Anorexia & BMI: Is Weight the Sole Determiner of Anorexia?

Contributor: Lauren Kofod, MD, Timberline Knolls

Lauren Kofod photoAnorexia nervosa is a complicated and dangerous illness. As with so many diseases of both a physical and psychological nature, it is not the result of one factor, event or life experience; anorexia results from many contributing issues in a woman or girl’s life.

Since anorexia is an illness in which an individual starves herself, weight is certainly relevant. But, for a diagnosis of anorexia to be rendered, there must be more evidence than low weight.

The Criteria for Mental Illness

Criteria for any mental illness are established by the Diagnostic and Statistical Manual; the most recent version is the DSM5. Perhaps the most significant change in this latest publication is the deletion of amenorrhea (discontinuation of the menstrual cycle) as criteria.

Low weight does remain central to the diagnosis. The wording is “significantly low body weight in the context of age, sex, developmental trajectory, and physical health”.

Other Factors for Anorexia Diagnosis

The manual also outlines other factors related to diagnosis. These include:

  • Intense fear of weight gain
  • Interference with weight gain despite low weight
  • Disturbance in the way in which weight and body are perceived
  • Undue influence of weight regarding self-evaluation
  • Minimization and denial of the seriousness of low-body weight

Body Mass Index (BMI) is a number calculated from a person’s weight and height. BMI provides a reliable indicator of body fatness for most people and is used to screen for weight categories that might lead to health problems.

In the case of anorexia, BMI is used in assessing severity of the problem. It is an important prognostic tool and is helpful in determining level of care.

BMI, Anorexia and Mortality

evening-walk-338365_640Not only is lower BMI associated with more serious complications, there is also a connection to a higher risk of death. In 2010, a small study highlighting higher mortality risk at lower BMI’s was conducted in Japan.(1)

In this study, researchers analyzed the connection between in-hospital mortality and body mass index at admission. Those with severe anorexia were hospitalized in order for the treatment team to manage the acute medical conditions related to the illness.

The Findings from the Study

Researchers used a nationwide hospital-based database. They identified 669 eligible patients with anorexia (BMI ≤ 16.5) from 229 hospitals between July and December of that year. Not surprisingly, more than 90 % of the patients were female.

Notably, 100 of these patients were admitted involuntarily. The average body mass index was 13.1, and the in-hospital mortality rate proved to be 0.7 %. Five of those who died had a BMI under 11. This indicates that patients with an extremely low BMI may be more likely to die, despite admission to a hospital.

The Rate of Suicide in Anorexia Sufferers

eye-277159_640The major risk factor with anorexia is higher suicide rates. In fact, anorexia has the highest rate of successful suicide compared to other eating disorders. Interestingly, the rate of suicide attempts is the same or even lower than bulimia.

So how can this outcome be explained? The truth is that when women or girls with severe anorexia attempt suicide, instead of using the action as a possible cry for help or or a plea for attention, they genuinely want to die. Therefore, there may be fewer attempts, but far more deaths.

The suicide rate associated with anorexia is one of the highest of all psychiatric illnesses; if suicide is combined with all of anorexia’s potential medical complications, untreated anorexia nervosa has the highest mortality rate of any psychiatric disorder.

Don’t Ignore This Serious Disease

Whether anorexia develops in a young child, an adolescent, or a woman in her 30s or 50s, it is a serious disease, and as such, it needs to be treated. The earlier treatment begins, the better the chances for a full and complete recovery.

If you, or someone you know, is struggling with anorexia, please consult with a physician or therapist and get the help you need and deserve.



Community Discussion – Share your thoughts here!

What has been your experience with anorexia and taking the first step towards treatment and recovery? What advice would you share with someone that is just starting down this path?

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on January 16th, 2015
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