Diabetes and disordered eating behaviours in a community-based sample of Australian adolescents

Abstract

Background: People with diabetes have been shown to be at risk for disordered eating compared to their nondiabetic peers. However, the majority of studies have been conducted in relatively small samples drawn from clinical diabetes settings or registries. Community-based samples are required to better understand disordered eating behaviours in this population. In a large community-based population sample of Australian adolescents, this study aimed to (1) investigate disordered eating behaviours in adolescents reporting a diagnosis of diabetes compared to their non-diabetic peers and (2) test associations between disordered eating behaviours and insulin restriction. Methods: Secondary school students (n = 4854; mean (SD) age 14.4 (1.6) years; 47% boys) completed an online survey, including self-reported presence of diabetes, demographics, weight status, substance use, insulin restriction and disordered eating behaviours. Clinically meaningful cutoffs for disordered eating behaviours were generated for analysis. Results: Disordered eating behaviours, specifically self-induced vomiting (diabetes 19.2%, no diabetes 3.3%; p < 0.001), laxative use (diabetes 15.4%, no diabetes 2.1%; p < 0.001), use of cigarettes (diabetes 26.9%, no diabetes 4.3%; p < 0.001) and other drugs (diabetes 28.9%, no diabetes 4.0%; p < 0.001), cleanse/detox (diabetes 30.8%, no diabetes 10.5%; p < 0.001) and extreme weight loss diets (diabetes 13.5%, no diabetes 4.7%; p < 0.003) were higher in those reporting a diagnosis of diabetes. In addition, 17% of those with diabetes reported frequent insulin restriction (≥ once per week), and insulin restriction was associated with more frequent disordered eating behaviours. Conclusion: There was a high rate of disordered eating behaviours in adolescents with diabetes compared to their peers without diabetes. The findings of this study may have the potential to inform future health promotion, prevention, and early intervention approaches for those with comorbid diabetes and disordered eating behaviours. Future longitudinal studies are required to evaluate disordered eating behaviours in those with diabetes over time in community-based samples.

Obsessed with Healthy Eating: A Systematic Review of Observational Studies Assessing Orthorexia Nervosa in Patients with Diabetes Mellitus

“…ON is problematic, but is also seen as a "salvation" from chronic diseases. Women with DM in particular tend to be more preoccupied with their diet and body weight, demonstrating a greater frequency and severity of EDs [13,57]. Weight status appears to be a strong predictor of EDs, especially among women with overweight/obesity attempting to lose weight [10,58].…”

“…It was first described by Bratman [2] as an exaggerated, unhealthy obsession with healthy eating. The difference Nutrients 2021, 13,3823 2 of 14 between adhering to healthy eating principles versus ON is that, in the latter case, the affected individual might be driven by dietary asceticism, cherry-picked evidence, or even by evidence-based recommendations, leading to a restrictive dietary pattern in pursuit of improved health [3]. Moreover, ON often has an underlying psychopathology, with a frequent overlap of symptoms between ON and anorexia nervosa (AN), obsessivecompulsive disorder (OCD), somatic symptom disorder, illness anxiety disorder, and psychotic spectrum disorders [4], leading to the development of ON as a manifestation of "healthism" [5].…”

“…Overall, it appears that EDs often coincide with DM, leading to "corrective" practices such as the use of laxatives or diuretics, bingeing, vomiting [13], engaging in excessive exercise [14], and even withholding insulin [15]; this is referred to as diabulimia [16][17][18]. Moreover, in a population of patients with T1DM and EDs, 93.8% reported being diagnosed with DM before their ED diagnosis, suggesting a increasing psychopathology as a possible epiphenomenon of DM diagnoses among ED-prone individuals [14,19].…”

Reconsidering a role for attachment in eating disorder management in the context of paediatric diabetes

“…Eating disorders and disordered eating are more common in individuals with diabetes compared to the general population. In one recent study (Pursey et al, 2020) which surveyed secondary school students, disordered eating behaviours were considerably more common in individuals with diabetes (13.5%) compared to without diabetes (4.7%), though the authors did not distinguish between type 1 and type 2 diabetes. It is worth noting that while type 1 diabetes (an autoimmune condition leading to lack of insulin production) has historically been far more common in paediatric patients, the prevalence of type 2 diabetes (associated with modifiable lifestyle factors as well as genetic factors, and leading to insulin resistance rather than lack of production) is steadily increasing (Botero & Wolfsdorf, 2005).…”

A multidisciplinary team approach to screening, assessment and early intervention for young people with type 1 diabetes and disordered eating behaviour

“…However, the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-V) (American Psychiatric Association, 2013) classifies insulin omission as a purging behaviour that can be associated with a diagnosis of Bulimia Nervosa when present alongside binge eating, or Anorexia Nervosa if the person is severely restricting both food and insulin. A recent large scale study found 17% of young people questioned reported insulin restriction (Pursey et al, 2020) whilst other studies suggest that up to 40% of young people with T1D have used insulin manipulation for weight loss (Pinhas-Hamiel et al, 2015). This behaviour is a particular concern for those caring for young people with T1D due to the significant negative impact it can have on health and increased mortality rates (Peveler et al, 2005).…”