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Two observation windows are distinguished throughout: a short-term window between day 1 (pre) and day 12 (post) of dosing, and a longer-term window between day 12 and the two-month follow-up (d\u2009+\u200960), capturing both changes temporally associated with leptin administration and the course of continued weight gain after the end of dosing. Over the short-term window the clinical course comprised a modest weight gain (BMI 15.4 \u2192 16.2\u00a0kg\/m\u00b2), a marked reduction in eating-disorder cognitions and compulsive exercise, attenuation of starvation-associated motor hyperactivity, and changes in objective sleep architecture (more N3 sleep, less wake after sleep onset). In this window, broader cognitive-affective and depressive symptom dimensions remained largely unchanged, and subjective insomnia did not yet improve. Over the longer-term window the course comprised continued substantial weight gain (BMI 18.3\u00a0kg\/m\u00b2 at d\u2009+\u200960), a marked drop in subjective insomnia, partial normalisation of circadian rhythm parameters in nonparametric analysis, and a transient increase in broader cognitive-affective symptoms. As a single retrospective case observation, the findings are hypothesis-generating and cannot be disentangled from concurrent weight gain and inpatient treatment.<\/jats:p>","DOI":"10.1186\/s40337-026-01748-x","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T05:44:51Z","timestamp":1787809491000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Improvements in sleep, weight, and eating-disorder symptoms following off-label leptin treatment in an adolescent with chronic anorexia nervosa and insomnia: a case report"],"prefix":"10.1186","volume":"14","author":[{"given":"Alexander","family":"D\u00fcck","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hang","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Melinat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"Kruzer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Berger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"K\u00f6lch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Reinhardt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hannes","family":"Brehme","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annelie","family":"Zimmermann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Linda","family":"Frintrop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olaf","family":"Reis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"1748_CR1","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1016\/j.sleep.2018.03.032","volume":"48","author":"A Abdou","year":"2018","unstructured":"Abdou A, Tarek, Esawy HI, Abdel Razek Mohamed G, Hussein Ahmed H, Elhabiby MM, Khalil SA, El-Hawary YA. 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They also consented to the use of the data. Any evaluation and publication of the data occurred exclusively in pseudonymised form (i.e., no personal identification can be made on the basis of these data alone). In accordance with the principles of Good Scientific Practice, the Ethics Committee of Rostock University Medical Center was informed retrospectively about the publication of these clinical data (registration number A2025-0021), and no ethical objections to the publication were raised.","order":1,"name":"Ethics","label":"Ethics approval and consent to participate","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Written informed consent for publication of this case report and any accompanying images and data was obtained from the patient and, as the patient was a minor at the time of treatment, from her parents\/legal guardians.","order":2,"name":"Ethics","label":"Consent for publication","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":3,"name":"Ethics","label":"Competing interests","group":{"name":"EthicsHeading","label":"Declarations"}}],"article-number":"203"}}