Weight Control Practices and Disordered Eating Behaviors Among Adolescent Females and Males With Type 1 Diabetes

Dianne Neumark-Sztainer, PHD, Joan Patterson, PHD, Alison Mellin, PHD, Diann M. Ackard, PHD, Jennifer Utter, MPH, Mary Story, PHD and Joseph Sockalosky, MD

Disclosures

Diabetes Care. 2002;25(8) 

In This Article

Abstract and Introduction

Objective: This study examines the prevalence of specific weight control practices/disordered eating behaviors and associations with sociodemographic characteristics, BMI and weight perceptions, family functioning, and metabolic control among adolescent females and males with type 1 diabetes.
Research Design and Methods: The study population included 70 adolescent females and 73 adolescent males with type 1 diabetes who completed the AHEAD (Assessing Health and Eating among Adolescents with Diabetes) survey. Data on BMI and glycosylated hemoglobin (HbA1c) were drawn from medical records.
Results: Unhealthy weight control practices were reported by 37.9% of the females and by 15.9% of the males. Among the females, 10.3% reported skipping insulin and 7.4% reported taking less insulin to control their weight. Only one male reported doing either of these behaviors. Weight control/disordered eating behaviors were not associated with age, parental level of education, family structure, or race/ethnicity. Higher levels of weight dissatisfaction tended to be associated with unhealthy weight control/disordered eating; associations with BMI were inconsistent. Family cohesion was negatively associated with disordered eating among females (r = -0.52; P < 0.001) and males (r = -0.41; P < 0.001), but correlations with other measures of family environment (control, independence, and responsibility for diabetes management) were not significant. Correlations between disordered eating and HbA1c levels were significant among females (r = 0.33; P < 0.01) and males (r = 0.26; P < 0.05).
Conclusions: Special attention is needed for youth with weight concerns and those from less cohesive families to assist in the development of healthy diabetes management behaviors.

Several studies have compared the prevalence of unhealthy weight control practices and other disordered eating behaviors among adolescents with and without type 1 diabetes. Findings have been inconsistent; in some studies, prevalence was higher among youth with type 1 diabetes,[9,13,25] while in other studies no differences were found.[28,40] Unhealthy weight control practices and other disordered eating behaviors have potentially harmful consequences for all adolescents and are associated with negative psychological well-being,[39] nutritional inadequacy,[10,15,22] and the later onset of eating disorders[19,27] and obesity.[38] The potential consequences of unhealthy weight control practices for adolescents with type 1 diabetes are of particular concern since these practices are associated with poorer metabolic control.[8,13,32,41] Furthermore, disordered eating behaviors and poor metabolic control among young women with type 1 diabetes have been associated with microvascular complications.[7,34,37] Therefore, there is real concern about youth with type 1 diabetes who are engaging in unhealthy weight control practices and other disordered eating behaviors, regardless of whether prevalences differ between individuals with and without diabetes.

In light of the potential serious consequences of engaging in unhealthy weight control practices, it is important to understand aspects unique to adolescent development that are associated with these behaviors among youth with type 1 diabetes. A greater understanding of risk and protective factors can assist in identifying youth at increased risk for unhealthy weight control practices and in guiding the development of effective interventions.

The pubertal changes in body shape and weight predispose some adolescent females to develop unhealthy eating attitudes.[42] The presence of type 1 diabetes may heighten attention to dietary restraints, weight gain, and food preoccupation.[42] Being overweight seems to be a risk factor associated with disordered eating among females with type 1 diabetes.[9,28] Furthermore, the risk for being overweight may be higher among females with type 1 diabetes, as compared with other females.[9] Rodin and Daneman[33] have suggested the following potential pathway from a diagnosis of type 1 diabetes to unhealthy weight control behaviors: Before a youth is diagnosed with diabetes, there is often weight loss, which may be perceived as desirable by many young females. Once insulin therapy begins, weight gain usually ensues, which could lead to or increase body dissatisfaction. Weight gain and body dissatisfaction may lead to the use of unhealthy weight control behaviors, particularly in the form of insulin restriction as a method to lose or maintain weight.[29,32]

Parent-adolescent relationships are sometimes challenged when a youth has diabetes, which can create distress and a greater risk for engaging in health-compromising behaviors, including disordered eating habits.[3,20] Parents are often unsure of appropriate limits for their youth with diabetes, which may increase family conflict. Maharaj et al.[18] reported that eating disturbances among youth with type 1 diabetes were associated with poor family communication, a lack of trust in the family, conflict, and inadequate support.

The present study expands upon the growing body of research examining weight control practices/disordered eating among youth with type 1 diabetes. The following specific research questions are addressed: 1) What types of weight control and disordered eating behaviors are used by adolescent females and males with type 1 diabetes? 2) Do unhealthy weight control behaviors differ by gender, age, parental level of education, weight status, or weight perception? 3) Does family structure (one versus two parents) or family functioning (cohesion, control, and/or independence) increase or reduce the risk of unhealthy weight control behaviors? and 4) What is the association between unhealthy weight control behaviors and glycosylated hemoglobin (HbA1c)?

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