Abstract
ObjectiveTo examine body image problems and their associations with disordered eating behavior in adolescents with type 1 diabetes and well-matched healthy peers.MethodsUsing a cross-sectional design, 183 adolescents with type 1 diabetes (13.02–18.05 years) were recruited from diabetes centers in southern Italy and compared to healthy peers matched for age and gender. Participants completed self-report measures of disordered eating behaviors (DEPS-r and EDI-3RF) and a gender-specific body image problem questionnaire (SATAQ-4R). Socio-demographic and clinical data (zBMI, HbA1c, and disease duration) were also collected. Hierarchical multiple linear regression analyses were computed to determine the relative importance of diabetes variables and body image problems on participants’ disordered eating behaviors after controlling for demographic variables.ResultsAdolescents with type 1 diabetes showed diabetes-specific eating problems in 37.7% of cases and had more eating problem symptoms (assessed as drive for thinness and bulimia) than healthy peers. Male adolescents with type 1 diabetes did not display more body image problems (p > 0.05); females with type 1 diabetes compared to females in the control group were found to be more pressured by family (p = 0.025) but less by media (p = 0.022) to improve their appearance and attain a thin body. zBMI and body image problems contributed to a significant increase in disordered eating behavior risk both in male and female adolescents with diabetes and in healthy peers (zBMI 0.213 < β < 0.426, p < 0.05; body image 0.243 < β < 0.572, p < 0.05). None of the variables analyzed were found to significantly predict male bulimic symptoms (all β < 0.296, p > 0.05).ConclusionSince in adolescence type 1 diabetes and insulin therapy may increase the risk of weight gain and promote focus and attention on the body and thus contribute to the development of body image problems and disordered eating behaviors, continuity of medical, nutritional, and psychological care is needed.
Highlights
Type 1 diabetes mellitus (T1D) is one of the most common chronic diseases of childhood (Stanescu et al, 2012; MayerDavis et al, 2017), one in which an autoimmune destruction of pancreatic β-cells leads to an absolute insulin deficiency (Todd, 2010; Atkinson et al, 2014)
According to most recent literature reviews (Hanlan et al, 2013; Conviser et al, 2018; Pursey et al, 2020), disordered eating behaviors (DEBs) were more common in youths with T1D compared to healthy peers, and this was significantly associated with poorer glycemic control (Young et al, 2013)
Of all adolescents with T1D who were asked to be included in the study (N = 261), 23.4% refused to consent to participation (N = 61)
Summary
Type 1 diabetes mellitus (T1D) is one of the most common chronic diseases of childhood (Stanescu et al, 2012; MayerDavis et al, 2017), one in which an autoimmune destruction of pancreatic β-cells leads to an absolute insulin deficiency (Todd, 2010; Atkinson et al, 2014). The T1D treatment regimen is complex and multifaceted, and it entails, from the time of diagnosis, the adherence of the patient (and his/her family) to many disease specific behaviors, such as lifelong insulin replacement therapy, blood glucose monitoring, dietary management, physical activity, and exercise (Fairchild, 2015; National Institute for Health and Care Excellence, 2015; American Diabetes Association [ADA], 2020b). According to most recent literature reviews (Hanlan et al, 2013; Conviser et al, 2018; Pursey et al, 2020), disordered eating behaviors (DEBs) were more common in youths with T1D compared to healthy peers, and this was significantly associated with poorer glycemic control (Young et al, 2013). Body image problems have been consistently recognized as a key contributor to DEB onset both in the general population (Striegel-Moore and Debra, 2002; Fairburn and Harrison, 2003; Striegel-Moore and Bulik, 2007; Amaral and Ferreira, 2017; Girard et al, 2018) and in adolescents with chronic illness (Neumark-Sztainer et al, 2002)
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