Why total anorexia recovery is important for brain health

Anorexia nervosa (AN) is a disease defined by food restriction and usually leads to malnutrition. Malnutrition affects every system of the body, and the brain rarely escapes the effects of malnutrition.

Brain changes associated with anorexia nervosa

AN is accompanied by changes in mood and thinking. Patients often have symptoms of anxiety and depression, and these symptoms do not precede eating disorders or are exacerbated by AN. Ancel Keys’ Minnesota study showed that anxiety and depression are among the symptoms of a half-starved diet in healthy men.

In addition, people with AN often withdraw socially, their thinking becomes more rigid and stubborn, and often know little about their disease.

One parent described her daughter in this way, “As if the physical decline was not terrible enough, she became a different and terrible person. She would lie and manipulate to get rid of diet and start exercising. She would lie and manipulate to explain The reason for getting more and more isolated from my friends. When I did try to’let her eat’, I reported to my husband what happened,’Her profile picture rotated three times like an exorcist, and the venom started from her mouth. Squirting out of it.'”


It is generally accepted that recovery from AN requires weight recovery and nutritional rehabilitation. This must take precedence over insight-centered therapeutic work. Three recent studies on the brain help explain why this is so important.

A study by Roberto and colleagues (2010) used MRI imaging technology to study the brains of 32 adult women with AN before and after weight recovery (reaching 90% of their ideal weight), and compared them with 21 unrecovered weights. The female brains were compared with one. The results show that:

  • Compared with healthy controls, underweight individuals with AN have significant deficits in brain gray matter volume.
  • These gray matter volume defects improved with short-term weight recovery, but did not fully normalize during the 51-week study.
  • The researchers concluded: “The correlation between BMI and volume changes suggests that starvation plays a central role in brain defects in patients with AN, although the mechanism by which starvation affects brain volume is unclear.”
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A study by Wagner and colleagues (2005) performed MRI brain scans on 40 women who had long-term recovery from eating disorders (subjects included patients with AN and bulimia nervosa). Their recovery time ranged from 29 to 40 months (much longer than Roberto’s study).The results show that:

  • All brain structures of the recovered women were normal, similar to the control group.
  • This study shows that abnormal brain structure is reversible long recover.

A study by Chui and colleagues (2008) evaluated 66 adult women with a history of pubertal onset AN and compared them with 42 healthy women. Participants underwent MRI and cognitive assessment. The results show that:

  • MRI scans of AN participants who remained low weight were abnormal.
  • Patients who have recovered their weight have normal brain volumes.
  • Participants who currently have lost their menstrual cycle or menstrual irregularities show obvious deficits in many cognitive areas, including language ability, cognitive efficiency, reading, mathematics, and language recall delays (even if changes in brain structure have been resolved).
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Brain recovery after anorexia

Together, these studies show that there is a complex interaction between weight status, brain structure, and optimal brain function. During AN, the brain material actually shrinks and it takes time to recover. Six months after fully regaining weight, the structure of the brain has not yet returned to normal.However, as long as there is enough time to maintain a healthy weight, the brain seems to be completely recover. Studies have shown that after three years of weight recovery, most people’s brains may look normal physically.

However, even if the brain looks normal after weight recovery, normal brain function may not have been restored. Compared with body weight (for women), menstrual function seems to be a mediator and better predictor of cognitive recovery, and complete cognitive function may not be restored until menstruation is maintained for at least six months. This is one of the reasons why recovery and continued menstruation are such important signs of recovery.

Parents of anorexia patients report that the time for complete “brain healing” ranges from six months to more than two years. When parents report that the brain is healing, they usually mean that they notice an improvement, “just like the patient comes out of a fog.” In addition, parents report that brain healing will bring about emotional and behavioral changes, making the patient feel better. Looks more stable during the recovery process and “returns to the previous (before the illness) self”. A book for parents is even titled “My Child Is Back”.

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It is important to recognize the 22nd rule of AN restoration. Individuals with AN usually have cognitive impairments and need to be at a healthy weight for a period of time to completely improve the cognitive impairment. However, some of the cognitive symptoms of AN make patients believe that they are “no problem” and therefore refuse treatment. This condition is called “agnosia”.

Impact on patients and families

According to Ovidio Bermudez, MD, chief clinical officer and medical director of the Children and Youth Services at Denver Diet Rehabilitation Center, the result of this study is that parents and treatment professionals cannot compromise on weight gain. Dr. Bermudez said that underweight patients need “brain rescue” so that “psychotherapy and behavior change can make a difference.”

This may be one of the reasons why family-based therapy (FBT) is generally more successful than individual therapy for young patients. Parents usually have to shoulder heavy responsibilities for malnourished children. It also illustrates the treatment challenges for elderly patients with anorexia, who may be trying to recover from their hungry brains. Studies have shown that only by fully and continuously recovering weight can individuals fully maintain their own recovery.