Determining treatment goal weights for children and adolescents with anorexia nervosa

Question 1

What are the 4 methods of determining treatment goal weight for children with anorexia?

Answer 1

1. Based on previous weight percentile prior to ED onset (preferred)
2. mean BMI calculation (50th %ile for age and sex): use if growth curve information isn’t available or incomplete
   * limitation in this method, especially in cases of AN
3. Weight at return of menstrual function + 2 kg
   * ex menstrual function lost or returns at 55kg, therefore goal is 55 + 2 = 57
   * wt at return of menstrual function is a minimal requirement for health
4. TGW based on weight at same percentile as height percentile
   * note that if there is slowed growth velocity, should use premorbid growth pattern instead
   * slowed growth velocity:
   • do bone age
   • if BA delayed and there is potential for future growth, consider assessing TGW at percentile consistent with premorbid growth pattern to maximize the growth potential that remains
   • rapid and sustained wt gain back to pre-pubertal weight can lead to catch-up growth in stature

If clinical uncertainty - defer determining treatment goal weight

Question 2

How often do you reassess treatment goal weight for anorexia?

Answer 2

q3-6 months