1.4. Body mass index at last menstrual period in anorexia nervosa

\udIn a previous study we reported on body weight\udand menstruation in the first 100 female patients on\udthe database, assessed between 1960 and 1970 (Crisp\ud& Stonehill, 1971). Patients with primary amenorrhea\udand onset of illness before 15 years of age were\udexcluded (because of an inability to control for\udgrowth rate and matching of a control population).\udDifficulties in obtaining accurate/honest information\udabout premorbid body weight andmenstruation\udwere recognised and addressed. The comparison\udgroup comprised the general population, matched\udfor age, sex and height. The proband group was premorbidly\udheavier than the general population (this\udfinding required that the information be sought from\udsources other than the patient). Menstruation ceased\udat a mean of 52.16.2 kg and returned when this\udweight threshold was regained in treatment\ud(53.36.2 kg). Thus, onset of amenorrhea in this\udanorectic population supervened at a level barely\udbelow mean matched population weight. At presentation\udin the clinic it was often put forward as the earliest\udfeature of the disorder whereas, in reality, a\udmean of around 8 kg of body weight had already\udbeen lost in relation to major (often concealed) dietary\udcalorie restriction. This early loss of menstruation,\udin people with anorexia nervosa, was\udattributed to the selective calorie starvation (predominantly\udcarbohydrate during the 1960s (see this\udIssue, Paper 3) that characterises the condition.\udDuring the 1960s there was a major adolescent\udsocial rebellion, including a so-called sexual revolution\udthat coincided with the introduction of the contraceptive\udpill and escalating availability of junk food, factors that probably contributed to the great\udincrease in incidence and prevalence of bulimia nervosa\udaround that time (Crisp, 1980). Concurrently it\udbecame evident clinically, in respect of anorexia nervosa,\udthat onset of amenorrhea, though still associated\udwith a wide range of body weights, was\udmore often occurring at lower weights