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Treatments are often ineffective and relapse is common. Most research attempting to understand the underlying causes and maintenance factors of AN has focused on environmental contributions, yet there is much to be explored in terms of biological risk and maintenance factors. In this paper, we focus primarily on AN research related to genetics and the complex microbial community in the gut (intestinal microbiota), and how these impact our conceptualization of this disorder. Emerging research identifying significant negative genetic correlations between AN and obesity suggests that the conditions may represent \u2018metabolic bookends\u2019. The identification of underlying biological mechanisms may provide both insight into extreme weight dysregulation on both ends of the spectrum and new possible points of entry for AN treatment. Additionally, the reported microbial imbalance (dysbiosis) in the gut microbiota in AN patients, potentially due to a nutrient\u2010 and energy\u2010deprived gut environment, implies alterations in functional and metabolic capacity of the gut microbiome. The extent to which AN and obesity can also be considered to be \u2018microbiome bookends\u2019 requires further investigation. Finally, we discuss ongoing and future AN projects exploring the interplay between host genomics, the environment, and cumulative microbial genomes (microbiome) as well as interventions at the microbial and gut level.<\/jats:p>","DOI":"10.1111\/pcn.12857","type":"journal-article","created":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T19:07:32Z","timestamp":1557169652000},"page":"518-525","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":63,"title":["Reconceptualizing anorexia nervosa"],"prefix":"10.1111","volume":"73","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7772-3264","authenticated-orcid":false,"given":"Cynthia M.","family":"Bulik","sequence":"first","affiliation":[{"name":"Department of Psychiatry University of North Carolina at Chapel Hill  Chapel Hill USA"},{"name":"Department of Nutrition University of North Carolina at Chapel Hill  Chapel Hill USA"},{"name":"Department of Medical Epidemiology and 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