["European Eating Disorders Review, Volume 34, Issue 3, Page 571-583, May 2026. ", "\nABSTRACT\n\nBackground\nAnorexia nervosa is considered one of the most severe eating disorders. Previous studies have established that eating disorders are linked to symptoms of anxiety and depression.\n\n\nAims\nThis study aimed to assess the relationship between anxiety and depressive symptoms, clinical and biological markers of malnutrition, and problematic physical activity in a cohort of extremely malnourished inpatients with anorexia nervosa.\n\n\nMethod and Results\nIn this large prospective, monocentric study, 71 severely malnourished patients with a mean age of 29.41 ± 11.15 years were enroled. Out of the 71, 67 (94.37%) patients were females. Psychological, clinical, and biochemical assessment were done. Out of the 71 patients studied, 48 had moderate to severe depression, 42 experienced anxiety, and 37 had moderate to severe‐obsessive‐compulsive disorder. Results indicated that the lower the BMI the higher were the symptoms of depression and anxiety, while the higher the albumin, cortisol, and physical activity levels, the higher were the symptoms of depression and anxiety. Cortisol and The Godin Leisure Time Exercise Questionnaire (GLTEQ) scores were significant predictors of Beck Depression Inventory‐II (BDI) scores.\n\n\nConclusion\nThese results highlight the complex interplay between psychological symptoms, physical activity, and nutritional status in patients with anorexia nervosa. Aligning with previous studies, healthcare providers should adopt integrated treatment plans that address both the psychological and nutritional requirements of anorexia nervosa patients.\n\n\nTrial Registration\nThe study was declared to the French data protection authority (CNIL: 2029030vO; MR004; 10.3390/nu16132095)\n\n"]