159. Eating Disorder Outpatient Clinic Outcomes Among an LGBTQ-Identifying Adolescent and Young Adult Sample

Abstract

Recent literature suggests that adolescents and young adults (AYA) who identify as LGBTQ may be at unique risk for developing eating disordered (ED) behaviors. A quality improvement-related retrospective chart review of an Adolescent Medicine outpatient ED program explored outcomes, including in patients who identify as LGBTQ. The goal of articulating outcomes specifically in the LGBTQ population was to highlight features that may improve early identification and management of ED in gender minority AYA in the ED program but also in the broader community. The IRB-approved retrospective chart review was conducted on a randomly selected population of active AYA patients in a medical ED clinic. Data collected included demographics, several items related to sexual identity and sexuality, types of ED behavior, co-morbid psychiatric illness, and past ED treatment setting(s). For each chart reviewed, data was collected from visits conducted 6 months apart for up to 36 months after the initial visit. Information was collected, de-identified, and stored in REDCap. A descriptive analysis was conducted. Sixty-eight (11%) of the total 623 active patient charts were reviewed. Among participants, 13 (19%) identified as LBGTQ. Of these, 8 identified as female, 2 identified as male, and 3 identified as non-binary; 4 were not cis-gender; 2 were receiving gender affirming care. All patients reported restriction; 8 reported additional ED behaviors including vomiting (54%), excessive exercise (38%), calorie counting (23%), binge eating (15%), and weight loss pills/supplements (8%). None had any ED treatment prior to establishing with the clinic. Two (15%) patients did not engage in longitudinal care with the ED program (1 terminated care in <1 month and 1 had 2 visits over a year apart). Over the course of time in treatment, 4 patients (31%) required a higher level of ED care beyond outpatient support: 3 (23%) enrolled in a partial hospital, and 1 (8%) was admitted to the medical inpatient unit. Eleven patients (85%) had follow-up 4-7 months after establishing care, at which point 1(9%) had achieved goal weight; 4 (36%) had gained weight; 1 (9%) had maintained weight below goal; and 2 (18%) had lost weight. Seven patients (54%) had follow-up 11-13 months after establishing care: 1 (14%) had reached goal weight; 3 (43%) had gained weight; 1 (14%) maintained weight; 1 (14%) lost weight; and 1 (14%) had a non-linear weight trajectory. Of the two patients who received gender-affirming care, both achieved goal weight after starting gender-affirming care. After beginning this care, one achieved goal weight within three months and one achieved goal weight within a year. Both maintained their goal weight after reaching it. Gender minority adolescents with ED may benefit from earlier intervention and management when both ED and gender-treating providers are aware of patterns of ED presentation. Despite the small sample size, this study identifies demographics, ED behaviors, and weight change over time among LGBTQ patients in a medical ED clinic. Further research is needed to identify and better understand unique features of ED presentation and trajectory among LGBTQ-identifying AYA.