- Email: [email protected]
170. Associations of Supplement Use and Eating and Exercise Behaviors in University Students
Poster Abstracts / 56 (2015) S85eS129
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Sources of Support: The study was supported in part by LEAH number T71MC00009, MCHB, HRSA, Boston Children’s Hospital Program for Patient Safety and Quality. This study was also supported in part by a grant from the Group Health Foundation in Seattle, Washington.
30s to the upper 40s. These data demonstrate the effectiveness of residential treatment for adolescent patients with eating disorders. Sources of Support: None
168.
MEDIA INFLUENCES BY GENDER AND SEXUAL ORIENTATION AMONG ADOLESCENTS WITH EATING DISORDERS Caroline L. Salas-Humara, MD 1, Zachary McClain, MD 1, Nadia Dowshen, MD 1, Jennifer Carlson, MD 2, James Lock, MD 3, Rebecka Peebles, MD 1.
DEMOGRAPHICS AND OUTCOMES OF ADOLESCENTS WITH EATING DISORDERS TREATED IN RESIDENTIAL CARE Martin Fisher, MD, FSAHM 1, Jennifer R. Henretty, PhD 2, Ronald Feinstein, MD 1, Nadia Saldanha, MD 1, Marcie Schneider, MD, FSAHM 3, Joan Malizio, RN 1, Joanna Stein, MPH 1. 1
North Shore - Long Island Jewish Health System; 2Center for Discovery; 3Greenwich Adolescent Medicine.
Purpose: Patients with eating disorders receive care in several types of settings, depending on the level of care they require. These include out-patient, intensive out-patient (IOP), day program/ partial hospitalization, residential, and in-patient care on a medical or psychiatric unit. While there have been studies that have described the demographics and outcomes of patients treated as in-patients or out-patients, there have been almost no studies describing patients who have been treated in residential facilities. The purpose of this study was to describe the demographics and outcomes of the female adolescents treated in the 10 residential facilities of the Center for Discovery (in California, Washington, and Connecticut) over an 8 year period. Methods: Data was collected on admission and discharge of all patients treated in each of the Center for Discovery facilities from 2006 through 2013. The data were entered into a database in 2014 and descriptive statistics were calculated from the first admission for all patients (n¼1501) and for a subgroup of 759 patients who met the inclusion criteria for this report (female, <18 years of age, and in treatment for 2 weeks). Results: The 759 adolescent patients were 10-17 (mean 15.2 1.6) years of age and in treatment at the facilities for 14-205 (mean 51.8 25.8) days. Diagnoses were categorized as anorexia nervosarestricting type (AN-R, n¼309) anorexia nervosa e purging type (AN-P, n¼117), bulimia nervosa (BN, n¼244), eating disorder not otherwise specified (EDNOS, n¼88) and binge eating disorder (BED, n¼1). The 426 patients with anorexia nervosa (AN-R and AN-P) had a mean body mass index (BMI) of 16.6 and mean % ideal body weight (IBW) of 83.4% on admission and a mean BMI of 18.9 and mean % IBW of 94.7% on discharge. Patients with AN gained a mean of 13.63 pounds in the program. The 361 patients with purging disorders (BN and AN-P) were reported to be purging a mean of 3.25 times per day on admission and 0.02 times per day on discharge, for the prior 30 days. The 759 total patients had a mean of 1.0 in-patient admissions and 0.6 residential/partial/IOP admissions prior to treatment at the facilities and 90% had received out-patient treatment. The mean Global Assessment of Functioning (GAF) Score for the 759 patients was 35.3 (9.1) on admission and 48.7 (10.1) on discharge; the GAF scores did not differ statistically by diagnosis. Conclusions: This study population of 759 adolescent females treated in the residential facilities of the Center for Discovery between 2006 and 2013 had a mean length of stay of 7 ½ weeks. Those with anorexia nervosa increased their mean BMI from 16.6 to 19.9 and mean % IBW from 83.4% to 94.7% while those with purging disorders decreased their purging from 3.25 to 0.02 times per day. Mean GAF scores for all patients increased from the mid
169.
1
Children’s Hospital of Philadelphia; 2Lucile Packard Children’s Hospital Mountain View; 3Stanford University School of Medicine.
