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Eighty-five per cent of what? Discrepancies in the weight cut-off for anorexia nervosa substantially affect the prevalence of underweight.

Publication ,  Journal Article
Thomas, JJ; Roberto, CA; Brownell, KD
Published in: Psychological medicine
May 2009

DSM-IV cites <85% of expected body weight (EBW) as a guideline for the diagnosis of anorexia nervosa (AN) but does not require a specific method for calculating EBW. The purpose of the present study was to determine the degree to which weight cut-off calculations vary across studies, and to evaluate whether differential cut-offs lead to discrepancies in the prevalence of individuals who are eligible for the AN diagnosis.Two coders independently recorded the EBW calculation methods from 99 studies that either (a) compared individuals with AN to those with subclinical eating disorders or (b) conducted AN treatment trials. Each weight cut-off was applied to a nationally representative (n=12001) and treatment-seeking (n=189) sample to determine the impact of EBW calculation on the proportion who met the AN weight criterion.Coders identified 10 different EBW methods, each of which produced different weight cut-offs for the diagnosis of AN. Although only 0.23% of the national sample met the lowest cut-off, this number increased 43-fold to 10.10% under the highest cut-off. Similarly, only 48.1% of treatment seekers met the lowest cut-off, whereas 89.4% met the highest.There is considerable variance across studies in the determination of the AN weight cut-off. Discrepancies substantially affect the proportion of individuals who are eligible for diagnosis, treatment and insurance reimbursement. However, differences may not be fully appreciated because the ubiquitous citation of the 85% criterion creates a sense of false consensus.

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Published In

Psychological medicine

DOI

EISSN

1469-8978

ISSN

0033-2917

Publication Date

May 2009

Volume

39

Issue

5

Start / End Page

833 / 843

Related Subject Headings

  • United States
  • Thinness
  • Psychiatry
  • Patient Acceptance of Health Care
  • Middle Aged
  • Male
  • Humans
  • Health Surveys
  • Female
  • Eligibility Determination
 

Citation

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Thomas, J. J., Roberto, C. A., & Brownell, K. D. (2009). Eighty-five per cent of what? Discrepancies in the weight cut-off for anorexia nervosa substantially affect the prevalence of underweight. Psychological Medicine, 39(5), 833–843. https://doi.org/10.1017/s0033291708004327
Thomas, J. J., C. A. Roberto, and K. D. Brownell. “Eighty-five per cent of what? Discrepancies in the weight cut-off for anorexia nervosa substantially affect the prevalence of underweight.Psychological Medicine 39, no. 5 (May 2009): 833–43. https://doi.org/10.1017/s0033291708004327.
Thomas, J. J., et al. “Eighty-five per cent of what? Discrepancies in the weight cut-off for anorexia nervosa substantially affect the prevalence of underweight.Psychological Medicine, vol. 39, no. 5, May 2009, pp. 833–43. Epmc, doi:10.1017/s0033291708004327.
Journal cover image

Published In

Psychological medicine

DOI

EISSN

1469-8978

ISSN

0033-2917

Publication Date

May 2009

Volume

39

Issue

5

Start / End Page

833 / 843

Related Subject Headings

  • United States
  • Thinness
  • Psychiatry
  • Patient Acceptance of Health Care
  • Middle Aged
  • Male
  • Humans
  • Health Surveys
  • Female
  • Eligibility Determination