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Anorexia, Leptin Relationship Explored
> 12/28/2006 2:32:34 PM

Molecular Psychiatry, a journal from the Nature family of publications, has a feature article in their December issue exploring the connection between the hormone leptin, which plays an integral part in metabolism, energy and appetite, and anorexia nervosa. Compiled and written as a collaborative effort by four doctors at two universities in Germany, the article brings together an impressive amount of information and research centered on the hormone leptin and obesity and eating disorders. We previously discussed leptin and its potential as an antidepressant, and that line of study was drawn out of previous research into the hormone as a cog in combating obesity. This new article shows just how deep the connections between leptin, weight, body image and mental health run.

It would be impossible to do justice to all the facets of the review in this post, but we would like to spotlight some points of interest:

Those suffering with eating disorders will almost universally show decreased levels of circulating leptin. Anorexics who were assessed at intake for inpatient treatment of eating disorders had leptin levels at or below the fifth percentile compared to age matched controls.
Once treatment has begun and anorexia patients begin to put on weight, their leptin levels will often spike dramatically, leading to a period of hyperleptinaemia or elevated leptin levels. It has been theorized by researchers that this period of hyperleptinaemia is linked to a relapse and continued weight loss.
While those individuals who are sick faced hypoleptinaemia and upon initial recovery will experience hyperleptinaemia, researchers have found that it is possible for eating disorder patients to achieve normal leptin levels again, but often this can take as much many or six months or more of sustained, effective treatment.

Writing in the conclusion, lead author Dr. Hebebrand, et al. did an excellent job of summarizing what has thus far been learned about the relationship between anorexia and leptin:

There is no doubt that leptin plays an important role in [anorexia nervosa], both with respect to clinical symptomatology and course. Leptin secretion is profoundly perturbed in this eating disorder. Normalization of secretion after weight recovery requires time, the recovery of leptin-dependent somatic and behavioural symptoms may take even longer. The degree of hypoleptinaemia in acute AN is an indicator of the severity of the disorder; thus, pronounced hypoleptinaemia is not only indicative of an exceedingly low fat mass but also reveals that the neuroendocrine adaptation to semi-starvation has maximally progressed in such critically ill patients.

This review pulls together a great deal of information, but as the authors also make sure to point out, there is a great deal that still needs to explored. The relationship between eating disorders, specifically anorexia, leptin levels and overall health are beginning to come into focus, but only further study will illuminate more of the issues. Can leptin be used in treatment for anorexia? Should leptin levels be screened and used as part of the diagnosis process? Eventually we will have answers to these and other questions, but for now, this review sets the entire scientific community on a path toward informed study.

This image comes from Laura Greenfield's excellent documentary, Thin, which can be found on the web here and we've previously written up here.

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