Weight Requirements for Catch-Up Growth in Adolescent Girls with Eating Disorders

• Adolescent girls presenting with an eating disorder with onset of weight loss before menarche are at risk of being stunted by undernutrition. They have, however, considerable growth potential and will catch up in stature if adequately treated. In contrast to postmenarcheal teenagers the younger girls have an insidious onset of disease with an often long period of diminished weight gain and stunting of growth. Disturbed eating behaviour may be discrete and go unnoticed during the early stages of disease. Presentation is therefore usually delayed until weight loss makes the diagnosis evident. At presentation weight deficit may be considerable due to not only weight loss but also the absence of expected weight gain. There is a decrease in linear growth, which in some cases may have completely halted. Following start of treatment there may be considerable weight gain, especially during the first year of treatment. Resumption of linear growth is, however, delayed to the second year of treatment. Growth may then continue for several years at an age when girls usually have almost reached their final height. Catch-up growth is thus achieved by prolonging the growth period rather than growing at an increased rate. Catch-up can reach the growth trajectory of prepubertal growth, i.e. the growth channel before onset of the eating disorder. This level of catch-up growth is achieved if weight gain reaches the prepubertal weight curve. When catch-up in weight and height stabilises at this level, menarche ensues. Considerable catch-up growth is thus possible in eating disorders with onset before menarche. A prerequisite is rapid weight restoration, before growth potential is lost with age. Once weight gain is achieved full catch-up in stature and completion of puberty by menarche may take several years.

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