The impact of psychiatric comorbidities on patient-reported surgical outcomes in adults treated for the median arcuate ligament syndrome.

OBJECTIVE: Median arcuate ligament syndrome (MALS) is an often overlooked, surgically correctable condition that mimics functional chronic abdominal pain. Patient-reported surgical outcomes are unpredictable in MALS. The objective of this study was to define the psychiatric comorbidities in a cohort of adults undergoing surgery for MALS and to determine whether these comorbidities are predictive of patient-reported quality of life (QOL) outcomes. METHODS: A prospective observational trial was conducted between April 1, 2010, and December 31, 2015, at a single tertiary care hospital. Adults with a diagnosis of chronic abdominal pain in the setting of celiac artery compression were enrolled in a prospective Institutional Review Board-approved observational trial. Patients completed psychological assessments before surgery for MALS and at 6 months after surgery. The primary outcome was patient-reported health-related QOL (young adult version of the Pediatric Quality of Life Inventory). RESULTS: A total of 51 patients (80% female; n = 41) with a mean age of 30.5 (±12.4) years were enrolled. Surgery significantly improved celiac artery hemodynamics in the entire cohort (P < .0001) as well as overall QOL (67.8 ± 14.6 [before surgery] vs 80.3 ± 13.7 [after surgery]; P < .001). Psychiatric diagnoses were common in this cohort, with 14 of 51 (28%) patients meeting criteria for a psychiatric diagnosis. There were no differences in the number of patients with psychiatric diagnoses between presurgical and postsurgical evaluations (14 [28%] vs 13 [26%]; P = .8). Exploratory analyses suggest that having a psychiatric diagnosis at the presurgical evaluation may predict significantly lower postsurgical QOL (R2 = 0.009; P = .01). CONCLUSIONS: Surgery improves patient-reported QOL in adults treated for MALS. Psychiatric diagnoses are common in adults with MALS and predict worse patient-reported QOL outcomes.

Relationship between desired weight constructs and eating disorder severity following treatment for anorexia nervosa.

BACKGROUND: Desired weight is an indicator of illness severity in youth with anorexia nervosa (AN), but its impact on eating disorder symptoms over time and in adults is unknown. This study examined longitudinal associations between two desired weight constructs (desired weight percentage, weight difference percentage) and eating disorder severity and body mass index (BMI) in patients aged 16-62 years old with AN presenting for inpatient or day hospital treatment. METHOD: Participants (N = 160) completed the Eating Disorder Examination and measures of height and weight at treatment admission, discharge, and 3, 6, and 12 months post-discharge. Desired weight percentage was calculated as [desired BMI(desired weight in kg/height in meters2 )/healthy BMI] × 100. weight difference percentage was calculated as [(actual weight-desired weight)/actual weight] × 100. RESULTS: At admission, participants were approximately 78.6% of a healthy BMI and desired to be 81% of a healthy BMI. During the year following treatment, participants were 89% of a healthy BMI, but wanted to be 86% of a healthy BMI. Individuals with lower desired weight percentage (wanting to be a lower percentage of a healthy BMI) or higher weight difference percentage (wanting to lose a larger percentage of weight) at treatment admission endorsed greater eating disorder severity across time. Additionally, individuals with higher desired weight percentage or weight difference percentage had higher BMIs at intake, and greater increases in BMI over time. DISCUSSION: Results highlight that desired weight constructs represent correlates of illness severity in AN and may inform an individual's likely weight trajectory during and after treatment.

Ecological momentary assessment of maladaptive eating in children and adolescents with overweight or obesity.

OBJECTIVES: Contextual factors related to maladaptive eating behavior in youth with overweight/obesity are poorly understood. This pilot study sought to elucidate immediate internal and external cues related to perceptions of overeating and loss of control (LOC) over eating in a heterogeneous sample of children and adolescents with overweight/obesity assessed in their natural environments. METHOD: Community-based youth [N = 40; 55% female (n = 22)], aged 8-14 y (M age = 11.2 ± 1.9 y), with overweight/obesity (M z-BMI = 2.07 ± 0.49) reported on all eating episodes and their physiological, environmental, affective, and interpersonal antecedents and correlates via ecological momentary assessment over a 2-week period. Generalized estimating equations were used to assess the relationship between contextual variables and degree of overeating and LOC. RESULTS: Eating occasions involving greater food hedonics (i.e., perceived palatability of food being consumed) were associated with greater LOC severity (within-subjects effect: B = 0.01, p = .015), although youth with lower overall levels of food hedonics reported higher LOC severity ratings on average (between-subjects effect: B = -0.04, p = .005). Youth reporting higher overall cravings reported higher average ratings of LOC severity (between-subjects effect: B = 0.20, p = .001). Finally, youth reporting greater overall influence of others on eating behavior evidenced greater average levels of overeating severity (between-subjects effect: B = 0.17, p < .001). DISCUSSION: Eating-related factors appear to be most strongly associated with LOC severity, while environmental factors were most associated with overeating severity. Interventions targeting maladaptive eating in youth with overweight/obesity may benefit from helping youth incorporate palatable foods and satisfy cravings in a planned and controlled manner, and enhancing awareness of social-contextual effects on eating.

