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Indirect calorimetry measurement is the most reliable method for determining caloric needs and predicting resting energy expenditure (REE) as observed from a study conducted on 32 patients with eating disorders such as anorexia nervosa and bulimia nervosa. The difference between the empirically prescribed diets and REE was significant in patients with anorexia nervosa and insignificant in patients with bulimia nervosa.

A study of 10 women patients with anorexia nervosa and 10 healthy women to determine the causes of amenorrhea reveals that neurotransmitter abnormalities which influence gonadotropin releasing hormone (GnRH) release affect hypothalamic dysfunction associated with amenorrhea. The results confirm an increased central dopaminergic activity in anorexia but do not prove that dopaminergic inhibition of GnRH release affects luteinizing hormone secretion as the patients showed no response to metoclopramide, a central D-2 dopamine receptor blocker. Weight loss, low body fat or exercise are not the only causes of amenorrhea in anorexia nervosa.

Anorexia nervosa inpatients may be able to tolerate higher rates of weight gain while in therapy than previously thought. Two groups of anorexia nervosa patients were studied, with one group receiving a behavioral contract instructing them to gain 0.8 pound in four days, and the other group receiving a behavioral contract specifying a 1.2 pound gain in four days. The 1.2 pound group was able to gain the expected weight without experiencing problems with refeeding. Such results may indicate that a slightly more rapid weight gain among patients hospitalized with anorexia nervosa is possible and may shorten the hospital stay and reduce cost of treatment. A five- to seven-day stabilization period with no weight gain at the beginning of treatment was noted, but was not shown to defeat the hospital treatment overall., Objective. To ascertain the rate of weight gain of inpatients with anorexia nervosa under two behavioral contracts, differing in criterion weight gain required to earn increasing privileges. Design. Follow-up comparison of cohorts receiving different interventions. Setting. Eating disorders service, operating on a general adolescent medicine unit. Patients. Patients admitted consecutively who met the following criteria: (1) weight at least 15% less than that expected for age, sex, and height; (2) female gender; (3) absence of chronic medical illness; (4) hospital stay of at least 28 days. Twenty-two patients meeting these criteria were treated between July 1987 and October 1988, when contract 1 was in effect. This cohort of patients was compared with a group of 31 patients, also meeting the these criteria, who were treated between November 1988 and December 1991, when contract 2 was in effect. Interventions. The behavioral contract, signed by the patient on admission, specifies the minimum 4-day weight gain necessary to earn increasing ward privileges, such as use of phone, frequency of visits, etc. Contracts 1 and 2 differed only in the 4-day weight gain criterion: 0.8 lb (0.36 kg) and 1.2 lb (0.55 kg), respectively. Results. The results of analysis of covariance, with admission weight as the covariate, revealed a significant interaction between contract and day, such that patients receiving contract 2 gained weight more rapidly (0.36 lb/d) than those receiving contract 1 (0.20 lb/d). There was no confounding difference between groups in the use of psychotropic medication, and no complications of refeeding in either group. Conclusion. Increasing the 4-day criterion weight gain from 0.8 to 1.2 lb in a behavioral contracting intervention was associated with a significant increase in the rate of weight gain, without an accompanying increase in complications of refeeding. This result simultaneously: (a) provides support f or the efficacy of behavioral contracting and (b) reveals malleability in the rate of gain based on the targeted gain specified in the contract. Pediatrics 1994;93:989-991; anorexia nervosa, behavior therapy, weight gain.

A study was conducted to examine the treatment goal weight in adolescents with anorexia nervosa (AN) using BMI percentiles. Findings reveal that BMI percentile of 14th-39th percentile is used for treatment goal weight.

Emergency contraception (EC) is the use of a method of contraception after unprotected intercourse to prevent unintended pregnancy. Although first described over 20 years ago, physician awareness of EC has been limited and many feel uncomfortable prescribing it. Objective. To assess the knowledge, attitudes, and opinions of practicing pediatricians regarding the use of EC in adolescents. Methods. An anonymous questionnaire was mailed to all 954 active members of New York Chapter 2, District II of the American Academy of Pediatrics. The questionnaire assessed basic knowledge, attitudes, and opinions regarding EC in adolescents. Data were analyzed by physician age, gender, year completed residency, and practice type. Results. Two hundred thirty-three practicing pediatricians (24.4%) completed the survey. Of the respondents, 23.7% had been asked to prescribe EC to an adolescent and 49% of these cases involved a rape victim. Only 16.7% of pediatricians routinely counsel adolescent patients about the availability of EC, with female pediatricians more likely to do so. Most respondents (72.9%) were unable to identify any of the Food and Drug Administration-approved methods of EC. Only 27.9% correctly identified the timing for its initiation and only 31.6% of respondents felt comfortable prescribing EC. Inexperience with use was cited as the primary reason for not prescribing EC by 70% of respondents. Twelve percent cited moral or religious reasons and 17% were concerned about teratogenic effects. There were no differences in comfort level based on age, gender, or practice type. Twenty-two percent of respondents believed that providing EC encourages adolescent risk-taking behavior and 52.4% would restrict the number of times they would dispense EC to an individual patient. A minority of respondents (17%) believed that adolescents should have EC available at home to use if necessary and only 19.6% believed that EC should be available without a prescription. The vast majority (87.5%) were interested in learning more about EC. Conclusions. Despite the safety and efficacy of EC, the low rate of use is of concern. Pediatricians are being confronted with the decision to prescribe EC but do not feel comfortable prescribing it because of inadequate training in its use. Practicing pediatricians are aware of their lack of experience and are interested in improving their knowledge base. Pediatrics 2001;107:287-292; emergency contraception, adolescents., ABBREVIATIONS. EC, emergency contraception; FDA, Food and Drug Administration. Although the rate of adolescent pregnancy in the United States is declining,[1] it is still more than twice that of other [...]