Research Poster Presentations / Journal of Adolescent Health 64 (2019) S48eS94 S53

100. 101.

STARVING FOR SUPPORT: NATURAL LANGUAGE PROCESSING AND THE GENETIC RISK FOR BODY MASS INDEX AND WEIGHT LOSS
MACHINE LEARNING ANALYSIS OF ANOREXIA NERVOSA IN PRO- BEHAVIORS
EATING DISORDER COMMUNITIES Jason Ming-Hung Nagata, MD, MSc 1, Benjamin W. Domingue, PhD 2,
Kyle Aaron McGregor, PhD 1, Olivia Clancy 2 Kirsten Bibbins-Domingo, PhD, MD, MAS 1, Andrea K. Garber, PhD, RD 1,
1
New York University Langone Health; 2New York University. Scott Griffiths, PhD 3, Stuart B. Murray, PhD 1
1
University of California, San Francisco; 2Stanford University;
3
University of Melbourne.
Purpose: There are an ever increasing number of social media plat-
forms available for people to connect and build online communities.
Purpose: Three genetic loci have been found to be involved with
Pro-eating disorder communities, notably anorexia nervosa (AN),
both body mass index (BMI) and anorexia nervosa, however, it is
have developed a steady presence on Twitter. While these commu-
unknown if genetic risk for BMI is associated with unhealthy weight
nities can be beneficial for individuals who are not yet ready or able
control behaviors. The objective of this study was to determine the
to seek professional help, multiple studies have revealed the detri-
association between genetic risk for obesity and weight loss behav-
mental side effects these communities can have on users, such as
iors in young adults.
normalization of maladaptive behaviors, encouragement of behav-
Methods: We analyzed data from the National Longitudinal Study of
iors and sharing new ways to perpetuate behaviors. To date, few
Adolescent to Adult Health (Add Health) when participants were 18-
studies have investigated the ways in which available social media
26 years old. Genetic risk scores included 97 single nucleotide
data from self-identified anorexic individuals could be used to better
polymorphisms identified in published genome-wide association
inform screening, treatment, and follow-up with these individuals.
studies for BMI. Phenotypes included self-reported: 1) weight loss
This study evaluated the ways in which natural language processing
goals; 2) dieting; and 3) “unhealthy weight control behaviors” such
(NLP) and machine learning algorithms, coupled with qualitative
as vomiting, fasting/skipping meals, or laxative/diuretic use to lose
methods, could collect, categorize, and inform clinician insights
weight.
about pro-eating disorder communities.
Results: Among 5728 subjects, genetic risk for obesity was associated
Methods: Twitter crawling algorithms were developed and deployed
with greater odds of weight loss attempts in females (OR 1.21, 95%
through the Twitter API to find tweets based on key words such as:
confidence interval [CI] 1.12-1.30) and males (OR 1.33, 95% CI 1.19-
“ana” “proana” “thinspo” and “meanspo.” This initial corpus of tweets
1.47). Genetic risk for obesity was also associated with greater odds of
containing the identified keywords was then qualitatively assessed to
dieting (females: OR 1.15, 95% CI 1.06-1.26; males: OR 1.30, 95% CI
further refine the algorithmic process of identifying appropriate
1.14-1.48) and unhealthy weight control behaviors (females: OR 1.12,
tweets and removing irrelevant tweets. This process resulted in a
95% CI 1.00-1.24; males: 1.37, 95% CI 1.16-1.63). The adjusted odds
cleaned corpus of 970 unique tweets over a ten-day period. This
ratios for the association between genetic risk for obesity and weight
cleaned dataset was then utilized for NLP to identify common words,
loss attempts decreased (from 1.21 to 1.01 in females, 1.33 to 1.04 in
phrases, and topics. Concurrently, data was hand coded in a thematic
males) after accounting for BMI, suggesting that the relationship may
analysis process to identify deeper themes within the dataset. These
be mediated by BMI.
themes could inform qualitative lines of inquiry as well as machine
Conclusions: Genetic risk for higher BMI was associated with weight
learning systems. Qualitative insights were utilized to improve
loss attempts, dieting, and unhealthy weight control behaviors in
sentiment analysis as well as classification of unstructured data
both males and females; however, this association may be mediated
though a semi-supervised machine learning process.
by BMI. Further research on the genetic risk architecture on BMI and
Results: Analysis revealed that emotional restraint was not present
weight control behaviors may explain treatment nonresponse and
and judgement of one’s self on external standards was present within
inform joint treatment strategies.