Psychological Factors and Outcomes in the Surgical Treatment of Pediatric Patients With Median Arcuate Ligament Syndrome.

OBJECTIVE: Median arcuate ligament syndrome (MALS) is a frequently overlooked cause of chronic abdominal pain (CAP), and results in many symptoms that mimic other gastrointestinal conditions that result in CAP. A small, but growing body of literature indicates that surgery improves quality of life (QOL) in patients with MALS. The purpose of the current study was to examine the psychological characteristics of pediatric patients with MALS to determine their prevalence and impact on surgical outcomes. METHODS: Thirty-two pediatric patients completed psychological assessments before surgery, and 6 months postsurgical intervention. Descriptive analyses and t tests were conducted to characterize the sample and compare psychosocial and QOL items. To explore possible associations between coping and ultimate changes in QOL, exploratory multiple regressions were conducted. RESULTS: Comorbid psychological conditions were common, occurring in about half the sample before and after surgery. Current pain significantly improved, as well as patient and parent-reported QOL constructs (Ps < 0.05). Parent-reported observations of patients using catastrophizing or helpless strategies to cope with pain before surgery was significantly associated with changes in patient and parent-reported QOL following surgery (Ps = 0.04). CONCLUSIONS: Comorbid psychological conditions are common in pediatric patients with MALS, and are maintained following surgery. While surgery improved pain and QOL, the need for presurgical psychological interventions for MALS is implicated.

Relationship between desired weight and eating disorder pathology in youth.

OBJECTIVE: Individuals with eating disorders (ED), particularly anorexia nervosa (AN), and bulimia nervosa (BN), often wish to reduce their body weight in pursuit of a thin ideal, but no study has examined the relation between desired weight and ED pathology in a clinical population of youth. Given the potential impact of desired weight on normalization of eating patterns and weight restoration, we examined the relation between desired weight and ED pathology in youth with AN or BN. METHODS: Participants were 340 youth presenting to an outpatient ED clinical research program. Height and weight were measured, and youth completed the Eating Disorder Examination. Desired weight was operationalized as "desired weight percentage" (calculated as a percentage of expected body weight [EBW]) and "weight difference percentage" (actual weight minus desired weight, divided by actual weight and multiplied by 100). RESULTS: Youth with AN desired to be a lower percentage of their EBW than youth with BN (p < .001). However, youth with AN, on average, wanted to gain 5.28% of their body weight and youth with BN wanted to lose 13.60% (p < .001). Desired weight percentage and weight difference percentage were associated with greater ED psychopathology, controlling for ED diagnosis, age, and sex (ps < .001). DISCUSSION: Desired weight is associated with elevated ED psychopathology. Weight goals may shift as individuals progress through treatment; if they do not, then desired weight may be an important indicator of a lack of psychological progress.

Thin and sexy vs. muscular and dominant: Prevalence of gendered body ideals in popular dolls and action figures.

We examined the extent to which popular dolls and action figures were portrayed with gendered body proportions, and the extent to which these gendered ideals were associated with heterosexual "success." We coded internet depictions of 72 popular female dolls and 71 popular male action figures from the websites of three national stores in the United States. Sixty-two percent of dolls had a noticeably thin body, while 42.3% of action figures had noticeably muscular bodies. Further, more thin dolls were portrayed with more sex object features than less thin dolls, including revealing, tight clothing and high-heeled shoes; bodies positioned with a curved spine, bent knee, and head cant; and with a sexually appealing facial expression. More muscular male action figures were more likely than less muscular ones to be shown with hands in fists and with an angry, emotional expression, suggesting male dominance.