(290) Body Image Insights among adolescents with Cystic Fibrosis in the modulator era

Background: BI in CF has long been an area of interest, with historical focus has been on malnutrition. Effectiveness of modulator therapies has yielded a trend of increasing overweight and obese status in association with improved respiratory and gastrointestinal symptoms[1]. Prior studies suggest higher body image (BI) satisfaction among women with CF in the pre-modulator era[2]; however, established measures (e.g., CFQR) of BI may focus on low weight rather than diverse concerns. We present the results of a QI project where adolescents with CF (ACF) answered questions about BI.

Methods: Patients ≥ age 12 completed two questions about BI (written for our clinic, Table 1) at CF clinic visits. We sought to approach BI broadly given past assessments focused on low weight and BI. Supportive feedback and educational resources were available to all. Patients with scores consistent with BI concerns affecting daily life were encouraged to seek focused intervention. Retrospective chart review was performed. Mann-Whitney tests were used to investigate differences between patient groups.

Results: In the first quarter of screening (n=13), mean response to Q1 was 7.96 (2.34). Respondents were 62% female (n=8) and 38% male (n=5). Average age was 15.76 years (1.45) [12-16]. Mean BMI was at the 53^rd percentile. Mean response to Q2 was 4.64(1.01). Mean body satisfaction score (BSS) among males (8.5) was higher compared to females (7.86). Patients ever having had a gastrostomy tube scored body satisfaction lower (mean=6.63) compared to patients never having one (mean=8.55), with trend towards statistical significance at p< 0.07. Patients on modulator therapy rated body satisfaction significantly lower (mean=7.45) than those not on modulators (mean=9.80) (p=0.05). A trend towards statistical significance (p< 0.07) was seen comparing patients with pancreatic insufficiency (mean=7.68) versus patients with pancreatic sufficient status (mean=9).

Conclusions: As numbers of patients with overweight or obese status have increased with modulator access, our center aimed to reassess BI in our patient population. Our first quarter of data collection suggests regular BI evaluation is feasible and warranted given patient feedback and score variability. Differences in BSS between males and females have been reported[2], thought to be related to preference for lower body weight and historic challenges with weight gain. Our sample showed higher body satisfaction among males, which may support continued gender-skewed weight preference. Whether this pattern persists in a larger sample is of interest, as well as potential association with objective BMI and modulator use. Decreased BI perception in patients with gastrostomy tubes has been reported[3] and may indicate an opportunity for increased support. This population of ACF rated body satisfaction favorably. Screening will be administered on an annual basis, and may allow insight into populations at-risk for BI-related distress, potential interventions, including discussion of attaining ideal body composition in the modulator era to optimize physical and emotional health.

Acknowledgements:

References: [1]Litvin M, Yoon JC.Nutritional excess in cystic fibrosis: the skinny on obesity.J Cyst Fibros Off J Eur Cyst Fibros Soc.2020;19(1):3-5
[2]Tierney S,Body Image.Body image and cystic fibrosis: a critical review.2012 Jan;9(1):12-9
[3]Abbot J,Morton AM, Musson H,et al.Nutritional status, perceived body image and eating behaviours in adults with cystic fibrosis.Clinical Nutrition (2007) 26, 91-99