Total energy expenditure as measured by doubly-labeled water in outpatients with bulimia nervosa

Objective: This study measured total energy expenditure (TEE) in symptomati c outpatient women with bulimia nervosa and normal controls. The study aime d to test the conceptual model of bulimia nervosa as an illness characteriz ed by a physiological state of starvation, despite normal weight. Method: T otal fat and fat-free mass were measured using hydrodensitometry and total energy expenditure was assessed via the doubly-labeled water method, in nin e normal weight outpatient females with DSM-III-R bulimia nervosa and ten h ealthy female controls. Results: Patients and controls were similar in age, body mass index, weight, lean body mass, and levels of exercise and genera l activity. Patients had an average baseline binge frequency of 14.7 episod es per week and purge frequency of 16.8 times per week, and had been ill fo r an average of 11.9 years. Group mean TEE did not differ between patients and controls (patients 2380 +/- 482 kcal/day, controls 2368 +/- 515 kcal da y). Observed TEE in the bulimic subjects did not differ significantly from TEE predicted on the basis of data from the controls. Discussion: This find ing of normal TEE in symptomatic outpatients with bulimia nervosa is consis tent with a previous study that found no difference in TEE in a sample of s ymptomatic inpatients with bulimia nervosa. These data suggest that the ene rgy conserving metabolic adaptations characteristic of semi-starvation do n ot occur in patients with bulimia nervosa. (C) 2001 by John Wiley & Sons, I nc.