Stunting and Anorexia

Most experts now probably agree that stunting is a development disorder[1]. Stunting, or being too short for one’s age, is defined as a height that is more than two standard deviations below the World Health Organization (WHO) Child Growth Standards median[2]. It is a largely irreversible outcome of inadequate nutrition and repeated bouts of infection during the first 1000 days of a child’s life.

In my previous paper, 'Stunting: Malnutrition or Exploitation?'[3], I claimed that stunting is not only the result of malnutrition, but also of child exploitation. Both are indicative of poverty.

I also linked stunting to rigorous training by athletes. These athletes eat meals that contain more than enough nutrients to grow, but their bodies use these nutrients to enhance the short-term goals to the detriment of long-term growth. My conclusion was that, while stunting is usually monitored in children less than five years of age, stunting should also be monitored in children older than five years of age.

But what if malnutrition is the result of an ill-advised choice? What if anorexia also leads to stunting? The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) classifies Anorexia Nervosa as an eating disorder. Criteria include [1] Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health, [2] Intense fear of gaining weight or becoming fat, even though underweight and [3] Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight[3].

How will a voluntary restriction of energy intake relative to requirements, that leads to a significantly lower body weight in the context of age, sex, developmental trajectory and physical health, influence your growth?

One study revealed that 'Male children of women with a history of Anorexia Nervosa [...], and female children of women with Anorexia Nervosa, were shorter throughout childhood'[4]. Another study found that 'linear growth retardation was a prominent feature of Anorexia Nervosa in our sample of male adolescent patients, preceding, in some cases, the reported detection of the eating disorder. Weight restoration, particularly when target weight is based on the premorbid height percentile, may be associated with significant catch-up growth, but complete catch-up growth may not be achieved'[5].

Therefore, anorexia is a type of malnutrition and can lead to stunting.

Part 1 'Stunting: Malnutrition or Exploitation?' can be read here.
Part 3 'Smoking and Stunting' can be read here.

[1] Kraemer: Making Stunting a Development Indicator in Sight and Life - 2016 
[2] WHO Global Nutrition Targets 2025: Stunting Policy Brief. See here. 
[3] De Vries: Stunting: Malnutrition or Exploitation? in Sight and Life - 2016 
 [4] American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders 5 – 2013 
[5] Easter et al: Growth trajectories in the children of mothers with eating disorders: a longitudinal study in BMJ Open - 2014 
 [6] Modan-Moses et al: Stunting of growth as a major feature of anorexia nervosa in male adolescent in Pediatrics - 2003