Rate of weight gain as a predictor of readmission in adolescents with eating disorders

Meghna R. Sebastian; Constance M. Wiemann; Albert C. Hergenroeder

doi:10.1515/ijamh-2018-0228

Article

Rate of weight gain as a predictor of readmission in adolescents with eating disorders

Meghna R. Sebastian , Constance M. Wiemann and Albert C. Hergenroeder

Published/Copyright: February 26, 2019

Published by

Become an author with De Gruyter Brill

Submit Manuscript Author Information Explore this Subject

From the journal International Journal of Adolescent Medicine and Health Volume 33 Issue 4

Abstract

Background

Readmission after hospital discharge is common in adolescents with eating disorders. Studies on the association between rapidity of weight gain and readmission are inconsistent. With an emphasis on more rapid weight gain during hospitalization, the effect of this strategy on readmission rates warrants further investigation.

Objective

This project explored the relationship between rate of weight gain during hospitalization and medically necessitated readmissions.

Subjects

Eighty-two patients who: were admitted due to an eating disorder during a 5-year period; achieved weight restoration to ≥84% of ideal body weight (IBW); had a follow-up visit with the adolescent medicine service after discharge; and, had information available on rate of weight gain.

Methods

Data were extracted from medical records. Multiple logistic regression was used to analyze the effect of rate of weight gain on readmission. The effect of a comorbid psychiatric diagnosis was tested for an interaction.

Results

Of patients 20.7% required readmission. The median rate of weight gain was 118.6 g/day [interquartile range (IQR) = 91.8–150.8]. There was a 1.8 times [95% confidence interval (CI) = 0.9–3.6, p = 0.087] greater odds of readmission with each increase in weight gain quartile after adjusting for potential confounders. Patients in the lowest rate of weight gain quartile and no psychiatric co-morbidity had a significantly lower predicted probability of readmission (25.1%) compared to those with a psychiatric comorbidity and in the highest quartile of rate of weight gain (48.4%).

Conclusion

Patients with eating disorders who have rapid inpatient weight gain and psychiatric co-morbidities may be at increased risk for readmission.

Keywords: adolescents; eating disorders; readmission; weight gain

Funding source: Texas Children’s Hospital

Award Identifier / Grant number: 2531202692

Funding statement: ACGME Fellowship – Texas Children’s Hospital 2531202692.

Acknowledgments

The authors acknowledge Amanda Dave and Chris Henges for their role in generation of the database.

Conflicts of interest: None

References

[1] Golden NH, Katzman DK, Sawyer SM, Ornstein RM, Rome ES, Garber AK, et al. Update on medical management of eating disorders in adolescents. J Adolesc Health. 2015;56:370–5.10.1016/j.jadohealth.2014.11.020Search in Google Scholar

[2] Castro J, Gila A, Puig J, Rodriguez S, Toro J. Predictors of rehospitalization after total weight recovery in adolescents with anorexia nervosa. Int J Eat Disord. 2004;36(1):22–30.10.1002/eat.20009Search in Google Scholar

[3] Lund BC, Hernandez ER, Yates WR, Mitchell JR, McKee PA, Johnson CL. Rate of inpatient weight restoration predicts outcome in anorexia nervosa. Int J Eat Disord. 2009;42(4):301–5.10.1002/eat.20634Search in Google Scholar

[4] Howard WT, Evans KK, Quintero-Howard CV, Bowers WA, Andersen AE. Predictors of success or failure of transition to day hospital treatment for inpatients with anorexia nervosa. Am J Psychiatry. 1999;156:1697–702.10.1176/ajp.156.11.1697Search in Google Scholar

[5] Lock J, Litt I. What predicts maintenance of weight for adolescents medically hospitalized for anorexia nervosa? Eat Disord. 2003;11:1–7.10.1002/erv.496Search in Google Scholar

[6] Kaplan AS, Walsh BT, Olmsted M, Attia E, Carter JC, Devlin MJ, et al. The slippery slope: prediction of successful weight maintenance in anorexia nervosa. Psychol Med. 2009;39(6):1037–45.10.1017/S003329170800442XSearch in Google Scholar

