Prediction of the Onset of Disturbed Eating Behavior in Adolescent Girls With Type 1 Diabetes

Abstract

OBJECTIVE -The purpose of this study was to identify predictors of the onset of disturbed eating behavior (DEB) in adolescent girls with type 1 diabetes.RESEARCH DESIGN AND METHODS -In this prospective study, participants completed the Children's Eating Disorder Examination interview and self-report measures at baseline and at four follow-up assessments over 5 years. Participants were 126 girls with type 1 diabetes, aged 9 -13 years at baseline. Of the 101 girls who did not have DEB at baseline, 45 developed DEB during the follow-up period; the 38 for whom data were available for the assessment before onset of DEB were compared with 38 age-matched girls who did not develop DEB. DEB was defined as dieting for weight control, binge eating, self-induced vomiting, or the use of diuretics, laxatives, insulin omission, or intense exercise for weight control.RESULTS -Logistic regression indicated that a model including BMI percentile, weight and shape concern, global and physical appearance-based self-worth, and depression was significantly associated with DEB onset ( 2 ϭ 46.0, 5 d.f., P Ͻ 0.0001) and accounted for 48.2% of the variance.CONCLUSIONS -Even though scores on the measures were within the published normal range, the onset of DEB was predicted by higher depression and weight and shape concerns and lower global and physical appearance-based self-worth as well as higher BMI percentile 1-2 years earlier compared with those not developing DEB. Early interventions focused on helping girls with diabetes develop positive feelings about themselves, their weight and shape, and their physical appearance may have protective value. Diabetes Care 31:1978-1982, 2008D isturbed eating behavior (DEB) tends to persist and worsen over time and is associated with the development of clinical eating disorders (1). Both clinical and subthreshold eating disorders are more common in teenage girls and young women with type 1 diabetes than in their nondiabetic peers (2,3) and have more significant health consequences in this population related to compromised metabolic control (2,4) and increased risk of hospitalization and diabetes-related medical complications (5,6). Identification of risk factors for DEB in girls with diabetes is of practical utility because it may allow targeted interventions to be instituted to prevent or diminish the onset of DEB in this high-risk group.In their recent review of risk factors for eating disorders, Striegel-Moore and Bulik (1) noted that internalization of an ideal of bodily thinness, body dissatisfaction, higher body weight, and dieting have consistently been identified as predictors of eating disturbance in longitudinal studies. Negative affect, including depressed mood and low self-esteem (7), and low perceived social support (8) have also been shown to predict subsequent disordered eating in some studies. However, evidence for the role of all of these risk factors has been limited. Although the mechanisms that account for the increased risk in girls with diabetes are not certain, diabetes has be...

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Deep Brain Stimulation for Autism Spectrum Disorder: Current and Future Uses

“…Insulin therapy leads to weight gain which can result in subsequent emotional distress, which can initiate disordered eating behaviours such as binge eating or insulin omission [43]. Amongst girls with T1DM and comorbid ED 35% of the variance has been explained by lower self-esteem and higher BMI scores [44] Similar research with people with T1DM has found DEB is significantly predicted by weight and shape worries, higher depression rates, higher BMI scores and lower appearance-based self-worth (p <0.001) [45]. These factors accounted for 48.2% of variance, offering support for the dual pathway model Olmsted et al, Daneman et al [46] FIGURE 1 and Pinhas-Hamiel et al [47] specify that T1DM specific factors interact with individual, family and social risks to lower the threshold for an ED.…”

Inadequate Coping Attitudes, Disordered Eating Behaviours and Eating Disorders in Type 1 Diabetic Patients

“…Clinicians working with adolescent and young adult women diabetes should be cognizant of patterns that might indicate the presence of DEB in their patients. They can include extreme concerns about weight and body shape, unusual patterns of intense exercise, sometimes accompanied or followed by frequent hypoglycemia, unusually low-calorie meal plans, unexplained elevations in HbA1c values, repeated problems with diabetic ketoacidosis and amenorrhea (Olmsted et al, 2008). Recently, Markowitz et al (Markowitz et al, 2010) proposed a 16-items diabetes-specific self-reported measure of disordered eating for brief screening tool for disordered eating in diabetes.…”