Disordered eating and body dissatisfaction in adolescents with type 1 diabetes and a population-based comparison sample: comparative prevalence and clinical implications

Characteristics of persons with an eating disorder and type 1 diabetes and psychological comparisons with persons with an eating disorder and no diabetes

OBJECTIVES

Describe characteristics of patients who have both an eating disorder and type 1 diabetes and compare their responses on psychological tests with those with an eating disorder and no diabetes at time of initial assessment to an eating disorder facility.

METHOD

A chart audit conducted on all 48 patients with ED-DMT1 who were seen collaboratively by the diabetes and eating disorder treatment teams between 2005 and 2008 at Park Nicollet Health Services and 96 (1:2) matched eating disordered controls.

RESULTS

Diabetes was diagnosed an average of 10.2 years (SD = 9.4) before the diagnosis of an eating disorder; HbA1c at initial assessment was 11% (±3.2%). Those without diabetes reported greater depression (p = .048) and greater state and trait anxiety (p = .015 and p = .039, respectively) at initial assessment.

DISCUSSION

Persons with both an eating disorder and type 1 diabetes were less psychologically compromised than their matched cohorts with an eating disorder only. These findings may not remain constant during the course of treatment.

Body image distortion and three types of weight loss behaviors among nonoverweight girls in the United States

PURPOSE

To examine the relationship between body image distortion (BID) and onset of three types of weight loss behavior among nonoverweight girls in the United States.

METHODS

Data were from the National Longitudinal Study of Adolescent Health (Add Health) (n = 20,745) and included 5,173 nonoverweight (body mass index [BMI] < 85th percentile) adolescent females aged 11-19 years who completed Wave I and II interviews. Actual and perceived weight statuses were compared to assess BID. Logistic regression was used to predict onset of three types of weight loss behaviors at Wave II from BID at Wave I, adjusting for Wave I weight loss behaviors and demographics.

RESULTS

At Wave I, 85% of nonoverweight girls engaged in weight control behaviors, and 29% displayed BID (i.e., overestimation of weight status). When compared to girls without BID, those with BID at Wave I had 4.3 times greater odds of onset of extreme weight loss behavior (e.g., vomiting, laxatives, diet pills) (OR = 4.5, CI = 2.44-7.42) and 2.3 times higher odds of onset of dieting to control weight (OR = 2.30, CI = 1.72-3.06) 1 year later. Girls who practiced extreme weight loss had 10.7 times greater odds of continuing unsafe practices 1 year later than girls who did not (OR = 10.67, CI = 4.27-26.63). BID was unrelated to exercise for weight control.

CONCLUSIONS

BID predicts onset of unsafe, but not safe, weight loss behavior among nonoverweight girls. Brief assessment of BID may help identify nonoverweight girls at risk for unsafe weight loss practices and strengthen prevention efforts.

Brief screening tool for disordered eating in diabetes: internal consistency and external validity in a contemporary sample of pediatric patients with type 1 diabetes

OBJECTIVE To update and validate a diabetes-specific screening tool for disordered eating (the Diabetes Eating Problem Survey [DEPS]) in contemporary youth with type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 112 youth with type 1 diabetes, ages 13-19 years, completed the DEPS. Higher scores on the DEPS indicate more disordered eating behaviors. Youth and their parents also completed additional surveys to examine diabetes-specific family conflict, negative affect related to blood glucose monitoring, youth quality of life, and diabetes burden. Clinicians provided data on height, weight, A1C, and insulin dosing. The DEPS was revised into a shorter, updated measure and validated. RESULTS The revised 16-item DEPS (DEPS-R) displayed excellent internal consistency (Cronbach's alpha = 0.86). Construct validity was demonstrated by positive correlations with zBMI (P = 0.01), A1C (P = 0.001), diabetes-specific family conflict (P < 0.005), youth negative affect around blood glucose monitoring (P = 0.001), parental diabetes-specific burden (P = 0.0005), and negative correlations with frequency of blood glucose monitoring (P = 0.03) and quality of life (P < or = 0.002). External validity was confirmed against clinician report of insulin restriction. CONCLUSIONS The DEPS-R is a 16-item diabetes-specific self-report measure of disordered eating that can be completed in <10 min. It demonstrated excellent internal consistency, construct validity, and external validity in this contemporary sample of youth with type 1 diabetes. Future studies should focus on using the DEPS-R to identify high-risk populations for prevention of and early intervention for disordered eating behaviors.

Self-reported history of overweight and its relationship to disordered eating in adolescent girls with Type 1 diabetes

AIMS

Increased body weight and disordered eating attitudes/behaviours are common in adolescent girls with Type 1 diabetes (T1D). Disordered eating increases risks for diabetes-related complications. This study aimed to identify a rapid screening approach for disordered eating attitudes and behaviours in adolescent girls with T1D and to examine the relationship between disordered eating and body weight in this population.

METHODS

Ninety adolescent girls, aged 12-19 years, provided a self-assessment of weight status. Participants also completed questionnaires to assess attitudes/behaviours toward food and eating, appetitive responsiveness to the food environment, disinhibition in eating and weight history.

RESULTS

Forty-three per cent of participants reported a history of overweight. Compared with participants who reported never being overweight, those who reported ever being overweight were significantly older, scored significantly higher on all measures of disordered eating attitudes/behaviours (P < or = 0.009) and were 4.8 times more likely to be currently overweight or obese (P < 0.001). Glycated haemoglobin (HbA(1c)) was similar between those who did and did not report ever being overweight.

CONCLUSIONS

Because of the ill-health effects of disordered eating and the higher rate of overweight in adolescent girls with T1D, effective screening tools are warranted. The single question 'Have you ever been overweight?' may be sufficient as a first question to screen for those at high risk for disordered eating attitudes/behaviours and to provide early intervention and prevention.