Purpose: The purpose of this study is to determine if adolescent sexual minority youth (SMY) with ED are more influenced by images in the media than their heterosexual counterparts. Methods: ED adolescents ages 12-19y (mean 16.2) were recruited at an academic referral center; independent variables were sexual orientation (sexual minority defined as gay, lesbian, bisexual, or questioning) and gender. Outcomes were dichotomized answers to questions about media influences on body image from the Project EAT survey (Neumarck-Szteiner et al.). Descriptive, Chi-square, and ANOVA testing were performed using SPSS v20. Results: Subjects (n¼164; 21M, 143F) reported a mean of 16.1 months of disease and averaged 86% median body weight. Anorexia nervosa was diagnosed in 39% (n¼64), 7% (n¼12) had bulimia nervosa, and 54% (n¼88) had EDNOS. Sexual minorities comprised 8.8% (n¼21; 4M,10F) of the study population. Overall, heterosexual youth trended toward being more likely to compare their bodies to look like people on TV than SMY (71.5% vs 50%, p¼0.095). Heterosexual females reported comparing their bodies to those of TV and movie stars more than heterosexual males (70.3% vs 35.3%, p¼0.004), but there were not significant differences in media influences when comparing within genders by sexual orientation. Conclusions: In this clinical sample of youth with ED, SMY did not report more media influences on their body image than heterosexual youth, and, in fact, results trended to show that heterosexual youth compared their bodies to those in the media more. This difference is in contrast to what has been reported in community-based studies of youth with eating disorder symptoms. Additionally, heterosexual females reported more media comparisons than heterosexual males. These results demonstrate the need for further exploration of the relationship between gender and media pressure among youth with eating disorders. Sources of Support: The parent study was funded by the American Heart Association. 170. ASSOCIATIONS OF SUPPLEMENT USE AND EATING EXERCISE BEHAVIORS IN UNIVERSITY STUDENTS Jennifer Carlson, MD, FSAHM 1, Anna Greer, BA 2, Katherine Bell Hill, MD 1, James Lock, MD, PhD 1, Rebecka Peebles, MD 3.
AND
1
Stanford University School of Medicine; 2University of Washington School of Medicine; 3The Childrens Hospital of Philadelphia.
Purpose: Athletes have long been found to use ergogenic supplements to enhance their athletic performance, but few studies have looked at supplement use across different levels of physical activity. This study sought to describe supplement use in university
S88
Poster Abstracts / 56 (2015) S85eS129
students and characterize some of the health habits of supplement users. Methods: University students were recruited through a social media site to complete an on-line questionnaire examining athletics and health. Questions included current and ever-use of specific supplements, athletic activities, eating behaviors, and the Eating Disorder Examination Questionnaire (EDEQ). Results were analyzed with chi-squared and t-test statistics. Results: 1637 students (973F, 661M) with a mean age of 20.8 years completed the questionnaire. Student’s levels of activity were: 10.1% sedentary (S), 30.7% recreational exerciser (RE), 24.6% competitive exerciser (CE), and 34.6% competitive and recreational exerciser (CRE). Overall, 15.2% F and 38.9% M currently used a supplement; 24.2% F and 56.1% M had ever used a supplement. For specific supplement use rates see supplemental table attached. Male users were more likely to be involved with increased exercise than nonusers (CRE: 47.1% vs 33.2%, CE: 25.7% vs 26.5%, RE: 21.0% vs 25.7%, S: 6.2% vs 14.6%, p<.001). Females did not demonstrate any difference based on activity level (CRE: 34.5% vs 31.5%, CE: 24.3% vs 23.4%, RE: 34.5% vs 35.5%, S: 6.8% vs 9.6%, p¼.68). When comparing current users and nonusers, female users were more likely to have reported bingeing/purging/laxative use in the prior month (F: 53.4% vs 46.6%, p¼.02; M: 29.2% vs 28.6%, p¼.86). Male users were more likely to report driven/compelled exercise than nonusers (M:83.3% vs 68.5%, p<.001, F: 77.7% vs 73.5%, p¼.28). For EDEQ scores and subscales, both male and female users had higher scores than nonusers (EDEQ-Restraint: M 1.3(1.3) vs 0.8 (1.1), p<.001, F 1.9(1.5) vs 1.6(1.5), p¼.02; EDEQ-Shape Concern: M 1.4(1.3) vs 1.1(1.2), p¼.002, F 2.8(1.6) vs 2.3(1.6), p¼.003; EDEQ-Global: M 1.0(0.9) vs 0.7(0.9), p<.001, F 2.0(1.3) vs 1.7(1.3), p¼.028). Conclusions: Ergogenic supplements are used at high rates by university students and are often associated with other unhealthy weight management practices or weight concerns. While rates and behaviors differ between genders, users appear to be of all physical activity levels. Sources of Support: Stanford University Undergraduate Research Program. 171. WEIGHT-RELATED COACHING PRESSURES, MENTAL HEALTH, SLEEP, AND QUALITY OF LIFE IN COMPETITIVE UNIVERSITY ATHLETES Courtney Alexandra Cheek, BS 1, Katherine Hill, BA 2, Jennifer Carlson, MD 2, James Lock, MD, PhD 2, Rebecka Peebles, MD 2. 1 The Children’s Hospital of Philadelphia; 2Stanford University School of Medicine.
