Objective: Adolescents and young adults with type 1 diabetes (T1D) demonstrate high rates of disordered eating behaviors (DEBs) and may experience physiological and psychological vulnerabilities not currently included in established risk models of DEBs. This study examined associations among constructs included in the recently proposed T1D-specific modified dual pathway model and examined age as a moderator of these associations.Method: Participants included adolescents (n = 307; age M = 15.71, SD = 1.33), young adults (n = 313; age M = 21.20, SD = 2.10), and adults (n = 198; age M = 30.51, SD = 2.81) recruited via the T1D Exchange Clinic Registry. Data were collected from participants' medical records and from self-report questionnaires assessing dietary regimen, dietary restraint, body dissatisfaction, hunger/satiety, diabetes-specific negative affect, and DEBs. Multiple group path modeling was used to test hypotheses.Results: Approximately 31% of participants were at risk for an eating disorder. The original modified dual pathway model had poor model fit. The addition of three empirically defensible paths improved model fit. Diabetes-specific dietary regimen, diabetes-specific negative affect, and hunger/satiety disruption all were associated with DEBs. A fully varying multiple group model by age fit best; however, only the dietary restraint to DEBs pathway demonstrated a distinct pattern across age cohort, which attenuated from the adolescent to the adult cohort.Discussion: This study provides preliminary support for associations proposed in the modified dual pathway model and suggests potential for intervening on diseasespecific risk factors of DEBs in a T1D population.
K E Y W O R D Sadolescent, eating disorder, hunger, type 1 diabetes, young adult
Summary
Implicit and explicit weight bias is prevalent among healthcare professionals and results in negative outcomes, including weak physician‐patient rapport, low patient trust in physicians, and avoidance of healthcare. This study aimed to decrease weight bias in medical students via a one‐session, curriculum‐based intervention founded on the elaboration likelihood model (ELM). First‐year medical students (N = 101) were quasi‐randomly assigned to a group‐based experimental or education‐based control intervention. Data collected included measures of implicit and explicit weight bias and empathy (pre‐intervention and up to 2 days post‐intervention), and thoughts regarding weight bias (collected at the end of the intervention). Social desirability was identified as an important covariate. After controlling for social desirability, the intervention group showed no greater reduction in multi‐item explicit bias rating scales or a computerized implicit bias task than the control group. Both groups showed less discomfort when near individuals with obesity (p < 0.01). The intervention group wrote a greater number of statements about weight bias and obesity (p < 0.05) and a greater number of statements about the harms of weight bias (p < 0.001) than the control group on a thought‐listing task. Results highlight use of the ELM and the importance of controlling for social desirability in weight bias interventions. A thought‐listing task captured unique intervention effects, highlighting potential gaps in the assessment of weight bias.
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