Changes in body image and onset of disordered eating behaviors in youth with type 1 diabetes over a five-year longitudinal follow-up

Body image dissatisfaction during the first year of pediatric inflammatory bowel disease diagnosis

OBJECTIVES

Dissatisfaction with one's body can be distressing; youth with inflammatory bowel disease (IBD) may be at increased risk for body image dissatisfaction given disease symptoms and treatment side effects. Yet, no studies have examined body image dissatisfaction over time in youth with IBD and whether depressive symptoms are associated with change in dissatisfaction.

METHODS

Fifty-seven pediatric participants (8-17 years old) newly diagnosed with IBD were enrolled. Youth completed questionnaires assessing body image dissatisfaction and depressive symptoms shortly after diagnosis (Time 1) and 12 months later (Time 2). Multilevel longitudinal modeling was used to test the extent to which body image dissatisfaction changed across the first year of diagnosis and to test change in body image dissatisfaction as a function of depressive symptoms.

RESULTS

Findings indicated significant between- and within-person variance in body image dissatisfaction over the 12 months, yet the sample as a whole did not report significant changes in dissatisfaction from Time 1 to Time 2. Children reporting depressive symptoms greater than their individual average over time reported greater body image dissatisfaction. Between-person variation in depressive symptoms demonstrated a significant interaction with time. As an individual's depressive symptoms exceeded the group average, their body image dissatisfaction increased, although less drastically as time since diagnosis progressed.

CONCLUSIONS

Findings suggest that body image dissatisfaction is a complex and dynamic construct across youth and that interventions for pediatric IBD patients need to be tailored to the needs of individuals. Methods for assessing body image dissatisfaction efficiently and repeatedly across multiple visits are provided.

Prevalence of eating disorder symptoms in people with insulin-dependent-diabetes: A systematic review and meta-analysis

AIMS

To examine the prevalence of eating disorder symptoms (EDS) in 16 years and older individuals with insulin-dependent diabetes including both clinical and subclinical eating disorder symptoms.

METHODS

We searched PubMed, Embase, Scopus, PsycINFO, and CINAHL databases to discover studies reporting prevalence of eating disorder symptoms in patients with insulin-dependent diabetes (both type 1 and type 2). We performed a meta-analysis to estimate the pooled prevalence of eating disorder symptoms and an independent meta-analysis to estimate the prevalence of insulin omission.

RESULTS

A total of 45 studies were included in the meta-analysis of eating disorder symptoms. Diabetes Eating Problem Survey (DEPS-R) was the most frequently used screening tool (in 43 % of studies, n = 20). The pooled prevalence of eating disorder symptoms was 24 % (95 % CI 0.21-0.28), whereas in studies using DEPS-R, it was slightly higher, 27 % (95 % CI 0.24-0.31), with the prevalence ratio (PR) of 1.1. The prevalence differed between screening tools (χ2 = 85.83, df = 8, p < .0001). The sex distribution was associated with the observed prevalences; in studies with a higher female prevalence (>58 %), the pooled eating disorder symptom prevalence was higher [30 % (95 % CI 0.26-0.34) vs. 18 % (95 % Cl 0.14-0.22), PR 1.7]. The prevalence of insulin omission was 21 % (95 % CI 0.13-0.33).

CONCLUSIONS

Eating disorder symptoms and insulin omission are common in patients with insulin-dependent diabetes regardless of age. DEPS-R is the most used screening tool. Studies with a higher proportion of female participants report higher prevalence rates.

Comparative Analysis of Body Image Dissatisfaction, Depression, and Health-Related Quality of Life in Adults with Type 1 Diabetes: A Case-Control Study

(1) Objective: This case-control study investigated body image dissatisfaction, depression, and health-related quality of life (HRQoL) in adults with type 1 diabetes. (2) Methods: A total of 35 adults with diabetes and an equal number of age- and gender-matched controls were included. Assessment tools used were the Body Image Disturbance Questionnaire (BIDQ), the Hospital Anxiety and Depression Scale (HADS), and the RAND 36-Item Health Survey. Both quantitative and qualitative data were analyzed. (3) Results: Body image dissatisfaction did not differ significantly between the groups. However, adults with diabetes reported higher levels of depression (p = 0.002) and lower scores for physical health (p = 0.015) and general health (p < 0.001) on the HRQoL measure. Qualitative analysis identified common themes related to physical disturbance, effect on activities, and psychosocial concerns. (4) Conclusions: Despite similar body image dissatisfaction, adults with type 1 diabetes exhibited increased depression and reduced HRQoL. These findings emphasize the need to integrate psychological well-being into type 1 diabetes management. They also support further research into the impact of body image dissatisfaction in T1D and potential interventions to address it.

