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Body Mass Index and Disordered Eating in Adolescent Females with Type 1 Diabetes

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Body Mass Index and Disordered Eating in Adolescent Females with Type 1 Diabetes Body Mass Index and Disordered Eating in Adolescent Females with Type 1 Diabetes A Thesis Submitted to the Faculty of Drexel University by Jessica Tuttman Markowitz, M.S. in partial fulfillment of the requirements for the degree of Doctor of Philosophy May 2008 ii Dedications To Andrea. Your ability to cope with diabetes and its challenges gracefully is amazing and inspiring. To Adam, thank you for being endlessly supportive, for cooking wonderful meals, for moving repeatedly without complaint, and for being the calming force in my life. And to Sam, who can always make me smile and helps keep life in perspective. iii Acknowledgments Thank you to my mentor, Michael R. Lowe, Ph.D. for his help with this dissertation, as well as his support throughout graduate school. I would like to thank my dissertation committee members, Evan Forman, Ph.D., Pamela Geller, Ph.D., Nancy Silverman, Ph.D., and Terri Lipman, Ph.D., for their suggestions and support throughout this project. I would also like to thank Rebecca Thompson and the staff at St. Christopher’s Hospital for Children, as well as the staff members of Camp Carefree in New Durham, NH, the Donovan McNabb Camp in Green Lane, PA, and Camp Setebaid in Shickshinny, PA. Their generosity in providing me with locations to recruit participants, as well as their help with recruitment enabled me to collect data successfully. Several graduate school colleagues were extremely helpful during the dissertation process. I would like to thank Graham Thomas for statistical consultation, Yelena Chernyak for helping with recruitment, and Meghan Butryn and Christina Psaros for constant support. I would like to thank my parents who are a constant source of support and inspiration. Last, but not least, my sister, Andrea Tuttman, inspired me to do this research. She helped with the formation of my research questions and was there along the way to answer inquiries about daily life with diabetes. Thanks, Ands. iv Table of Contents ABSTRACT ...............................................................................................................vii 1. INTRODUCTION .................................................................................................1 1.1 The problem of obesity ....................................................................................1 1.2 Childhood obesity ............................................................................................1 1.3 Predictors of obesity ........................................................................................3 1.4 Type 1 diabetes ................................................................................................4 1.5 New and future treatments for type 1 diabetes ................................................9 1.6 Compliance with treatment in adolescence ......................................................12 1.7 Diabetes and psychological issues during adolescence ...................................13 1.8 Prevalence of eating disorders in type 1 diabetes ............................................14 1.9 Prevalence of overweight and obesity in type 1 diabetes ................................18 1.10 Onset of eating disorders and obesity in type 1 diabetes ...............................20 1.11 Effects of eating disorders and obesity on type 1 diabetes development ......21 1.12 Type 1 diabetes and the development of eating disorders and obesity ..........23 1.13 Consequences of eating disorders and obesity in type 1 diabetes .................27 1.14 Insulin and appetite ........................................................................................30 1.15 Intervention studies ........................................................................................30 1.16 Possible predictors of overweight and disordered eating ..............................33 1.17 The current study ...........................................................................................37 1.18 Hypotheses .....................................................................................................40 2. METHODS ............................................................................................................41 2.1 Participants .......................................................................................................41 v 2.2 Measures ..........................................................................................................41 2.3 Procedure .........................................................................................................44 2.4 Statistical analyses ...........................................................................................46 3. RESULTS ..............................................................................................................48 3.1 Final sample demographics..............................................................................48 3.2 Level of disordered eating attitudes and behaviors in the current sample .......50 3.4 Correlates of eating disorder characteristics ....................................................51 3.5 Correlates of current BMI ...............................................................................53 3.6 Correlates of change in BMI over time ............................................................56 3.7 Exploratory hypothesis ....................................................................................56 4. DISCUSSION ........................................................................................................58 4.1 Implications for interventions ..........................................................................66 4.2 Limitations of the current study .......................................................................68 4.3 Future directions in research ............................................................................70 LIST OF REFERENCES ...........................................................................................71 APPENDIX A: RECRUITMENT FLYER ................................................................80 APPENDIX B: DEMOGRAPHICS QUESTIONNAIRE .........................................81 APPENDIX C: EDE-Q ..............................................................................................84 APPENDIX D: TFEQ (COGNITIVE RESTRAINT & DISINHIBITION) ..............87 APPENDIX E: DIET AND WEIGHT HISTORY QUESTIONNAIRE ...................90 APPENDIX F: PFS ....................................................................................................91 APPENDIX G: PARENT QUESTIONNAIRE .........................................................93 Vita .............................................................................................................................94 vi List of Tables 1. Ethnicity by site ....................................................................................................48 2. Demographics by type of site (Mean and SD) ......................................................49 3. Variables by ethnicity ...........................................................................................50 4. Correlates of EDE-Q subscales and global scale ..................................................51 5. EDE-Q comparison scores (Mean and SD) ..........................................................52 6. Correlates of current BMI .....................................................................................55 7. Correlations between weight status and EDE-Q ...................................................57 vii Abstract Body mass index and disordered eating in adolescent females with type 1 diabetes. Jessica Tuttman Markowitz, M.S. Michael R. Lowe, Ph.D. Obesity is one of the top ten global health problems as recognized by the World Health Organization and is an epidemic in the United States. Type 1 diabetes is a disease in which disordered eating and overweight can cause significant medical comorbidities. The prevalence of overweight and some eating disorders are greater in adolescent females with type 1 diabetes than in those without the disorder. The development of type 1 diabetes may be affected by elevated body mass index (BMI). In addition, the management of the disorder (and associated risk factors) can be affected by disordered eating as well as elevated BMI. This study aimed to examine the relationship between disordered eating attitudes and behaviors and overweight with a number of self-report variables. These included attitudes toward food, weight and dieting history, and diabetes treatment variables. The purpose of the study was to better understand this population and begin to develop effective interventions. Data were collected at one pediatric endocrinology clinic and three summer camps with the final sample yielding data from 90 females, ages 12-19, with type 1 diabetes. The current sample had a significantly higher BMI that that of a non-diabetic comparison sample. A significant positive relationship was found between eating disorder characteristics and cognitive restraint, BMI, and weight suppression. Those participants who reported a history of dieting scored higher on a measure of eating disorder characteristics than those without a history of dieting. A significant positive relationship was found between BMI and appetitive responsiveness to the food environment, disinhibition, and BMI category at first viii diagnosis. Participants who reported never being overweight displayed less eating disorder characteristics than those who were overweight
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