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Body composition of anorexia nervosa patients assessed by underwater weighing and skinfold-thickness measurements before and after weight gain^1,2

¹ From the University Center St-Jozef, Kortenberg, Belgium, and the Departments of Rehabilitation Sciences and Kinesiology, Faculty of Physical Education and Physiotherapy, Catholic University of Leuven, Belgium.

Background: Weight restoration is a crucial element in the treatment of patients with anorexia nervosa. Therefore, the validity of different methods for measuring body composition is important.

Objective: We tested the concurrent validity of hydrodensitometry (underwater weighing) and anthropometry (12 skinfold thicknesses) and assessed body composition and subcutaneous fat before and after a refeeding program and a multifaceted program of therapy in a specialized inpatient unit for eating disorders.

Design: The body composition of a large sample of anorexia nervosa patients (97 restricting type, 33 binging-purging type) was studied by using 2 methods both before and after weight gain. We applied a behavioral contract for weight restoration with a minimum weekly gain of 700 g and a maximum of 3 kg. Bland-Altman analysis of agreement, Pearson correlation analysis, t tests, and analysis of covariance were used.

Results: There was good agreement between the results obtained by underwater weighing and by skinfold-thickness measurement (r = 0.76, P < 0.001); the results produced by the 2 methods did not differ significantly. On average, a significant weight gain (11.9 kg) was observed, composed of 6.6 kg fat and 5.3 kg fat-free mass.

Conclusions: Body fat estimation by skinfold-thickness equation appeared to be as accurate as underwater weighing. The refeeding program led to a significant increase in body weight, of which 55.5% was body fat. The mean ratio of fat-free mass to fat mass at the end of the treatment was 3.4:1.

Key Words: Anorexia nervosa • body composition • body fat measurement • hydrodensitometry • skinfold-thickness measurement • underwater weighing • weight gain

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