Body Image Perception and Satisfaction of Junior High School Students: Analysis of Possible Determinants

Body image (BI) is a multidimensional construct that refers to one's perceptions of and attitudes toward one's own physical characteristics. Adolescence is a critical developmental stage in which concerns about BI increase. Therefore, the present cross-sectional study aimed to evaluate body image and aesthetic body shape standards in a sample of middle school students living in China. The researchers gathered demographic information, as well as height and weight data, for their study. They used a body silhouette to assess body image perception and body shape aesthetics and calculated two indexes: BIP, which measures the accuracy of self-perception and the estimation of bodily dimensions, and BIS, which indicates the difference between an individual's perceived and ideal body images. A total of 1585 students in three grades at two middle schools were included in the study (759 = female, mean age = 13.67 ± 0.90; 839 = male, mean age = 13.70 ± 0.90). The results showed that the BIP bias rate of middle school students was 55.7%, and the BI dissatisfaction rate was 81.0%. Females tended to overestimate their body shape and desire to be thinner compared to males. Students with a higher BMI grading were more prone to underestimating their body shape and aspiring to be thinner. Furthermore, 8.6% of students chose underweight as the ideal body type for boys, while 22.6% chose underweight as the ideal body type for girls. In conclusion, there are significant gender differences in the aesthetic standards of body shape, and adolescents believe that for women, a thin body shape is beautiful.

Exploring the determinants of mental health, wellbeing, and lifestyle in 8-11 year old children with type 1 diabetes and their healthy counterparts in Kuwait

Type 1 diabetes is a chronic disease with an early onset, but little is known about its psychological effects in middle childhood. The present study was the first to explore the relationship between mental health, wellbeing, and lifestyle of 8-11 years old children with Type 1 diabetes and their parents, and a healthy comparison group. A total of 200 parent-child dyads were recruited in diabetic clinics and from primary schools in Kuwait. Both groups completed a series of behavioural and physical assessments relating to health, wellbeing, and lifestyle. A significant relationship was found between higher Body Mass Index (BMI) and poorer mental health, including low academic self-esteem, depression, and anxiety, in the diabetes group. This group had significantly higher mean scores in mental health problems, and lower scores in wellbeing, compared with control group. Both groups had poor dietary habits and low levels of physical activity. Unlike previous studies, no differences were found between parents' mental health for children with Type 1 diabetes and parents of the control group. Although elevated problem scores on a variety of indices remained within normal range, the pattern of results indicates that children with diabetes would profit from early screening and preventative intervention to reduce the likelihood of psychological and behavioural difficulties later on.

Disordered eating behaviour in adolescents with type 1 diabetes on continuous subcutaneous insulin infusion; relation to body image, depression and glycemic control

BACKGROUND

Disordered eating behaviour (DEB) represents a significant morbidity among people with type-1 diabetes (T1D). Continuous-subcutaneous insulin infusion (CSII) improves glycemic control and psychological wellbeing in those with T1D. However, its relation to DEB remains obscure.

OBJECTIVES

To compare DEB among adolescents with T1D on CSII versus basal-bolus regimen and correlate it with body image, HbA1C and depression.

METHODS

Sixty adolescents with T1D (30 on CSII and 30 on basal-bolus regimen), aged 12-17 years were studied focusing on diabetes-duration, insulin therapy, exercise, socioeconomic standard, hypoglycemic attacks/week and family history of psychiatric illness. Anthropometric measures, HbA1C, binge eating scale (BES), body image tool, patient health questionnaire-9 (PHQ9) and the Mini-KID depression scale were assessed.

RESULTS

Among the studied adolescents with T1D, six had DEB (10%), 14 had poor body-image perception (23.3%), 42 had moderate body-image perception (70%) and 22 had depression (36.7%). Adolescents with T1D on CSII had significantly lower BES (p = 0.022), Mini-KID depression (p = 0.001) and PHQ9 (p = 0.02) than those on basal-bolus regimen. BES was positively correlated to depression (p < 0.001), HbA1C (p = 0.013) and diabetes-duration (p = 0.009) and negatively correlated to body-image (p = 0.003).