Purpose: Competitive collegiate athletes are burdened with expectations for high physical and mental performance. Coaches can be important and healthy influences, but can also pressure athletes to achieve certain weight and shape standards. Little is known about how weight-related coaching pressures may relate to mental health, sleep, and quality of life. This study examines weightrelated coaching pressures and mental health, sleep, and quality of life. Competitive university athletes (432M, 543F), from ten NCAAranked schools were recruited to complete an online survey examining athletics and health. Methods: Participants were classified as athletes if they participated in a competitive sport within the last 12 months. Predictors were overt coaching pressures (OVCP: asked by coach to lose
weight, prescribed a diet, or benched due to weight/body fat too high). Outcomes were the CDC Core Healthy Days and Project EAT-II. Results: 31% (130M, 172F) of athletes reported OVCP. OVCP athletes were more likely than non-OVCP athletes to report that in the past month they had poor mental health (6 v 4, p¼0.019), more days they were unable to do their usual activities due to poor health (3 v 2, p¼0.013), more days with pain that kept them from their usual activities (3 v 2, p¼0.024), and more days they did not get enough sleep (12 v 10, p¼0.003). Compared to non-OVCP athletes, athletes reporting OVCP were also more likely to have felt very much bothered or troubled in the past year by symptoms of depression (23.5% v 15.5%, p¼0.002), hopelessness (16.2% v 9.8%, p¼0.004), nervousness (22.2% v 15.6%, p¼0.013), worry (31.1% v 22.1%, p¼0.003), fatigue, (27.5% v 16.2%, p<0.001), trouble sleeping (44.4% v 34.8%, p¼0.009), and appetite changes (10.9% v 5.9%, p<0.001). Conclusions: Future research should focus on reducing overt coaching pressures in athletes, as well as further examining relationship between coaching pressures and athletes stress levels, depressive symptoms, anxiety, and loss of sleep. Sources of Support: This research was supported by the Stanford Undergraduate Research Fund. 172. USE OF AN EMR-BASED CARE PATH FOR NUTRITIONAL INSUFFICIENCY: HOW QUICKLY CAN WE SAFELY STABILIZE THEM? Erin H. Sieke, BA 1, Sarah Strandjord, BS 1, Miranda Richmond 2, Sarah Worley, MS 3, Ellen S. Rome, MD, MPH 3. 1
Cleveland Clinic Lerner College of Medicine; 2Case Western Reserve University; 3Cleveland Clinic Foundation.
Purpose: Care paths have been shown to improve treatment outcomes in illnesses such as asthma, but little data exists on the effectiveness of a standardized protocol for inpatient medical treatment of patients with nutritional insufficiency (NI) due to disordered eating. This study examined treatment outcomes following the implementation of a standardized inpatient care path for nutritional insufficiency using an electronic medical record (EMR). We compared patient outcomes in the years immediately following implementation (2005e2008) to the most recent admissions in 2013 and 2014. Methods: A retrospective chart review of patients treated on the EMR implemented NI Care Path at the Cleveland Clinic from June 2005eJune 2008 and May 2013eAugust 2014. Treatment outcomes included length of stay, change in percent median body weight, time to resolution of medical instabilities, and calorie level at initiation of the nutritional insufficiency protocol. Data was collected for 50 patients in 2005e2008 and 49 patients in 2013e2014 presenting for medical stabilization of nutritional insufficiency. The 2005-2008 and 2013-2014 cohorts were compared on demographic and clinical characteristics and on treatment outcomes using Chi-square and Fisher Exact tests for categorical characteristics, and t-tests or Wilcoxon rank sum tests for continuous characteristics. Results: Subjects (n¼81; 16% male) patients were admitted 99 times, with 18% of hospital stays being readmissions for NI. At admission, subjects had an average percent median body weight of 85.3% (59.7 e 120.4%), which did not differ between the two cohorts. Anorexia nervosa was diagnosed in 79% of patients (n¼64, 11% male), atypical anorexia nervosa in 1% (n¼1, 0% male), bulimia
S87
Sources of Support: The study was supported in part by LEAH number T71MC00009, MCHB, HRSA, Boston Children’s Hospital Program for Patient Safety and Quality. This study was also supported in part by a grant from the Group Health Foundation in Seattle, Washington.
