# Preliminary validation of developmental weight suppression in youth with transdiagnostic eating disorders

## TL;DR

This study shows that a developmentally-adjusted weight suppression measure better correlates with eating disorder symptoms in adolescents than the traditional method.

## Contribution

The study introduces and validates a developmentally-adjusted weight suppression calculation using BMI z-scores for adolescents with eating disorders.

## Key findings

- Developmental WS negatively associated with shape and weight concerns in eating disorder symptoms.
- Traditional WS did not correlate with any eating disorder symptoms in the study.
- Developmental WS showed stronger, though not significantly different, associations with ED pathology.

## Abstract

Weight suppression (WS), traditionally defined as the difference between highest past and current weights at adult height, is a correlate and predictor of eating disorder (ED) psychopathology. However, for growing adolescents, it may be more appropriate to use a developmentally-adjusted calculation of WS. This study compared how developmental WS, calculated using zBMIs, compared with traditional WS, calculated using weights, as correlate of ED psychopathology in treatment-seeking adolescents with transdiagnostic EDs.

Adolescents with EDs (N = 93) completed the Eating Disorder Examination Questionnaire (EDE-Q) at presentation to outpatient care. Weight histories were extracted from medical records. Regressions examined the association between each measure of WS and EDE-Q scores, adjusting for ED diagnosis. Dominance analyses with bootstrapping assessed whether developmental WS outperformed traditional WS.

Developmental WS negatively associated with EDE-Q Shape (sr2 = 0.05, p =.020) and Weight Concern (sr2 = 0.05, p =.021). In contrast, traditional WS did not associate with any EDE-Q scores. Although dominance weights were larger for developmental WS compared to traditional WS, bootstrap sampling revealed no significant differences in magnitudes.

Results preliminarily support developmental WS as a correlate of body image concerns in youth with EDs, though replication is needed.

Weight suppression (WS), traditionally calculated as the difference between highest past and current weights, predicts transdiagnostic eating disorder (ED) onset and positively correlates with ED symptoms. However, a simple subtraction of weights does not capture differences with respect to height, age, and sex that may impact WS’s associations with ED pathology. This is a particular concern for youth, who are growing in age and height. For instance, 8 kg of WS may have a different impact on a 10-year-old who is 142 cm versus an 18-year-old who is 172 cm. To address this shortcoming, a “developmentally-adjusted” calculation of WS that quantifies the difference between highest premorbid and current BMI z-scores was recently published. The present study is the first to quantitatively compare how traditional versus developmentally-adjusted calculations of WS differentially associate with baseline ED pathology in treatment-seeking youth with transdiagnostic EDs. In contrast to the traditional calculation of WS, which did not associate with any ED symptoms, we found that the developmentally-adjusted calculation negatively associated with global eating pathology and body image concerns. Our findings provide quantitative evidence that a z-BMI-based calculation of WS, as opposed to a weight-based calculation, may be a better correlate of ED symptomatology in youth.