CONCLUSION

DEB is a prevalent comorbidity among adolescents with T1D, with higher frequency in those on basal-bolus regimen than CSII.

Body Size Misperception and Dissatisfaction in Elementary School Children

Background: To examine the association between body size perception (BSP) and body size dissatisfaction (BSD) in elementary school children and to document the potential contribution of individual factors [age, sex, and actual body size (BMI Z-scores: BMIZ)] that may influence their relationship. Methods: This study included 269 children (124 boys and 145 girls) between 6 and 13 years of age (9.2 ± 1.6 years). The BSP score was calculated as the difference between the perceived actual body size and BMIZ (actual body size). A negative BSP score indicated an underestimation of their body size. To assess the BSD score, the difference between perceived actual body size and desired body size was calculated. A positive BSD score indicated a desire to be thinner. Results: Perceived actual body size was smaller than BMIZ, independent of age group and weight status. Overall, 64% of children underestimated their body size. The young children living with obesity demonstrated the highest misperception. Results also showed that the proportion of children who desired to be thinner was higher in overweight and obese subgroups. No significant relationship was found between BSP and BSD scores in the entire sample, while a positive association was observed among younger children in the normal-weight and obese subgroups (r = 0.40; p < 0.001 and r = 0.78; p < 0.05, respectively). Conclusions: Underestimation and dissatisfaction of body size are more prevalent in children living with overweight/obesity. Moreover, there is an association between BSP and dissatisfaction, yet this association is dependent on age and weight status.

Disordered Eating Behaviors Among Italian Adolescents with Type 1 Diabetes: Exploring Relationships with Parents' Eating Disorder Symptoms, Externalizing and Internalizing Behaviors, and Body Image Problems

The purpose of this study is to examine associations of disordered eating behaviors (DEBs) with body image problems, parents' eating disorder symptoms, and emotional and behavioral problems among adolescents with type 1 diabetes (T1D). 200 adolescents (M age = 15.24 ± 1.45 years) with T1D completed a self-report measure of DEBs and body ideal internalization, and their parents completed self-report measures of parents' eating problems and child's psychological symptoms. Seventy-three (36.5%) adolescents were DEPS-r-positive (scores ≥ 20), with higher rates among girls (χ² = 9.034, p = .003). Adolescents with T1D and DEBs reported lower SES, worse metabolic control, higher zBMI (p < .001), more eating disorder symptoms, more body image problems, and more emotional and behavioral problems than adolescents with T1D but no DEBs (all p < .05). Parents of adolescents with DEBs showed higher levels of bulimia (p = .028) than parents of adolescents without DEBs. In both genders, pressure to conform to societal norms about body image (p < .01) and externalization symptoms (p < .05) emerged as significant predictors of DEBs. Findings suggest that adolescents with T1D and DEBs showed an alarming psychological condition, with higher level of body image and more emotional and behavioral problems.

Disordered eating behaviors in youths with type 1 diabetes during COVID-19 lockdown: an exploratory study

BACKGROUND

Recent research indicates that patients with type 1 diabetes (T1D) are at higher risk for disordered eating behaviors (DEBs) than their peers without diabetes. The present study aimed to explore the prevalence of DEBs in a sample of Italian children and adolescents with T1D and in matched-pair healthy controls during the COVID-19 lockdown.

METHODS

In a cross-sectional study, 138 children and adolescents with T1D (aged 8.01-19.11 years, 65 boys) attending a Southern Italian diabetic service and 276 age- and gender-matched healthy peers voluntarily completed an online survey about eating behaviors (ChEAT and EAT-26), anthropometric characteristics, and clinical characteristics.

RESULTS

8.69% (N = 12) of participants with T1D and 13.4% (N = 37) of controls had ChEAT/EAT-26 scores indicating presence of DEBs, with no differences between patients-whether children (total ChEAT score F(1, 157) = .104, p = .748) or adolescents (total EAT-26 score F(1, 255) = .135, p = .731)-and healthy peers. zBMI values were lower than those measured in the latest diabetes visit (p < .0001), while HbA1c values remained unchanged (p = .110). In both groups, adolescents had lower Oral Control scores than children (T1D: F(1, 138) = 20.411, p < .0001, η2 = .132, controls: F(1, 276) = 18.271, p < .0001, η2 = .063); additionally, gender (female) and age were found to be significant predictors of several ChEAT/EAT-26 scores.

