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

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.