Comment on Calugi et al. The Role of Weight Suppression in Intensive Enhanced Cognitive Behavioral Therapy for Adolescents with Anorexia Nervosa: A Longitudinal Study. Int. J. Environ. Res. Public Health 2023, 20, 3221
Roswith Roth
Round 1
Reviewer 1 Report
The study of Calugi et al. researched the effect of weight suppression in the treatment of adolescents suffering from anorexia nervosa. Weight suppression is defined as the difference between highest weight and current weight upon reaching adult height and has recently attracted the interest of numerous researchers and clinicians involved in the study and treatment of eating disorders.
The comment reported that the “weight suppression is a predictor of larger weight gain in non-clinical samples and in samples with persons with eating disorders [3-6]” and “it may help to anticipate treatment course and outcome in patients with anorexia nervosa [Meule A, 2022], but “does not substantially impact the likelihood of successful weight maintenance or time to relapse following restoration to a minimally normal weight in AN [Uniacke B, 2020]”, thus indicating that greater baseline weight suppression refers to greater weight gain, consistent with findings from the existing literature. Furthermore, the results for weight suppression in the regression models (reported in Table S1 in the article's supplementary material), as also reported by the commentary, quantify weight suppression and BMI at treatment end and follow-up, respectively, while maintaining age, disease duration and baseline questionnaire scores constant, as as stated on p.6 the other variables "was excluded because of the high multicollinearity". Despite this, as also reported in this study “Piers AD, Espel-Huynh HM, Lowe MR. The independent and interacting effects of weight suppression and admission body mass index on treatment weight change in patients with anorexia nervosa or bulimia nervosa. Int J Eat Disord. 2019;52(11):1301-1309. doi:10.1002/eat.23149”, weight suppression (WS) and body mass index (BMI) have predicted weight change in individuals with eating disorders, but the interaction between these variables is understudied, the results indeed show the potential importance of considering an individual's weight and weight history when predicting their treatment weight change, and the authors reported it in the discussion and conclusion section.
Minor editing of English language required
Author Response
The summary by the reviewer did not include any suggestions what could or should be changed in the manuscript, so I'm not able to provide any changes
Reviewer 2 Report
The author Adrian Meule has an excellent expertise with eating disordered patients and scientific papers containing statistical analyses considering weight suppression – also in adolescents with Anorexia Nervosa. The original paper of Calugi et al. doesn’t take in to consideration these papers and the statistical analyses calculated and presented there. The suggestion to recalculate the data of the Calugi paper including the weight suppression and z-BMI at baseline as predictors of the outcome z-BMIs should clarify the discrepancies between the results of other authors and the results of Calugi et al. The suggestion to examine further models with other covariates in a second step might result in further findings in this area.
Author Response
The summary by the reviewer does not include any suggestions what could or should be changed in the manuscript, so I'm not able to provide any changes
