Women with anorexia nervosa (AN) have elevated marrow fat mass despite low visceral and subcutaneous fat depots, which is inversely associated with bone mineral density (BMD). Whether marrow fat mass remains persistently elevated or decreases with recovery from AN is currently unknown. In this study, we investigated changes in marrow fat in women who have recovered from AN (AN‐R). We also studied the relationship between preadipocyte factor (Pref)‐1—a member of the EGF‐like family of proteins and regulator of adipocyte and osteoblast differentiation—and fat depots and BMD in AN‐R compared with women with AN and healthy controls (HC). We studied 29 women: 14 with active or recovered AN (30.7 + 2.2 years [mean ± SEM]) and 15 normal‐weight controls (27.8 ± 1.2 years). We measured marrow adipose tissue (MAT) of the L4 vertebra and femur by ¹H‐magnetic resonance spectroscopy; BMD of the spine, hip, and total body by DXA; and serum Pref‐1 and leptin levels. We found that MAT of the L4 vertebra was significantly lower in AN‐R compared with AN (p = 0.03) and was comparable to levels in HC. Pref‐1 levels were also significantly lower in AN‐R compared with AN (p = 0.02) and comparable to levels in healthy controls. Although Pref‐1 was positively associated with MAT of the L4 vertebra in AN (R = 0.94; p = 0.002), we found that it was inversely associated with MAT of the L4 vertebra in HC (R = −0.71; p = 0.004). Therefore, we have shown that MAT and Pref‐1 levels decrease with recovery from AN. Our data suggest that Pref‐1 may have differential effects in states of nutritional deprivation compared with nutritional sufficiency. © 2012 American Society for Bone and Mineral Research.