Weight Suppression, Binge Eating, and Purging as Predictors of Weight Gain During Inpatient Treatment in Persons With Bulimia Nervosa

Objective

Persons with bulimia nervosa (BN) often gain weight during treatment, which potentially poses a threat to treatment adherence. Although weight suppression has been found to be a predictor of weight gain in persons with BN, research about the trajectory of weight changes during treatment and other predictors thereof is scarce.

Method

The current study examined weight suppression as well as self-reported binge eating severity and purging frequency at admission as predictors of weight change in 746 persons with BN (95% female) who received inpatient treatment at the Schoen Clinic Roseneck (Prien am Chiemsee, Germany) between 2015 and 2020.

Results

Body mass index (BMI) increased linearly across treatment weeks. Higher weight suppression predicted larger weight gain, particularly in those with a relatively low BMI at admission. More frequent purging and less severe binge eating predicted larger weight gain but high binge eating severity in combination with infrequent purging attenuated this effect.

Conclusions

Results replicate that those with high weight suppression are at higher risk for gaining weight during BN treatment but extend these findings in that this effect additionally depends on current BMI, similar to findings reported in persons with anorexia nervosa. They further demonstrate that the core features of BN—binge eating and purging—also predict weight change both separately and interactively and may, therefore, be considered in psychoeducation and therapy planning.