Dr. Halmi Replies

To the Editor: It is of special interest that the inpatients in the study by Dr. Russell et al. who had not reached a body mass index of 19 (the lower end of the normal weight range) at the time of discharge were doing less well 6–10 years later than those who had reached or exceeded a body mass index of 19. There are now two databases from two continents supporting the fact that patients with anorexia nervosa will have a significantly better outcome if they can stay in a structured setting until they reach a normal weight range. In the inpatient unit for specialized eating disorders at Cornell Medical Center’s Westchester Division, the characteristics of patients with anorexia nervosa who were hospitalized were examined during the years 1984 through 1998. During the 1980s the mean body mass index at discharge was 19.5; by 1998 it had fallen to 17.7. During this time, readmissions of patients with anorexia nervosa increased from 0% in the 1980s to 40% of those hospitalized on this specialized unit. The length of stay decreased significantly, from 149.5 days (1984) to 127.3 days (1989) to 57.4 days (1994) to 23.7 days (1998). These data indicate further that if patients are discharged at a body mass index below a normal range, they are more likely to relapse.