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Eating Disorders in Type 1 Diabetic YouthWhat is the problem and what is known about it so far?Adolescents, particularly females, are at risk for developing eating disorders and dissatisfaction with their body because of a combination of normal changes related to puberty and society's emphasis on thinness as a beauty ideal. Adolescents with type 1 diabetes may be at even greater risk because insulin can lead to weight gain and because the daily focus on diet necessary for diabetes management could lead to an unhealthy preoccupation with food and weight. For some diabetic adolescents, such concerns may lead to dangerous practices, including reducing or skipping insulin doses to avoid weight gain. However, studies of this issue so far have yielded mixed results. Why did researchers do this particular study?The researchers wanted to find out whether eating disorders and body dissatisfaction are more common among adolescents with type 1 diabetes than among those without diabetes. Who was studied?A clinic-based group of 143 adolescents with type 1 diabetes and a population-based group of 4,746 youths, all of whom had participated in previous health and eating studies. How was the study done?Participants completed surveys and had their height and weight measured. What did the researchers find?Although some of the type 1 diabetic adolescents used unhealthy weight practices, overall they reported less weight dissatisfaction, were less likely to use any unhealthy weight control behaviors, and were more likely to report eating regular meals than their nondiabetic peers. Diabetic females reported less dieting, fasting, or severely limiting eating to control weight during the past year than their nondiabetic counterparts. However, diabetic males were less likely than their nondiabetic peers to exercise and eat fruits and vegetables for healthy weight control. Of the diabetic adolescents, 1.4 percent of males and 10.3 percent of females reported omitting insulin and 1.4 percent of males and 7.4 percent of females reported reducing insulin doses to control weight. Diabetic adolescents who manipulated insulin were more likely to have body dissatisfaction that their diabetic peers who did not manipulate insulin. What were the limitations of the study?Differences between the two groups may have had some bearing on the results. The diabetic adolescents came from an endocrinology clinic and had good metabolic control, whereas the nondiabetic group was recruited from schools and therefore may have had a greater range of healthy and unhealthy behaviors. Furthermore, members of the diabetic group, who were generally healthy, stuck with their diabetes regimens, and received regular specialty care may not have been typical teenagers with diabetes. Finally, surveys were only collected for diabetic participants who chose to respond. It is possible that disordered eating and unhealthy weight control behaviors were more common among those who chose not to respond. What are the implications of the study?This study suggests that adolescents with well-controlled type 1 diabetes who are receiving regular diabetes specialty care are not at increased risk for unhealthy weight control behaviors and weight dissatisfaction and in fact may be less likely to experience such problems than their nondiabetic peers. However, even with close medical supervision, some diabetic adolescents have unhealthy weight control concerns and behaviors, including insulin manipulation, which could lead to complications. The problem is likely greater among those not receiving such thorough medical care. Health care providers and school professionals may benefit from training, and parents may benefit from education to help them identify unhealthy weight control behaviors among all adolescents.
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