these Twitter communities. Additionally, users’ frequently requested
Sources of Support: J.M.N. is a participant in the Pediatric Scientist
“meanspo,” an extension of thinspo that serves as an inspiration for
Development Program (K12HD00085033), funded by the American
thinness by using aggressive and abrasive rhetoric to encourage users
Academy of Pediatrics and the American Pediatric Society, and the
to aspire for thinness. Additionally, posts asking for an “ana buddy,” a
Norman Schlossberger Research Fund from the University of Cali-
partner to help users hold each other accountable to their AN be-
fornia, San Fran
haviors, were extremely common. Additional information about
caloric restrictions, weekly weight loss goals, and a large number of
individuals tweeting from residential treatment for ED about lying 102.
about wanting to get better as a means to be released, as well as
genuine statements about wanting to change. WEIGHT GAIN ATTEMPTS, MUSCLE-BUILDING BEHAVIORS, AND
Conclusions: AN is a complicated disease with multiple causes, side FUTURE WEIGHT CHANGE AMONG YOUNG ADULTS IN THE
effects and comorbid illnesses. This pilot study offers a promising NATIONAL LONGITUDINAL STUDY OF ADOLESCENT TO ADULT
‘first-step’ approach towards understanding the mindset, experi- HEALTH
Jason M. Nagata, MD, MSc 1, Kirsten Bibbins-Domingo, PhD, MD, MAS 1,
ences, and potential gaps within current ED treatment approaches
Andrea K. Garber, PhD, RD 1, Scott Griffiths, PhD 2, Eric Vittinghoff, PhD 1,
from a patient perspective. NLP and ML processes are now developed
Stuart B. Murray, PhD 1
to scan, collect, and analyze this data in an ongoing way to develop 1
new AI processes with the ultimate goal of identifying individuals University of California, San Francisco; 2University of Melbourne.
with a higher likelihood of wanting to enter treatment. Overall, the
present study highlights the benefits of using new available data Purpose: Research on weight gain attempts in young adults is
streams to develop patient-informed comprehensive care models. limited, and has not yet been examined using nationally represen-
Sources of Support: NYU CAMS Undergaduate Internship tative samples in the US. The objectives of this study were 1) to
S54 Research Poster Presentations / Journal of Adolescent Health 64 (2019) S48eS94
determine the prevalence of weight gain attempts, and 2) to identify
their association with BMI and weight change at seven-year follow-
up using a nationally representative sample of young adults.
Methods: We used longitudinal cohort data from Wave III (18-26
years old) and Wave IV (24-32 years old) of the National Longitudinal
Study of Adolescent to Adult Health (Add Health). We analyzed self-
reported weight gain attempts and behaviors at Wave III and
anthropometric data at Waves III and IV to determine BMI and
weight change at seven-year follow-up. Multiple linear regression
analyses were used to determine the association between muscle-
building behaviors and BMI and weight change at seven-year follow-
up, adjusting for race/ethnicity, sex, age, education, smoking, and fast
food consumption.
Results: Of the 15,197 young adults aged 18-26 years old, 26.5% of
young men reported attempts to gain weight, including 39.5% of men
who were normal weight, 21.5% who were overweight, and 7.9% who
were obese by BMI. By contrast, only 4.6% of women reported at-
tempts to gain weight. Young men reported behaviors such as lifting
weights (15.7%); legal performance enhancing substances such as
creatine, monohydrate, and androstenedione (15.7%); and andro-
genic anabolic steroids (2.7%). Multivariate logistic regression ana-
lyses demonstrated that Black/African American males (Odds ratio
[OR] 2.40; 95% confidence interval [CI] 1.84-3.13) had greater odds of
weight gain attempts than White males. Adolescent males identi-
fying as homosexual or bisexual had lower odds (OR 0.46; 95% CI 0.25
e 0.84) of weight gain attempts than adolescent males identifying as
heterosexual. Young men who reported weightlifting to bulk up had
less BMI (B¼ -0.33 kg/m2, p¼0.023) and weight (B¼ -0.87 kg,
p¼0.036) gain at seven-year follow-up compared to those not
reporting weightlifting, adjusting for baseline BMI, race/ethnicity,
sex, age, education, smoking, and fast food. Performance enhancing
substances and anabolic steroids were not associated with BMI or
weight change at seven-year follow-up.
