The Importance of Restoring Body Fat Mass in the Treatment of Anorexia Nervosa An Expert Commentary

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Agnes Ayton


anorexia nervosa, body fat percentage, endocrine, metabolic


Anorexia nervosa is a severe mental disorder that is characterised by dietary restriction, low weight and wide spread endocrine abnormalities. Whilst the importance of weight restoration has been recognised in recent guidelines, the significance of normalising body fat mass has received less attention. Traboulsi et al systematic review and meta-analysis found that a minimum of 20.5% body fat mass is necessary for regular menses in women of reproductive age. This has significant implications for treatment as well as for research. In psychological treatment, this information should be included in the initial psycho-education at the beginning of treatment and also when addressing body image distortion. It is important to help the patient recognise that certain level of body fat percentage is essential for optimal health, such as the return of menstruation. The benefit of the return of menstruation goes beyond improved fertility: it signals the normalisation of sexual hormones, which have a widespread impact on the body and multiple pathways in the brain. Given the complex functions of adipocytes in various organs of the body, the metabolic effects of the normal body fat tissue should not be underestimated.  Further research is needed to elucidate the mechanisms behind the link between minimum body fat mass, menstruation, bone and brain health in anorexia nervosa. 

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