What does weight have to do with Atypical AN? A commentary on weight outcomes for adolescents with atypical anorexia nervosa in family-based treatment.

Abstract

Atypical anorexia nervosa (AAN) has historically been underrecognized by clinicians due to traditional markers of low weight as indicative of malnutrition. Inadequate case identification can lead to treatment delays while placing children and adolescents with AAN at further risk of medical and psychiatric sequalae. The accompanying article in this journal issue examines the challenges of determining weight-based treatment goals for this population. In this commentary, we elaborate on this discussion and question the validity of weight stabilization as a treatment target in child and adolescent AAN. Furthermore, we address: (1) the role of weight and historical, variable, and stable growth curves in shaping treatment goals; (2) future growth targets, including numeric and remission targets; and; (3) the impact of weight stigma and implicit weight bias in clinical decision-making. We argue that target weights must take a secondary role in the treatment of AAN, shifting the focus to the mental, behavioural, and nutritional aspects of this disorder. In addition, we recommend that clinicians acknowledge and mitigate fears around weight gain and weight-based social rejection for young people and families in treatment.