The psychological factors linked to disordered eating in adolescents with type 1 diabetes

The centre publishes new insights from the Diabetes MILES Youth – Australia study

by Dr Shikha Gray

Adolescence can be a turbulent time in life. It involves dealing with biological changes, as well as learning and negotiating new social roles and identities. These can be psychologically difficult developmental milestones. For young people with type 1 diabetes, adolescence can be even more fraught with challenges. They must navigate the complicated world of adolescence while also managing a physically and emotionally demanding health condition.

Central to the tasks of self-managing type 1 diabetes is continual decision making about food and eating. This includes planning, monitoring and calculating when and how much to eat, and the carbohydrate content of food and drink, as well as the flexibility not to eat when you don’t want to. What happens when the tasks of diabetes management and the experience of adolescence intersect?

Research has shown that 1228% of adolescents with type 1 diabetes meet the criteria for having an eating disorder (typically, bulimia nervosa or binge eating disorder). This is higher than the rate of eating disorders in the general population. Eating disorders can have devastating consequences for both the physical and emotional wellbeing of young people

How do we predict if adolescents with type 1 diabetes are at risk of disordered eating? This is the question asked by a team of researchers that includes Dr Emanuala Araia, and Dr Christel Hendrieckx and Prof Jane Speight from the ACBRD.

The researchers considered data from 447 adolescents (62% female, mean age: 16 years) who completed the Diabetes MILES Youth study – a national survey of Australian youth with type 1 diabetes.

They found:

  • Adolescents with higher levels of disordered eating were more likely to experience severe levels of depressive and anxiety symptoms, diabetes distress, and body dissatisfaction.
  • Adolescents with lower levels of disordered eating had better general emotional well-being, general quality of life and diabetes-related resilience.
  • Higher disordered eating was strongly associated with adolescents’ levels of diabetes distress, body dissatisfaction and self-reported HbA1c.

The researchers also found a gender difference: body dissatisfaction was almost five times higher in females than males. However, irrespective of gender, body dissatisfaction seemed to increase susceptibility to disordered eating.

Overall, the study provides a new piece of the puzzle in understanding disordered eating in adolescents with diabetes. We already knew that body dissatisfaction and Hba1c were important factors to consider – but this study highlights the need to also take into account diabetes distress. Knowing what is happening psychologically for adolescents with disordered eating means that we have a better idea of when and how to intervene. This study highlights the need for clinicians to be vigilant for signs of diabetes distress in young people, which could be an indication of disordered eating.

Reference: Araia E, King RM, Pouwer F, Speight JHendrieckx C. Psychological correlates of disordered eating in youth with type 1 diabetes: Results from Diabetes MILES Youth – AustraliaPediatric Diabetes, 21(4): 664-672.

If you (or someone you know) has concerns about disordered eating, check out the NDSS leaflet ‘Diabetes and disordered eating’: www.ndss.com.au/resources/diabetes-and-disordered-eating-fact-sheet/

To read more about issues concerning adolescents with diabetes, read our other blogs here.