Howe, C. J., Jawad, A. F., Kelly, S. D., & Lipman, T. H. (2008). Journal of the American Psychiatric Nurses Association, 13(6), 376-385.
Much has been published in the scientific and lay literature about the prevalence of eating disorders in adolescents, but we know little about how youth with diabetes view weight. This study sought to describe weight perception, weight satisfaction, and weight control behaviors in 300 male and female adolescents with type 1 diabetes.
Anorexia, bulimia, and eating disorders not otherwise specified (EDNOS) have severe consequences, and it has been demonstrated that adolescents with type 1 diabetes are at increased risk for disordered eating partly stemming from the focus on food inherent in disease management. Insulin omission provides teens with diabetes with a unique way to purge calories, resulting in hyperglycemia and caloric loss in the urine. The concurrence of eating disorders and diabetes greatly increases the prevalence of morbidity and mortality.
Participants completed a survey regarding "feelings about weight" and weight related behaviors. Most weight control behaviors were associated with gender (female), weight satisfaction, and weight perception. Weight dissatisfaction and heavy weight perception were associated with more unhealthy weight control behaviors that included fasting, omitting insulin, vomiting, and using laxatives and diuretics.
There are societal pressures and family attitudes, targeting females, related to the importance of being thin. These influences also effect youth with chronic illnesses. However, within the context of complex disease management, healthcare providers may not address eating behaviors. Pediatric nurses should work with parents of children and teens with chronic disorders to create an environment that encourages health and fitness rather than weight control, with the goal being to prevent eating disorders. All youth should be asked about weight perception and weight satisfaction, and those who have disordered eating should be referred. For nurses who work with children and adolescents with diabetes, it is important to consider insulin omission as a weight control behavior in those with chronic poor diabetes control or unexplained admissions because of ketoacidosis.