CONCLUSIONS

This exploratory study suggested that children and adolescents with T1D did not experience more DEB symptoms during the COVID-19 lockdown compared to healthy controls. Results revealed DEBs as more of a female adolescent developmental issue rather than a result of the challenges of living with a chronic illness under quarantine measures. Possible effects of parental pressure on their children's eating behaviors in the context of home confinement and of using a non-diabetes-specific measure to assess DEBs are discussed.

Eating disorders in adolescents with type 1 diabetes mellitus

PURPOSE OF REVIEW

Eating disorders represent one of the most common psychiatric disorders in adolescents with type 1 diabetes mellitus (T1DM), with a prevalence twice as high as in individuals without diabetes. The increased risk for acute and long-term medical complications and a three-fold mortality rate with this dual condition makes it extremely important to screen adolescents for eating disorders as soon as possible.

RECENT FINDINGS

A number of 13 surveys in the last two years focussed on prevalence rates of disordered eating and associations with sociodemographic, eating disorder-specific and diabetes-related factors in this population. Variations in study design, sample size, age range, sex, instruments to assess eating disorders and outcome make comparisons difficult. Healthcare professionals report challenges in detecting and treating adolescents with this dual condition because of a lack of validated screening tools, guidelines, and integration across specialist care. Studies on psychological treatments for the comorbidity of eating disorders and T1DM are scarce, especially for adolescents.

SUMMARY

The development and evaluation of psychological treatments for adolescents with eating disorders and T1DM are urgently needed.

Psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes

Jugendliche und junge Erwachsene mit Typ-1-Diabetes sind häufig von komorbiden psychischen Störungen betroffen. Dabei zeigt die Studienlage zur Verbreitung ein heterogenes und inkonsistentes Bild. Diagnose und Behandlung der somatopsychischen Begleiterkrankungen beeinflussen den Behandlungs- und Krankheitsverlauf sowie die Lebensqualität der Betroffenen. Trotzdem wird dies in der klinischen Praxis selten frühzeitig berücksichtigt. Das multizentrische Verbundprojekt COACH verfolgt das Ziel, die Erkennung und Behandlung psychischer Komorbidität für diese Zielgruppe in der bundesweiten Routineversorgung zu optimieren.

Body Image Problems and Disordered Eating Behaviors in Italian Adolescents With and Without Type 1 Diabetes: An Examination With a Gender-Specific Body Image Measure

Objective

To examine body image problems and their associations with disordered eating behavior in adolescents with type 1 diabetes and well-matched healthy peers.

Methods

Using a cross-sectional design, 183 adolescents with type 1 diabetes (13.02–18.05 years) were recruited from diabetes centers in southern Italy and compared to healthy peers matched for age and gender. Participants completed self-report measures of disordered eating behaviors (DEPS-r and EDI-3RF) and a gender-specific body image problem questionnaire (SATAQ-4R). Socio-demographic and clinical data (zBMI, HbA1c, and disease duration) were also collected. Hierarchical multiple linear regression analyses were computed to determine the relative importance of diabetes variables and body image problems on participants’ disordered eating behaviors after controlling for demographic variables.

Results

Adolescents with type 1 diabetes showed diabetes-specific eating problems in 37.7% of cases and had more eating problem symptoms (assessed as drive for thinness and bulimia) than healthy peers. Male adolescents with type 1 diabetes did not display more body image problems (p > 0.05); females with type 1 diabetes compared to females in the control group were found to be more pressured by family (p = 0.025) but less by media (p = 0.022) to improve their appearance and attain a thin body. zBMI and body image problems contributed to a significant increase in disordered eating behavior risk both in male and female adolescents with diabetes and in healthy peers (zBMI 0.213 < β < 0.426, p < 0.05; body image 0.243 < β < 0.572, p < 0.05). None of the variables analyzed were found to significantly predict male bulimic symptoms (all β < 0.296, p > 0.05).

Conclusion

Since in adolescence type 1 diabetes and insulin therapy may increase the risk of weight gain and promote focus and attention on the body and thus contribute to the development of body image problems and disordered eating behaviors, continuity of medical, nutritional, and psychological care is needed.

