Among girls with type 1 diabetes, a “remarkably high” number appear to develop eating behaviours associated with anorexia, bulimia and other clinical eating disorders, researchers in Canada report.

These girls may display “weight and shape concerns, lower self-esteem and higher symptoms of depression in the ‘normal’ non-clinical range,” said Dr Marion Olmsted, of the University of Toronto in Ontario.

She and her colleagues followed 101 girls with type 1 diabetes, between nine and 13 years old at baseline, for five years. They found that about half of the subjects developed disturbed eating behaviour.

The girls’ behaviours included eating less for weight control rather than diabetes control, binge-eating, self-induced vomiting, using diuretics or laxatives, and exercising excessively to control weight, Dr Olmsted and colleagues report in the medical journal Diabetes Care.

Over the five-year study, the investigators gathered data on self-esteem, attitudes regarding physical appearance and social acceptance, depression, quality of parental relationships, diabetes control, and height and weight.

To determine which characteristics were associated with the development of disturbed eating behaviour the researchers compared data for 38 girls who developed disturbed eating behaviours and 38 of their counterparts who did not.

Higher body mass index (the ratio of weight to height used to estimate if someone is under- or over-weight), concerns with weight and shape, lower self-esteem, and more reports of depressive symptoms during the previous one to two years, were the characteristics most significantly associated with disturbed eating behaviour.

However, as noted, measures of weight and shape, low self-esteem, and symptoms of depression were still within a “normal” range in the girls with developed disturbed eating behaviour.

“The threshold for identifying girls with diabetes who are at risk for disturbed eating behaviour needs to be set very low,” Dr Olmsted’s group suggests.

Early interventions may help girls with diabetes develop positive feelings about themselves, their weight and shape, and their physical appearance, the researchers add.

Reuters Health

SOURCE: Diabetes Care, October 2008