Developmental Consequences of Restrictive Eating Disorders after Childhood Obesity: Two Case Reports

Although childhood overweight has been associated with an increased risk for later development of eating disorders, there has been little research indicating whether previously overweight children and adolescents have an increased risk for restrictive eating disorders such as anorexia nervosa or atypical anorexia nervosa. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines anorexia nervosa as the restriction of energy intake relative to requirements, leading to a significantly low body weight, an intense fear of gaining weight or becoming fat, and disturbance in the way in which one’s body weight or shape is experienced. In atypical anorexia nervosa, the DSM-5 specifies that all criteria for anorexia nervosa can be met for this disorder, except that after despite significant weight loss the individual’s weight is currently within or above the normal range. In treatment of these disorders, the intense fear of weight gain may be further intensified in previously obese children because they have earlier experienced the significant consequences of obesity. The purpose of this report is to present two cases of previously obese children who later developed restrictive eating disorders. These cases demonstrate how previously obese children may be at risk for restrictive eating disorders with treatment further complicated by an intensified fear of recurrent weight gain. In these cases, treatment was complicated by an intensified fear of weight gain due to the patients’ prior obesity. The mortality rate of restrictive eating disorders may be increased in previously obese children and adolescents due to delay in diagnosis and more complicated treatment, making clinician screening imperative.