30s to the upper 40s. These data demonstrate the effectiveness of residential treatment for adolescent patients with eating disorders. Sources of Support: None
168.
MEDIA INFLUENCES BY GENDER AND SEXUAL ORIENTATION AMONG ADOLESCENTS WITH EATING DISORDERS Caroline L. Salas-Humara, MD 1, Zachary McClain, MD 1, Nadia Dowshen, MD 1, Jennifer Carlson, MD 2, James Lock, MD 3, Rebecka Peebles, MD 1.
DEMOGRAPHICS AND OUTCOMES OF ADOLESCENTS WITH EATING DISORDERS TREATED IN RESIDENTIAL CARE Martin Fisher, MD, FSAHM 1, Jennifer R. Henretty, PhD 2, Ronald Feinstein, MD 1, Nadia Saldanha, MD 1, Marcie Schneider, MD, FSAHM 3, Joan Malizio, RN 1, Joanna Stein, MPH 1. 1
North Shore - Long Island Jewish Health System; 2Center for Discovery; 3Greenwich Adolescent Medicine.
Purpose: Patients with eating disorders receive care in several types of settings, depending on the level of care they require. These include out-patient, intensive out-patient (IOP), day program/ partial hospitalization, residential, and in-patient care on a medical or psychiatric unit. While there have been studies that have described the demographics and outcomes of patients treated as in-patients or out-patients, there have been almost no studies describing patients who have been treated in residential facilities. The purpose of this study was to describe the demographics and outcomes of the female adolescents treated in the 10 residential facilities of the Center for Discovery (in California, Washington, and Connecticut) over an 8 year period. Methods: Data was collected on admission and discharge of all patients treated in each of the Center for Discovery facilities from 2006 through 2013. The data were entered into a database in 2014 and descriptive statistics were calculated from the first admission for all patients (n¼1501) and for a subgroup of 759 patients who met the inclusion criteria for this report (female, <18 years of age, and in treatment for 2 weeks). Results: The 759 adolescent patients were 10-17 (mean 15.2 1.6) years of age and in treatment at the facilities for 14-205 (mean 51.8 25.8) days. Diagnoses were categorized as anorexia nervosarestricting type (AN-R, n¼309) anorexia nervosa e purging type (AN-P, n¼117), bulimia nervosa (BN, n¼244), eating disorder not otherwise specified (EDNOS, n¼88) and binge eating disorder (BED, n¼1). The 426 patients with anorexia nervosa (AN-R and AN-P) had a mean body mass index (BMI) of 16.6 and mean % ideal body weight (IBW) of 83.4% on admission and a mean BMI of 18.9 and mean % IBW of 94.7% on discharge. Patients with AN gained a mean of 13.63 pounds in the program. The 361 patients with purging disorders (BN and AN-P) were reported to be purging a mean of 3.25 times per day on admission and 0.02 times per day on discharge, for the prior 30 days. The 759 total patients had a mean of 1.0 in-patient admissions and 0.6 residential/partial/IOP admissions prior to treatment at the facilities and 90% had received out-patient treatment. The mean Global Assessment of Functioning (GAF) Score for the 759 patients was 35.3 (9.1) on admission and 48.7 (10.1) on discharge; the GAF scores did not differ statistically by diagnosis. Conclusions: This study population of 759 adolescent females treated in the residential facilities of the Center for Discovery between 2006 and 2013 had a mean length of stay of 7 ½ weeks. Those with anorexia nervosa increased their mean BMI from 16.6 to 19.9 and mean % IBW from 83.4% to 94.7% while those with purging disorders decreased their purging from 3.25 to 0.02 times per day. Mean GAF scores for all patients increased from the mid
169.
1
Children’s Hospital of Philadelphia; 2Lucile Packard Children’s Hospital Mountain View; 3Stanford University School of Medicine.