[7] Baran SA, Weltzin TE, Kaye WH. Low discharge weight and outcome in anorexia nervosa. Am J Psychiatry. 1995;152:1070–2.10.1176/ajp.152.7.1070Search in Google Scholar

[8] Fichter MM, Quadflieg N. Six-year course and outcome of anorexia nervosa. Int J Eat Disord. 1999;26:359–85.10.1002/(SICI)1098-108X(199912)26:4<359::AID-EAT2>3.0.CO;2-7Search in Google Scholar

[9] Bean P, Loomis CC, Timmel P, Hallinan P, Moore S, Mammel J, et al. Outcome variables for anorexic males and females one year after discharge from residential treatment. J Addict Dis. 2004;23:83–94.10.1300/J069v23n02_06Search in Google Scholar

[10] Castro-Fornieles J, Casula V, Saura B, Martinez E, Lazaro L, Vila M, et al. Predictors of weight maintenance after hospital discharge in adolescent anorexia nervosa. Int J Eat Disord. 2007;40:129–35.10.1002/eat.20340Search in Google Scholar

[11] Steinhausen HC, Grigoroiu-Serbanescu M, Boyadjieva S, Neumarker KJ, Winkler Metzke C. Course and predictors of rehospitalization in adolescent anorexia nervosa in a multisite study. Int J Eat Disord. 2008;41:29–36.10.1002/eat.20414Search in Google Scholar

[12] Hergenroeder AC, Wiemann CM, Henges C, Dave, A. Outcome of adolescents with eating disorders from an adolescent medicine service at a large children’s hospital. Int J Adolesc Med Health. 2014. DOI: 10.1515/ijamh-2013-0341.Search in Google Scholar PubMed

[13] Lay B, Jennen-Steinmetz C, Reinghard I, Schmidt MH. Characteristics of inpatient weight gain in adolescent anorexia nervosa: relation to speed of relapse and re-admission. Eur Eat Disord Rev. 2002;10:22–40.10.1002/erv.432Search in Google Scholar

[14] Willer M, Thuras P, Crow S. Implications of the changing use of hospitalization to treat anorexia nervosa. Am J Psychiatry. 2005;162:2374–6.10.1176/appi.ajp.162.12.2374Search in Google Scholar PubMed

[15] Castro-Fornieles J, Casula V, Saura B, Martinez E, Lazaro L, Vila M, et al. Predictors of weight maintenance after hospital discharge in adolescent anorexia nervosa. Int J Eat Disord. 2007;40(2):129–35.10.1002/eat.20340Search in Google Scholar PubMed

[16] Howard WT, Evans KK, Quintero-Howard CV, Bowers WA, Andersen AE. Predictors of success or failure of transition to day hospital treatment for inpatients with anorexia nervosa. Am J Psychiatry. 1999;156(11):1697–702.10.1176/ajp.156.11.1697Search in Google Scholar

[17] Kalisvaart JL, Hergenroeder AC. Hospitalization of patients with eating disorders on adolescent medical units is threatened by current reimbursement systems. Int J Adolesc Med Health. 2007;19(2):155–65.10.1515/IJAMH.2007.19.2.155Search in Google Scholar

[18] National Center Health Statistics. Plan and operation of a health examination survey of US youths 12–17 years of age. Rockville, MD: NHCS, Series 1, No. 8, 75–1018, 1974.Search in Google Scholar

[19] Geriatric: Nutrition Handbook, Chapman and Hall Nutrition Handbooks. Dordrecht, The Netherlands: Springer. 1998, p. 15.Search in Google Scholar

[20] Centers for Disease Control and Prevention. National Center Health Statistics. CDC Growth Charts. Hyattsville, MD: NHCS.Search in Google Scholar

[21] Garber A, Michihata N, Hetnal K, Shafer MA, Moscicki AB. A prospective examination of weight gain in hospitalized adolescents with anorexia nervosa on a recommended refeeding protocol. J Adolesc Health. 2012;50:24–9.10.1016/j.jadohealth.2011.06.011Search in Google Scholar PubMed PubMed Central

Received: 2018-10-01

Accepted: 2018-11-19

Published Online: 2019-02-26

You are currently not able to access this content.

Articles in the same Issue

https://doi.org/10.1515/ijamh-2018-0228

Keywords for this article

adolescents; eating disorders; readmission; weight gain