513 - Psychological Distress in Hospitalized Youth with Anorexia Nervosa and Premorbid Overweight or Obesity

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 513
Publication Number: 513.3

Katelyn E. Gordon, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Grace Jhe, Harvard Medical School, Boston, MA, United States; Richa Adhikari, Boston Children's Hospital, pomona, CA, United States; Abigail Matthews, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Melissa B. Freizinger, Boston Children's Hospital, Boston, MA, United States; Tracy Richmond, Boston Children's Hospital, Boston, MA, United States; Jessica A. Lin, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States

Presenting Author(s)

KG

Katelyn E. Gordon, MD (she/her/hers)

Clinical Fellow
Cincinnati Children's Hospital Medical Center
Cincinnati, Ohio, United States

Background: Youth with anorexia nervosa (AN) often experience significant psychological distress during nutritional rehabilitation. Overweight/obesity is also associated with psychological comorbidities, and upwards of 40% of youth with AN experience overweight/obesity prior to illness onset.

Objective: This study aimed to assess whether youth with AN and premorbid overweight/obesity experienced greater psychologic distress than patients with premorbid normal weights during inpatient nutritional rehabilitation, as measured by use of nasogastric tube (NGT) feeds, psychiatric medication use, and reported suicidal ideation (SI) during medical hospitalization.

Design/Methods:

Retrospective chart review examined 150 youth (aged 9-19) hospitalized at Boston Children’s Hospital for medical complications of AN or atypical AN between 2015-2020. Upon admission, patients were initiated on a nutritional rehabilitation protocol, including NGT feeds to supplement any meal/snack that was not completed orally. ANOVA and chi-square analyses examined differences across premorbid weight groups (overweight/obesity vs. normal) for sex, race, ethnicity, % total body weight lost, and prior treatment for AN. Rates of NGT use, psychiatric medication use, and patient-reported SI were compared for premorbid weight status using logistic and linear regressions. The effect modification of % total body weight lost on these associations was also assessed.

Results:

Participants had a mean age of 14.1 years (SD 2.3). Most were female (86%) and non-Hispanic White (80%). Patients with premorbid overweight/obesity (n=51, 34%) were more often male (p< .001) and more often lost a greater % of total body weight (p< .001) than patients with premorbid normal weights, and had a 4.5 times higher odds of using NGT feeds (95% CI 1.3, 14.7, p=.01) when controlling for % total body weight lost and sex. The relationship between NGT use and premorbid weight was not significantly moderated by % total body weight lost. No significant relationships were found between premorbid weight groups and psychiatric medication use or patient-reported SI.

Conclusion(s):

Hospitalized youth with AN and premorbid overweight/obesity had significantly higher odds of requiring NGT feeds than patients without premorbid normal weights, suggesting greater psychological distress specific to consuming nutrition orally. Whereas NGT feeding is an effective and often used tool during nutritional rehabilitation, it may indicate a greater need for early psychological support for some patients, particularly those with premorbid overweight/obesity.