Purpose: The purpose of this study is to determine if adolescent sexual minority youth (SMY) with ED are more influenced by images in the media than their heterosexual counterparts. Methods: ED adolescents ages 12-19y (mean 16.2) were recruited at an academic referral center; independent variables were sexual orientation (sexual minority defined as gay, lesbian, bisexual, or questioning) and gender. Outcomes were dichotomized answers to questions about media influences on body image from the Project EAT survey (Neumarck-Szteiner et al.). Descriptive, Chi-square, and ANOVA testing were performed using SPSS v20. Results: Subjects (n¼164; 21M, 143F) reported a mean of 16.1 months of disease and averaged 86% median body weight. Anorexia nervosa was diagnosed in 39% (n¼64), 7% (n¼12) had bulimia nervosa, and 54% (n¼88) had EDNOS. Sexual minorities comprised 8.8% (n¼21; 4M,10F) of the study population. Overall, heterosexual youth trended toward being more likely to compare their bodies to look like people on TV than SMY (71.5% vs 50%, p¼0.095). Heterosexual females reported comparing their bodies to those of TV and movie stars more than heterosexual males (70.3% vs 35.3%, p¼0.004), but there were not significant differences in media influences when comparing within genders by sexual orientation. Conclusions: In this clinical sample of youth with ED, SMY did not report more media influences on their body image than heterosexual youth, and, in fact, results trended to show that heterosexual youth compared their bodies to those in the media more. This difference is in contrast to what has been reported in community-based studies of youth with eating disorder symptoms. Additionally, heterosexual females reported more media comparisons than heterosexual males. These results demonstrate the need for further exploration of the relationship between gender and media pressure among youth with eating disorders. Sources of Support: The parent study was funded by the American Heart Association. 170. ASSOCIATIONS OF SUPPLEMENT USE AND EATING EXERCISE BEHAVIORS IN UNIVERSITY STUDENTS Jennifer Carlson, MD, FSAHM 1, Anna Greer, BA 2, Katherine Bell Hill, MD 1, James Lock, MD, PhD 1, Rebecka Peebles, MD 3.
AND
1
Stanford University School of Medicine; 2University of Washington School of Medicine; 3The Childrens Hospital of Philadelphia.
Purpose: Athletes have long been found to use ergogenic supplements to enhance their athletic performance, but few studies have looked at supplement use across different levels of physical activity. This study sought to describe supplement use in university
S88
Poster Abstracts / 56 (2015) S85eS129
students and characterize some of the health habits of supplement users. Methods: University students were recruited through a social media site to complete an on-line questionnaire examining athletics and health. Questions included current and ever-use of specific supplements, athletic activities, eating behaviors, and the Eating Disorder Examination Questionnaire (EDEQ). Results were analyzed with chi-squared and t-test statistics. Results: 1637 students (973F, 661M) with a mean age of 20.8 years completed the questionnaire. Student’s levels of activity were: 10.1% sedentary (S), 30.7% recreational exerciser (RE), 24.6% competitive exerciser (CE), and 34.6% competitive and recreational exerciser (CRE). Overall, 15.2% F and 38.9% M currently used a supplement; 24.2% F and 56.1% M had ever used a supplement. For specific supplement use rates see supplemental table attached. Male users were more likely to be involved with increased exercise than nonusers (CRE: 47.1% vs 33.2%, CE: 25.7% vs 26.5%, RE: 21.0% vs 25.7%, S: 6.2% vs 14.6%, p<.001). Females did not demonstrate any difference based on activity level (CRE: 34.5% vs 31.5%, CE: 24.3% vs 23.4%, RE: 34.5% vs 35.5%, S: 6.8% vs 9.6%, p¼.68). When comparing current users and nonusers, female users were more likely to have reported bingeing/purging/laxative use in the prior month (F: 53.4% vs 46.6%, p¼.02; M: 29.2% vs 28.6%, p¼.86). Male users were more likely to report driven/compelled exercise than nonusers (M:83.3% vs 68.5%, p<.001, F: 77.7% vs 73.5%, p¼.28). For EDEQ scores and subscales, both male and female users had higher scores than nonusers (EDEQ-Restraint: M 1.3(1.3) vs 0.8 (1.1), p<.001, F 1.9(1.5) vs 1.6(1.5), p¼.02; EDEQ-Shape Concern: M 1.4(1.3) vs 1.1(1.2), p¼.002, F 2.8(1.6) vs 2.3(1.6), p¼.003; EDEQ-Global: M 1.0(0.9) vs 0.7(0.9), p<.001, F 2.0(1.3) vs 1.7(1.3), p¼.028). Conclusions: Ergogenic supplements are used at high rates by university students and are often associated with other unhealthy weight management practices or weight concerns. While rates and behaviors differ between genders, users appear to be of all physical activity levels. Sources of Support: Stanford University Undergraduate Research Program. 171. WEIGHT-RELATED COACHING PRESSURES, MENTAL HEALTH, SLEEP, AND QUALITY OF LIFE IN COMPETITIVE UNIVERSITY ATHLETES Courtney Alexandra Cheek, BS 1, Katherine Hill, BA 2, Jennifer Carlson, MD 2, James Lock, MD, PhD 2, Rebecka Peebles, MD 2. 1 The Children’s Hospital of Philadelphia; 2Stanford University School of Medicine.