Conclusions: Weight gain attempts and muscle-building behaviors
are common among young men including those who are normal
weight, overweight or obese, African American men, and those self-
identifying as heterosexual. Weightlifting with the intention of
bulking up was associated with less BMI and weight gain at seven-
year follow-up. Future research should examine the long-term health
effects of muscle-building behaviors. Consideration of the unique
nature of male body image and weight gain attempts should be
incorporated into primary care screening for young men.
Sources of Support: J.M.N. is a fellow in the Pediatric Scientist
Development Program (K12HD00085033), funded by the American
Academy of Pediatrics and the American Pediatric Society, and was
supported by the Norman Schlossberger Research Fund from the
University of Californ
103.
WRIST SIZE AMONG ADOLESCENTS WITH RESTRICTIVE EATING
DISORDERS
Radhika Rastogi, BA 1, Alexa Nahra 2, Nicole Neifert 2, Erin H. Sieke, MD,
MS 3, Veronica Issac, MD 2, Ellen S. Rome, MD, MPH 2
1 2 3
Cleveland Clinic Lerner College of Medicine; Cleveland Clinic; The
Children’s Hospital of Philadelphia.
Purpose: Wrist circumference has been proposed as an estimate for
bone frame size among children. Emerging evidence suggests that it
may be informative on metabolic status as well, including risk for
insulin resistance in the pediatric population. However, the utility of
wrist size as a predictor in restrictive eating disorder symptomatology
remains unstudied. The intersection between the two may be signif-
icant given the body dysmorphia that many eating disorder patients
experience. Given that larger wrist sizes may be associated with larger
bone structures and higher body weights, we hypothesized that more
patients with eating disorders would have large bone structures with
greater weight at presentation and longer duration of illness.
Methods: A retrospective chart review was conducted on patients age
10 to 22 years seen at an outpatient subspecialty clinic for disordered
eating between January 2008 and July 2018. Degree of overlap be-
tween pinky and thumb when wrapped around their own wrist was
used to designate wrist size groups. Small was defined as an overlap
between the patient’s pinky and thumb, medium was defined as no
overlap but no space (just touching), and large was defined as a space
between pinky and thumb. The bone structure groups were compared
on presentation characteristics, including weight, height, BMI, and
duration of illness at time of presentation and DSM V eating disorder
diagnosis. Chi square analyses were performed for categorical vari-
ables and ANOVA was performed for continuous variables.
Results: Wrist size data was available on 72 patients (67 girls, 5 boys),
with no differences in the three groups by gender. Among these
patients, 6 (8%) had small wrist size, 33 (46%) had medium, and 33
(46%) had large. A greater proportion of patients with medium wrist
size had anorexia nervosa (67 % small vs. 84% medium vs. 54% large)
and a greater proportion of patients with large wrist size had atypical
anorexia (0% in small vs. 12% in medium vs. 27% large) (p ¼ 0.04).
There was no difference in age at presentation, sex, race, duration of
illness, and BMI at presentation between the groups.
Conclusions: A higher proportion of adolescents presenting with
eating disorders have medium and large bone structures based on wrist
measurement. More youth with large bones presented with atypical
anorexia, with more medium and small boned youth presenting with
anorexia nervosa. Despite greater bone size, neither BMI at presentation
nor duration of illness differed between the large boned versus medium
and small boned groups. These findings suggest that large boned pa-
tients present with greater weight loss in a comparable time period,
since a greater proportion of their body weight would be expected to
come from bone mass. Limitations include our small sample size. Future
studies will assess weight percentile at recovery by bone group, to
determine whether wrist structure predicts target range for weight
restoration in these patients, regardless of prior weight curve.
Sources of Support: None
104.
A MIXED METHODS STUDY ON DISORDERED EATING IN
TRANSGENDER YOUTH
An Pham, MD 1, Hannah Kerman, BA 2, David Inwards-Breland, MD,
MPH 1, Julia Crouch, MPH 1, Katie Albertson, BA 1, Kym Ahrens, MD,
MPH 1
1
Seattle Children’s Hospital; 2Brown University.
Purpose: Research shows that individuals with gender dysphoria have
body dissatisfaction, particularly during puberty. Body dysmorphia and
eating behaviors are closely connected and limited studies have shown
that transgender and gender non-conforming (TGNC) youth are at
higher risk of disordered eating. The purpose of this study is to identify
how often TGNC youth experience disordered eating and determine
whether there are unique factors specific to this population.
Methods: We recruited a sample of TGNC patients from Seattle
Children’s Gender Clinic. To create a gender diverse sample, we