Psychological correlates of disordered eating in youth with type 1 diabetes: Results from diabetes MILES Youth-Australia

BACKGROUND

This study examined the relationship between disordered eating (DE), body dissatisfaction (BD), and psychological variables; and identified correlates of DE in youth with type 1 diabetes.

METHODS

Data were from the Diabetes Management and Impact for Long-Term Empowerment and Success Youth Study-Australia, an online survey assessing the psychosocial impact of type 1 diabetes. Adolescents (N = 477; mean age 16 ± 2 years) with type 1 diabetes for at least 1 year, completed the Diabetes Eating Problem Survey-Revised, measures of BD, quality of life, well-being, depressive and anxiety symptoms, diabetes distress, and resilience.

RESULTS

DE correlated positively (moderate-large) with depressive and anxiety symptoms, diabetes distress, and BD; and negatively (moderate-large) with well-being, quality of life, and resilience. In contrast, BD correlated (moderately) with all psychological variables in females only. In the stepwise regression, high diabetes distress and BD were the strongest predictors of DE. While the magnitude of BD was almost five times higher in females, the level of DE risk across genders did not differ when BD was added into the model, which overall explained 71% of the variance.

CONCLUSIONS

This study explored potential risk and protective factors associated with DE. The novel finding that diabetes distress is a strong indicator of DE provides preliminary support for its inclusion into future risk models and potential target for intervention. Longitudinal studies are required to map how these factors predict changes over time with greater emphasis needed into understanding the gender-specific risks associated with BD, particularly during more difficult developmental phases, such as adolescence to young adulthood.

Screening and identification of disordered eating in people with type 1 diabetes: A systematic review

People with Type 1 diabetes (T1D) have been shown to be an at-risk group for the development of disordered eating behaviours, however, the validity of tools used to assess disordered eating behaviours in T1D is unclear. This review aimed to identify tools used to screen or identify disordered eating behaviours and eating disorders in people with T1D, and evaluate the validity and reliability of these tools. A systematic search strategy was conducted to October 2019 according to the PRISMA guidelines. The search strategy retrieved 2714 articles, with 100 articles describing 90 studies included in the review. Studies were predominantly conducted in adolescent females in clinical settings. Forty-eight individual tools were used across retrieved studies. Overall, the quality of tools reported in included articles was poor, with high risk of bias due to the use of non-validated tools (n = 44 articles) and few studies comparing to the reference standard (n = 10 articles) of a diagnostic interview. This review shows that a variety of tools have been used to screen and identify disordered eating behaviours and eating disorders in people with T1D. Future research including comparison to a gold standard diagnostic interview is warranted to further evaluate the validity and reliability of available tools.

Disturbed Eating Behaviors in Adolescents and Emerging Adults With Type 1 Diabetes: A One-Year Prospective Study

OBJECTIVE

Disturbed eating behavior (DEB) is prevalent in youth with type 1 diabetes and is accompanied by an increased risk for complications, morbidity, and mortality. Prospective studies on DEB in the challenging transition to adulthood are scarce. This longitudinal study examined DEB over a 1-year period and investigated the directionality of effects linking DEB to diabetes-specific functioning and depressive symptoms in adolescents and emerging adults.

RESEARCH DESIGN AND METHODS

Three hundred youth (16-28 years old) with type 1 diabetes participated in a two-wave longitudinal study. Questionnaires measured DEB (Diabetes Eating Problem Survey-Revised [DEPS-R]), self-management, diabetes distress, and depressive symptoms. HbA_1c values were obtained from physicians. Mixed ANOVA and cross-lagged analysis were used to examine prospective changes and directionality of effects, respectively.

RESULTS

Mean DEB remained stable in the total sample, but significant individual differences were observed based on the cutoff score of the DEPS-R: 19% displayed persistent DEB and 8% increased and 7.3% decreased in DEB over time. The remaining individuals scored low on DEB over time. These four groups were differentiated based on insulin restriction, omission, diabetes-specific functioning, and depressive symptoms. Cross-lagged analyses indicated that DEB predicted relative increases in depressive symptoms over time, whereas reciprocal associations with glycemic control were found.

CONCLUSIONS

This longitudinal study highlights the substantial impact DEB may have in the transition to adulthood, with a substantial portion of youth with type 1 diabetes being at risk for clinical DEB. Prospective pathways linking DEB to functioning were found, emphasizing the clinical relevance of assessing DEB over time.