Purpose: Competitive collegiate athletes are burdened with expectations for high physical and mental performance. Coaches can be important and healthy influences, but can also pressure athletes to achieve certain weight and shape standards. Little is known about how weight-related coaching pressures may relate to mental health, sleep, and quality of life. This study examines weightrelated coaching pressures and mental health, sleep, and quality of life. Competitive university athletes (432M, 543F), from ten NCAAranked schools were recruited to complete an online survey examining athletics and health. Methods: Participants were classified as athletes if they participated in a competitive sport within the last 12 months. Predictors were overt coaching pressures (OVCP: asked by coach to lose
weight, prescribed a diet, or benched due to weight/body fat too high). Outcomes were the CDC Core Healthy Days and Project EAT-II. Results: 31% (130M, 172F) of athletes reported OVCP. OVCP athletes were more likely than non-OVCP athletes to report that in the past month they had poor mental health (6 v 4, p¼0.019), more days they were unable to do their usual activities due to poor health (3 v 2, p¼0.013), more days with pain that kept them from their usual activities (3 v 2, p¼0.024), and more days they did not get enough sleep (12 v 10, p¼0.003). Compared to non-OVCP athletes, athletes reporting OVCP were also more likely to have felt very much bothered or troubled in the past year by symptoms of depression (23.5% v 15.5%, p¼0.002), hopelessness (16.2% v 9.8%, p¼0.004), nervousness (22.2% v 15.6%, p¼0.013), worry (31.1% v 22.1%, p¼0.003), fatigue, (27.5% v 16.2%, p<0.001), trouble sleeping (44.4% v 34.8%, p¼0.009), and appetite changes (10.9% v 5.9%, p<0.001). Conclusions: Future research should focus on reducing overt coaching pressures in athletes, as well as further examining relationship between coaching pressures and athletes stress levels, depressive symptoms, anxiety, and loss of sleep. Sources of Support: This research was supported by the Stanford Undergraduate Research Fund. 172. USE OF AN EMR-BASED CARE PATH FOR NUTRITIONAL INSUFFICIENCY: HOW QUICKLY CAN WE SAFELY STABILIZE THEM? Erin H. Sieke, BA 1, Sarah Strandjord, BS 1, Miranda Richmond 2, Sarah Worley, MS 3, Ellen S. Rome, MD, MPH 3. 1
Cleveland Clinic Lerner College of Medicine; 2Case Western Reserve University; 3Cleveland Clinic Foundation.
Purpose: Care paths have been shown to improve treatment outcomes in illnesses such as asthma, but little data exists on the effectiveness of a standardized protocol for inpatient medical treatment of patients with nutritional insufficiency (NI) due to disordered eating. This study examined treatment outcomes following the implementation of a standardized inpatient care path for nutritional insufficiency using an electronic medical record (EMR). We compared patient outcomes in the years immediately following implementation (2005e2008) to the most recent admissions in 2013 and 2014. Methods: A retrospective chart review of patients treated on the EMR implemented NI Care Path at the Cleveland Clinic from June 2005eJune 2008 and May 2013eAugust 2014. Treatment outcomes included length of stay, change in percent median body weight, time to resolution of medical instabilities, and calorie level at initiation of the nutritional insufficiency protocol. Data was collected for 50 patients in 2005e2008 and 49 patients in 2013e2014 presenting for medical stabilization of nutritional insufficiency. The 2005-2008 and 2013-2014 cohorts were compared on demographic and clinical characteristics and on treatment outcomes using Chi-square and Fisher Exact tests for categorical characteristics, and t-tests or Wilcoxon rank sum tests for continuous characteristics. Results: Subjects (n¼81; 16% male) patients were admitted 99 times, with 18% of hospital stays being readmissions for NI. At admission, subjects had an average percent median body weight of 85.3% (59.7 e 120.4%), which did not differ between the two cohorts. Anorexia nervosa was diagnosed in 79% of patients (n¼64, 11% male), atypical anorexia nervosa in 1% (n¼1, 0% male), bulimia