RESEARCH ARTICLE The Relationship Between Skinfold Thickness and Body Mass Index in North European Caucasian and East Asian Women With Anorexia Nervosa: Implications For Diagnosis and Management y Nerissa L. Soh 1 * , Stephen Touyz 2,3z , Timothy A. Dobbins 4 , Simon Clarke 5,6 , Michael R. Kohn 5,6 , Ee Lian Lee 7 , Vincent Leow 8x , Ken EK Ung 9 & Garry Walter 1,10z 1 Child and Adolescent Mental Health Services, Northern Sydney Central Coast Area Health Service, New South Wales, Australia 2 School of Psychology, University of Sydney, New South Wales, Australia 3 Peter Beumont Centre for Eating Disorders, New South Wales, Australia 4 School of Public Health, University of Sydney, New South Wales, Australia 5 Department of Adolescent Medicine and Centre for Research Into Adolescent’S Health (CRASH), Westmead Hospital, Westmead, New South Wales, Australia 6 Faculty of Medicine, University of Sydney, New South Wales, Australia 7 Department of Behavioural Medicine, Singapore General Hospital, Singapore 8 Private Practice, Grosvenor Street, Bondi Junction, New South Wales, Australia 9 Adam Road Hospital, Singapore 10 Department of Psychological Medicine, University of Sydney, New South Wales, Australia Abstract Objective: To investigate the relationship between skinfold thickness and body mass index (BMI) in North European Caucasian and East Asian young women with and without anorexia nervosa (AN) in two countries. Method: Height, weight and skinfold thicknesses were assessed in 137 young women with and without AN, in Australia and Singapore. The relationship between BMI and the sum of triceps, biceps, subscapular and iliac crest skinfolds was analysed with clinical status, ethnicity, age and country of residence as covariates. Results: For the same BMI, women with AN had significantly smaller sums of skinfolds than women without AN. East Asian women both with and without AN had significantly greater skinfold sums than their North European Caucasian counterparts after adjusting for BMI. Conclusion: Lower BMI goals may be appropriate when managing AN patients of East Asian ancestry and the weight for height diagnostic criterion should be reconsidered for this group. Copyright # 2008 John Wiley & Sons, Ltd and Eating Disorders Association. Keywords skinfolds; body mass index; anorexia nervosa; diagnostic criteria; ethnicity *Correspondence Nerissa L. Soh, Coral Tree Family Service, P.O. Box 142, North Ryde, NSW 1670, Australia. Tel: þ61 2 8877 5371. Fax: þ61 2 9887 2941. Email: nsoh@nsccahs.health.nsw.gov.au Published online 7 August 2008 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/erv.893 y Part of this manuscript was presented at the Dietitians Association of Australia’s 24th Annual Conference in May 2006 and submitted as part of a doctoral thesis to The University of Sydney. z Professor. x Consultant Psychiatrist. Eur. Eat. Disorders Rev. 17 (2009) 31–39 ß 2008 John Wiley & Sons, Ltd. and Eating Disorders Association. 31