"Thin and muscular": A cross-sectional mixed methods study of people's descriptions of health

As weight status is frequently associated with health and the COVID-19 pandemic has raised attention to weight status, we used a cross-sectional mixed-methods design to explore how weight status or body size is described when defining health. We recruited 288 participants who were 18 years and older and living in the United States to complete a study about health and health behaviors during the pandemic. First, we used directed content analysis to explore if and how weight status/body size is described when asked to define health. Next, we used intensity sampling and a constant comparison approach to assess whether descriptions of health differed by diagnosis of a chronic disease, sex, and weight bias internalization. Seventy percent (n = 202) of participants described an aspect of weight, body size, or shape when defining health, the majority of which (65%) indicated someone could be unhealthy due to their weight or size. Only 29% (n = 84) of participants implied or directly stated a person could be healthy regardless of weight or size. There were no significant differences in the description of health by chronic disease status or weight bias internalization. Women included health behaviors more frequently than men. Our findings indicate that weight was inextricably linked with health among most adults in the United States. To promote health and reduce the damaging effects of weight stigma, it is imperative that preventive interventions and policies include weight-inclusive messages that underscore the importance of the multiple indicators of health, beyond weight and size. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

“Thin and muscular”: A cross-sectional mixed methods study of people’s descriptions of health

As weight status is frequently associated with health and the COVID-19 pandemic has raised attention to weight status, we used a cross-sectional mixed-methods design to explore how weight status or body size is described when defining health. We recruited 288 participants who were 18 years and older and living in the United States to complete a study about health and health behaviors during the pandemic. First, we used directed content analysis to explore if and how weight status/body size is described when asked to define health. Next, we used intensity sampling and a constant comparison approach to assess whether descriptions of health differed by diagnosis of a chronic disease, sex, and weight bias internalization. Seventy percent (n = 202) of participants described an aspect of weight, body size, or shape when defining health, the majority of which (65%) indicated someone could be unhealthy due to their weight or size. Only 29% (n = 84) of participants implied or directly stated a person could be healthy regardless of weight or size. There 4 were no significant differences in the description of health by chronic disease status or weight bias internalization. Women included health behaviors more frequently than men. Our findings indicate that weight was inextricably linked with health among most adults in the United States. To promote health and reduce the damaging effects of weight stigma, it is imperative that preventive interventions and policies include weight-inclusive messages that underscore the importance of the multiple indicators of health, beyond weight and size.

A Case of Beriberi After MIS-C

Introduction: As of June 2021, 4 million children have tested positive for COVID-19 in the US. In contrast to adults, children are often hospitalized with gastrointestinal symptoms including persistent vomiting. Pancreatitis has also been seen in MISC, which can lead to malnutrition. Most physician learn about thiamine deficiency and Wernicke Encephalopathy in patients with severe alcoholism or in low-income settings. We cared for a child with Wernicke Encephalopathy due to subacute malnutrition and weight loss after pancreatitis secondary to MISC in the US. Case Description: A 13-year-old female presented to Levine Children's Hospital with weight loss. She was diagnosed with COVID on 1/23/21 with 1 week of URI symptoms, with baseline weight 165 pounds (BMI 31.1). She was seen in an Emergency Department (ED) on 3/1/21 for vomiting with lipase 350u/L;she received fluids and was discharged. She represented on 3/7/21 with persistent symptoms weighing 135.5 pounds (BMI 25.6) with lipase 790u/L. She was discharged after three days with a diagnosis of post-COVID pancreatitis and lipase 600u/L. After discharge, she continued losing weight despite ondansetron. She followed up with GI on 3/15, weighing 130 pounds (BMI 24.5). An abdominal MRI and endoscopy were normal. She was started on omeprazole and cyproheptadine. She presented to Levine Children's Hospital on 3/24/21 for a second opinion. Upon admission, her serum lipase was 895u/L and she weighed 115 pounds (BMI 21.7). She was started on dextrose-containing fluids and developed seizures on 3/27/21. MRI brain was normal. Ophthalmology noted bilateral abducens nerve palsy. She developed worsening mental status and respiratory failure, so was intubated. A repeat MRI brain revealed posterior reversible encephalopathy syndrome and findings specific for Wernicke Encephalopathy. Thiamine level was low, and empiric thiamine was initiated. She was started on feeds and clinically improved. She was then extubated and showed improvements in her motor function and ability to follow commands. She transferred to inpatient rehab and continues to make progress. Discussion: Identification of the degree of malnutrition for this patient was difficult to obtain due to non-communicating EMRs. This limited the providers' ability to accurately quantify the degree of weight loss and the potential for Thiamine deficiency. The combination of limited body storage and short half-life can result in total depletion of thiamine stores within 2 weeks leading to altered mental status. Unfortunately, stigmatization of obesity in children has been well documented and malnutrition may be overlooked due to a normal BMI. Conclusion: Obtaining growth charts for patients presenting with weight loss is important as they provide objective data and help prevent obesity bias. If a child has a history of weight loss and develops altered mental status, vitamin B deficiencies should be considered in the differential. Pancreatitis associated with MIS-C can cause significant malnutrition leading to Wernicke Encephalopathy.

