A brief mindfulness-based intervention reduces eating disorder symptoms and improves eating self-efficacy and emotion regulation among adults seeking bariatric surgery

Background Up to 64% of bariatric (weight-loss) surgery-seeking adults report eating disorder (ED) symptoms (i.e., binge eating, emotional eating, addictive-like eating, and grazing) that can interfere with surgery outcomes. Well-designed pre-surgical interventions targeting eating behaviours may reduce ED symptoms and protect against suboptimal surgery outcomes. Objectives Provide proof-of-concept data to inform the design and optimization of a pre-surgical mindfulness-based intervention (MBI) for ED symptoms. Evaluate whether the MBI produces meaningful improvements in ED symptoms and clarify the mechanisms-of-action by which the MBI impacts ED symptoms. Methods Twenty-one pre-surgical patients with obesity and ED symptoms referred to a MBI completed self-report measures of addictive-like eating, binge eating, emotional eating, grazing, mindful eating, eating self-efficacy, and emotion regulation pre-(T1) and post-(T2) MBI. Results Repeated-measures ANOVAs revealed improvements in binge eating symptoms (F (1,20) = 30.38, ηp2 = .60, p < .001) and grazing (F (1,20) = 7.57, ηp2 = .28, p = .012), pre- to post-MBI. Adjusting for multiple comparisons, no significant improvements were found for addictive-like eating or emotional eating. Eating self-efficacy (F (1,20) = 29.70, ηp2 = .60, p < .001) and emotion regulation (F (1,20) = 7.18, ηp2 = .26, p = .014) improved, while mindful eating decreased (F (1,20) = 16.25, ηp2 = .45, p = .001), following the MBI. Bivariate correlations found associations between improvements in the mechanism of eating self-efficacy and improvements in the ED symptom of grazing pre- to post-MBI (r = 0.46, p < .05).  As well, improvements in emotion regulation were associated with positive changes in binge and emotional eating and grazing (r = 0.55, p < .001, r = 0.66, p < .001, r = 0.61, p < .05, respectively). Conclusions After participating in the MBI binge eating, grazing, eating self-efficacy, and emotion regulation abilities improved. Further work is needed to understand and mitigate deterioration in mindful eating. Moreover, acceptability and feasibility of the MBI should be assessed prior to testing the MBI in a large-scale efficacy trial. Future research should assess the the impact of this intervention on post-surgery weight-loss, weight-loss maintenance, and maintenance of improvements in ED symptoms

Case Reports1. A Late Presentation of Loeys-Dietz Syndrome: Beware of TGFβ Receptor Mutations in Benign Joint Hypermobility

Background: Thoracic aortic aneurysms (TAA) and dissections are not uncommon causes of sudden death in young adults. Loeys-Dietz syndrome (LDS) is a rare, recently described, autosomal dominant, connective tissue disease characterized by aggressive arterial aneurysms, resulting from mutations in the transforming growth factor beta (TGFβ) receptor genes TGFBR1 and TGFBR2. Mean age at death is 26.1 years, most often due to aortic dissection. We report an unusually late presentation of LDS, diagnosed following elective surgery in a female with a long history of joint hypermobility. Methods: A 51-year-old Caucasian lady complained of chest pain and headache following a dural leak from spinal anaesthesia for an elective ankle arthroscopy. CT scan and echocardiography demonstrated a dilated aortic root and significant aortic regurgitation. MRA demonstrated aortic tortuosity, an infrarenal aortic aneurysm and aneurysms in the left renal and right internal mammary arteries. She underwent aortic root repair and aortic valve replacement. She had a background of long-standing joint pains secondary to hypermobility, easy bruising, unusual fracture susceptibility and mild bronchiectasis. She had one healthy child age 32, after which she suffered a uterine prolapse. Examination revealed mild Marfanoid features. Uvula, skin and ophthalmological examination was normal. Results: Fibrillin-1 testing for Marfan syndrome (MFS) was negative. Detection of a c.1270G > C (p.Gly424Arg) TGFBR2 mutation confirmed the diagnosis of LDS. Losartan was started for vascular protection. Conclusions: LDS is a severe inherited vasculopathy that usually presents in childhood. It is characterized by aortic root dilatation and ascending aneurysms. There is a higher risk of aortic dissection compared with MFS. Clinical features overlap with MFS and Ehlers Danlos syndrome Type IV, but differentiating dysmorphogenic features include ocular hypertelorism, bifid uvula and cleft palate. Echocardiography and MRA or CT scanning from head to pelvis is recommended to establish the extent of vascular involvement. Management involves early surgical intervention, including early valve-sparing aortic root replacement, genetic counselling and close monitoring in pregnancy. Despite being caused by loss of function mutations in either TGFβ receptor, paradoxical activation of TGFβ signalling is seen, suggesting that TGFβ antagonism may confer disease modifying effects similar to those observed in MFS. TGFβ antagonism can be achieved with angiotensin antagonists, such as Losartan, which is able to delay aortic aneurysm development in preclinical models and in patients with MFS. Our case emphasizes the importance of timely recognition of vasculopathy syndromes in patients with hypermobility and the need for early surgical intervention. It also highlights their heterogeneity and the potential for late presentation. Disclosures: The authors have declared no conflicts of interes

Parents' and children's beliefs about science and science careers

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