implications for practice? Degree of WS at pretreatment is associated with weight gain and is important for clinicians to consider before offering treatment to patients with EDs. Patients high in WS might benefit from further support (e.g., psychoeducation) prior to beginning treatment. AbstractIntroductionWeight suppression (WS—the difference between highest body weight and current body weight) has been proposed as a predictor of treatment outcome within eating disorders (EDs), although this hypothesis has not been consistently supported.Aim/QuestionReview the association between pretreatment WS and outcome following psychological treatment for EDs.MethodA comprehensive electronic database search for published and unpublished literature from 1979 to 2017. Reference lists were also inspected. Eligibility criteria were determined according to relevant guidelines and a quality appraisal was conducted.ResultsTwelve studies met inclusion criteria (one was subsequently excluded based on insufficient data). Greater WS was generally associated with weight gain at post‐treatment although not with other treatment outcomes.DiscussionThe existing evidence, with data from 1,566 participants, is summarized according to three main post‐treatment outcomes: weight change; treatment completion; and symptom abstinence. Patients with disordered eating and greater WS may need to gain more weight than others during treatment to achieve good outcomes. Recommendations for future studies are provided.Implications for practiceEvidence‐based treatments for EDs may benefit from considering WS when planning treatment, such as further psychoeducation on weight changes. Societal interventions regarding promotion of healthy eating may also draw on these findings.

Background This goal of this study was to understand the patterns of expressed emotions (EEs) in adolescent eating disorders. As such, this study compared EE among families of adolescents with anorexia nervosa ( AN ), bulimia nervosa ( BN ), and a psychiatric control group, major depressive disorder ( MDD ). This study also examined the influence of family status (intact vs. nonintact) and the presence of siblings on EE . Methods Two‐hundred and fifteen adolescents (ages 12–19) and their families were recruited for this study including 121 adolescents with AN , 54 adolescents with BN , and 40 adolescents with MDD . Adolescents with at least one parent completed the Standardized Clinical Family Interview. Adolescents completed structured diagnostic interviews to assess eligibility for the study, as well as a standardized questionnaire to assess depression. Results Analyses revealed that fathers showed higher levels of critical comments to adolescents with BN or MDD than those with AN , whereas mothers made more critical comments toward patients with BN . Mothers made the least number of positive remarks toward patients with MDD . In terms of the influence of family status, fathers from intact families showed more expressions of warmth and were less critical than fathers from nonintact families, whereas mothers from intact families were less critical but also made fewer positive remarks than mothers from nonintact families. The presence of siblings appeared to reduce mothers’ expression of warmth and emotional overinvolvement. Conclusions Unique patterns of EE were found to characterize AN , BN , and MDD . Family status and the presence of siblings exert an influence on EE that should be taken into consideration in future research.