Does Weight Matter?: Prospective Examination of Premorbid Body Weight as a Predictor of Eating Pathology

Despite years of research on eating disorders, their persisting prevalence suggests limited efficacy of current prevention efforts and establishes the need for the identification of additional risk and maintenance factors. Predominant conceptualizations of eating disorders have placed continued emphasis on psychosocial factors associated with eating pathology. As such, the role of actual body weight has received limited attention, and relevant relationships between these factors and eating disorder development remain elusive. Preliminary evidence has identified elevated premorbid body weights in eating disorder patients, suggesting that these individuals may be biologically predisposed to higher weights and that this predisposition may be a factor relevant to subsequent eating disorder development. The current study sought to examine whether higher premorbid body weights prospectively predict subsequent clinical status in a sample of female eating disorder inpatients. By examining body weight in relation to subsequent symptom severity, the current study sought to establish premorbid body weight as a factor relevant to the development of eating pathology. Results indicated a significant relationship between highest premorbid z-BMI and self-reported Eating Concerns at treatment intake, though this relationship was not significant when accounting for current BMI. There was also a marginally significant interaction between premorbid z-BMI and current weight, such that those with a higher current BMI and a history of relatively lower highest premorbid z-BMI exhibited the greatest eating and weight concerns. These finding suggest a potential combined influence of current and historical weight in the role of Eating and Weight concerns.M.S., Psychology -- Drexel University, 201

Predictors of illness course and health maintenance following inpatient treatment among patients with anorexia nervosa

Background Anorexia nervosa (AN) is a life-threatening psychiatric disorder associated with significant medical and psychosocial impairment. Hospital-based behavioral treatment is an effective intervention in the short-term. However, relapse rates following discharge are high and thus, there is a need to identify predictors of longitudinal outcome. The current study provides information regarding illness course and health maintenance among patients with AN over 5 years following discharge from an eating disorder inpatient unit. Methods Participants were individuals with AN who were discharged from a specialized, inpatient behaviorally-based unit. Prior to discharge, height and weight were measured and participants completed self-report measures of eating disorder severity and general psychopathology (depression, anxiety, harm avoidance). Participants were contacted annually for self-report measures of weight, eating disorder severity and clinical impairment. Outcome was defined by illness course (body mass index (BMI) and clinical impairment during the 5 years) and health maintenance (categories of weight and eating disorder symptom severity) across follow-up, using all available data. Linear mixed models were used to examine whether demographic and clinical parameters at discharge predicted BMI and clinical impairment over time. Additional analyses examined whether these variables significantly influenced an individual’s likelihood of maintaining inpatient treatment gains. Results One-hundred and sixty-eight individuals contributed data. Higher trait anxiety at discharge was associated with a lower BMI during follow-up (p = 0.012). There was a significant interaction between duration of illness and time, whereby duration of illness was associated with a faster rate of weight loss (p = 0.003) during follow-up. As duration of illness increased, there was a greater increase in self-reported clinical impairment (p = 0.011). Increased eating disorder severity at discharge was also associated with greater clinical impairment at follow-up (p = 0.004). Higher BMI at discharge was significantly associated with maintaining healthy weight across a priori BMI-based definitions of health maintenance. Conclusions Weight status (higher BMI) and duration of illness are key factors in the prognosis of AN. Higher weight targets in intensive treatments may be of value in improving outcomes

The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

AIM: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. METHODS: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. RESULTS: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90-1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69-1.27, P = 0.672). Longer delays were not associated with poorer outcomes. CONCLUSION: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

Hedonic Hunger, Disinhibited Eating, and the Physiological Impact of Palatable Food: A Study of Heart Rate Variability

Hedonic hunger and disinhibited eating behaviors, such as loss of control eating and eating in the absence of hunger, represent increased motivation for food and susceptibility towards overeating and are associated with a range of adverse physical and psychological outcomes. The persisting prevalence of these symptoms suggests limited efficacy of current prevention efforts and establishes the need for the identification of additional risk and maintenance factors. Heart rate variability (HRV) has been established as a measure of biological responsiveness and psychological well-being and may function as a physiological marker of food responsivity. Preliminary evidence has identified associations between reduced HRV and eating disorder symptoms, suggesting that eating pathology may be associated with different physiological responses to food. The current study sought to replicate and extend previous findings by employing HRV as a measure of arousal in response to food presentation across different hunger conditions in healthy adults. We examined relationships between multiple indices of HRV (HF, LF, LF/HF) and measures of hedonic hunger, loss of control eating, and eating in the absence of hunger. Results found similar patterns of HRV in response to food exposure and intake as previous research in nonclinical samples, with reduced HF HRV during food exposure and food intake and increased HF HRV following food intake. Although there was a marginally significant interaction between hedonic hunger and PFS, subsequent analyses found no relationship between HRV and PFS, LOC or EAH. Limitations and implications of the study are discussed.Ph.D., Psychology -- Drexel University, 201

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic : an international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks