Examination of a Modified Dual Pathway Model of disordered eating in youth with type 1 diabetes

Abstract

Disordered eating behavior (DEB) may be more prevalent in adolescents with type 1 diabetes (T1D) than their non-diabetic peers, and consists of binge eating, dietary restriction, purging, and/or extreme weight concerns. Co-occurring DEB and T1D may decrease glycemic control and can place individuals at greater risk for poor health outcomes. Given the risk for health complications in this population, it is important to consider variables that distinguish DEB from normative eating behavior in the context of a diabetic care regimen. Further, there are several aspects of the T1D disease process and treatment regimen which may place youth at higher risk for DEB, and which need to be accounted for when conceptualizing DEB in this population. Insulin treatment, subsequent weight gain, and disruptions to hunger and satiety regulation are hypothesized mechanisms through which the treatment of T1D may increase vulnerability to DEB as proposed by the Modified Dual Pathway model. These factors, as well as body image disatisfaction, dietary restraint, and depression were examined in conjunction with bulimic symptoms in a sample of 101 youth (43

were transitioning to insulin pump, and thus experienced with the treatment, and 58 were newly diagnosed). The current study lends support for the Modified Dual Pathway Model by demonstrating the unique relationship between hunger and satiety dysregulation and DEB, even when controlling for other known risk factors for DEB. Thus, the current study begins to address gaps in the literature regarding risk for DEB in youth with T1D by testing this expanded model. The Modified Dual Pathway Model incorporates psychosocial factors as well as physiological disease and treatment related factors in a more accurate and comprehensive conceptualization of risk for DEB in youth with T1D.