US-based researchers have found links between weight stigma and disordered eating behaviours among teens with type 1 diabetes
Entering the teenage years is a time of big change, physically, emotionally, and socially. Young people start to develop a stronger sense of who they are, become more independent, and their relationships with family and friends shift as they take on new experiences and responsibilities. It’s when we go through puberty and our body shape and size changes. And while changes are happening in our body, we may also start to place more value on what other people think about us.
For teens with type 1 diabetes (T1D), this period is even more complicated, needing to manage daily tasks like carb counting, glucose monitoring, and insulin dosing. During this time, teens with T1D may start to be more independent in their diabetes management, decisions and behaviours.
The teen years are also a high-risk period for disordered eating behaviours. Teens with T1D have a 2-3 times higher risk of developing an eating disorder. Disordered eating has been linked with higher HbA1c, higher rates of hospitalisation, and more frequent diabetes ketoacidosis. Disordered eating has also been linked with experiences of weight stigma.
Weight stigma mostly targets people living in larger bodies. It includes negative attitudes and stereotypes about a person or group simply because of body size. Weight stigma can look like negative social experiences, e.g., unwanted comments or being excluded from meals and outings. Weight stigma can also be internalised. This is when we blame and have negative feelings about ourselves because of our weight.
The daily attention on eating behaviours and physical activity needed in T1D self-management can make teens more susceptible to disordered eating. US-based researchers explored disordered eating and weight stigma among teens with T1D, and whether the two might be related.
What did the study involve?
The researchers collected personal and medical information, like gender, age, HbA1c, weight and height from 166 teens (aged 12-17 years) with T1D.
The teens also answered questions about:
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- Disordered eating attitudes and behaviours, using the 16-item Diabetes Eating Problems Survey
- Internalised weight stigma, using the 10-item Weight Bias Internalisation Scale
- Weight-based victimisation, using three (yes/no) items asking whether they had ever been teased or treated unkindly (victimised) because of their weight by (1) peers, (2) family members, or (3) healthcare professionals. Where the teens answered yes, they were then asked how often this had happened
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What did they find?
Nearly one quarter of the teens reported clinically elevated disordered eating. On average, the teens reported low internalised weight stigma. At least one experience of weight-based victimisation was reported by 30% of the teens. Peers and family members were the most common sources of weight-based victimisation, followed by healthcare professionals.
Female teens reported more internalised weight stigma and disordered eating compared with male teens. There was no significant difference between female and male teens for weight-based victimisation.
The study identified moderate to strong positive relationships between weight stigma and disordered eating:
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- When teens reported greater internalised weight stigma, they also typically reported greater disordered eating. When internalised weight stigma was low, so was disordered eating.
- When teens reported greater weight-based victimisation, they also typically reported greater disordered eating. When weight-based victimisation was low, so was disordered eating.
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It’s important to remember this research is correlational. That means it can show that two things tend to occur together, but it can’t show that one directly causes the other. Even so, the findings highlight the high rates of weight stigma and disordered eating among teens with T1D.
What can we do?
The researchers provided some recommendations to support better conversations with teens with T1D about weight. These included:
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- Being mindful of weight stigma and its potential to impact eating behaviours.
- Asking teens for their permission before talking about weight.
- Asking teens what word/s they prefer to use when describing their weight.
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Further research was also recommended, including diverse teen populations.
Let’s all pay attention to the weight of our words and actions with teens. To read more about weight stigma, check out our previous blogs.
Reference:
Trojanowski PJ, Warnick J, Darling KE, Tanner B, Shomaker LB, O’Donnell HK. Weight stigma in pediatric type 1 diabetes. Journal of Health Psychology, 30(10): 2805-2815.
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