Preliminary comparison of eating pathology and weight status in youth with and without food insecurity

Background: Food insecurity (FI) impacts over 14 million U.S. households, yet we lack research on associations between FI and eating pathology that may impact weight status in youth. We aimed to fill this gap with a small pilot study comparing youth with and without FI on weight status and disordered eating constructs. Methods: We recruited 34 youth (Mage = 12.8 ± 2.6;MBMI% = 64.2 ± 30.2;Girls = 59%;Black = 48.6%, Latinx = 22.9%, Asian = 2.9%, White = 2.9%, Multiracial = 17.1%, Other = 5.8%) from the Bronx, New York City prior to the COVID-19 pandemic. Height and weight were objectively measured, and body mass index percentile (BMI%) calculated. Youth were dichotomized into FI and non-FI groups using parent report of FI over 12 months. Eating and weight bias symptoms were measured by self-report. Cohen's d effect sizes from independent samples t-tests determined the magnitude of group differences on BMI, dietary restraint, shape/weight overvaluation, body dissatisfaction, and weight bias internalization scores as the sample size was underpowered to detect significance. Results: A moderate effect size emerged for dietary restraint (d = .66), with greater dietary restraint for youth with FI. Small effect sizes for BMI percentile (d = .38), weight bias internalization (d = .32), shape/weight overvaluation (d = .13), and body dissatisfaction (d = .13) emerged such that youth with FI had higher BMI%s and weight bias internalization scores, but lower body dissatisfaction and shape/weight overvaluation scores. As predicted due to sample size, results were not significant (ps >.05). Conclusions: Preliminary results suggest important differences in eating attitudes, behaviors, and weight status between youth with and without FI. While youth with FI have higher BMI%s and satisfaction with their bodies, they also show higher internalization of weight bias against larger bodies. Further research should assess whether greater dietary restraint for youth with FI is related to lack of food resources, desire to lose weight, eating pathology, or a combination of these factors. This work is novel in evaluating how FI is associated with eating pathology in diverse youth. Still, additional studies with larger sample sizes are needed;considering the moderate to small effect size estimates from the current study, statistically significant group differences may emerge.

Weight Bias During the COVID-19 Pandemic.

PURPOSE OF REVIEW: This review explores potential sources of weight bias and stigma during the COVID-19 pandemic, including "quarantine-15" messages and discussion of obesity in media and public health campaigns. We examine evidence of the effects of weight bias on well-being during the pandemic and highlight unanswered questions to be addressed in future research. RECENT FINDINGS: Studies that have investigated weight change during stay-at-home orders have yielded mixed findings and relied predominantly on self-reported retrospective recall, thus providing weak evidence of a widespread "quarantine-15" effect. No studies to date have evaluated the effects on weight stigma and health of obesity-focused COVID-19 media and public health messages. Individuals with a history of experiencing weight bias may be more vulnerable to binge eating and psychological distress during the pandemic. Weight bias and stigma during the COVID-19 pandemic, and their effects on health and well-being, warrant greater investigation and consideration in public health efforts.