Zebrafish models of diabetes-related CNS pathogenesis

Diabetes mellitus (DM) is a common metabolic disorder that affects multiple organ systems. DM also affects brain processes, contributing to various CNS disorders, including depression, anxiety and Alzheimer's disease. Despite active research in humans, rodent models and in-vitro systems, the pathogenetic link between DM and brain disorders remains poorly understood. Novel translational models and new model organisms are therefore essential to more fully study the impact of DM on CNS. The zebrafish (Danio rerio) is a powerful novel model species to study metabolic and CNS disorders. Here, we discuss how DM alters brain functions and behavior in zebrafish, and summarize their translational relevance to studying DM-related CNS pathogenesis in humans. We recognize the growing utility of zebrafish models in translational DM research, as they continue to improve our understanding of different brain pathologies associated with DM, and may foster the discovery of drugs that prevent or treat these diseases.

Parental assessment of disordered eating behaviors in their children with type 1 diabetes: A controlled study

OBJECTIVE

The purpose of this research is to examine the presence of disordered eating behaviors (DEBs) in youths with type 1 diabetes (T1D) according to their parents' evaluations. The roles of demographic and diabetes-related variables were also analyzed.

METHODS

In 54 patients with T1D (aged 10.07-15.08) and in 54 age- and gender-matched healthy controls, DEBs were assessed using a parent-report standardized measure. BMI was calculated from height and weight. Glycemic control was assessed based on the most recent glycosylated hemoglobin value (HbA1c). The association of demographic and clinical factors with DEBs was evaluated through correlation and linear regression analyses.

RESULTS

DEBs were observed more frequently in participants with T1D (33.3%) than in controls (11%) (χ² = 6.501, p = .04). The clinical sample obtained a higher score than controls in PEBEQ total score (t(106) = 2.464, p = .01), as well as in the Exaggerated interest in food (t(106) = 2.723, p = .008) and Rejection/disinterest in food subscales (t(106) = 2.216, p = .01). No gender differences were observed. In participants with T1D, but not in controls, PEBEQ total score was positively correlated with age (r = 0.203, p = .04), HbA1c (r = 0.335, p = .01), and zBMI (r = 0.298, p = .002); HbA1c (standardized beta =0.284, p = .04) was found to uniquely predict the PEBEQ total score.

CONCLUSION

Parents' evaluations may contribute to prompt detection of DEBs, which is crucial in developing appropriate strategies for timely intervention, especially during adolescence.

Associations between self-reported diabetes mellitus, disordered eating behaviours, weight/shape overvaluation, and health-related quality of life

BACKGROUND

Eating disorders (ED) and disordered eating behaviours (DEB) have been found to be common in people with diabetes mellitus (DM). However, findings have been inconsistent.

OBJECTIVE

This study investigated the association between self-reported diabetes (Type 1 or 2) with ED/DEB (binge eating, subjective binge eating or loss of control overeating, severe dieting and purging) weight/shape overvaluation, and health-related quality of life (HRQoL) in a household survey in South Australia.

METHOD

In 2017 2977 people aged ≥15 years, who were representative of the general population, were interviewed. Participants reported their gender, age, household income, highest educational attainment, area of residence, presence of DM, ED/DEB, level of overvaluation, current HRQoL and height and weight. For the analyses between ED/DEB, self-reported DM and HRQoL, a grouping variable was created: 1) people without ED/DEB or self-reported DM; 2) people without ED/DEB and with self-reported DM; 3) people with ED/DEB and without self-reported DM; and 4) people with ED/DEB and self-reported DM. Analyses were stratified by sex and age group.

RESULTS

Subjective binge eating prevalence was higher in people with self-reported DM (6.6% vs 2.8%, p = 0.016), and overvaluation was lower in those with DM (36% vs 43.8%, p = 0.007). In analyses stratified by sex and age group, subjective binge eating was higher in women and in people over 45 years with self-reported DM and overvaluation was lower in men and in people over 45 years with self-reported DM. However, these differences were not significant on tests of gender and age interaction. People in both DM groups scored significantly lower than people without DM groups on physical HRQoL. In contrast, people in both ED/DEB groups scored lower than people without ED/BEB on mental HRQoL.

CONCLUSION

People with self-reported DM had a higher prevalence of subjective binge eating, a lower prevalence of overvaluation and there were no significant effects of age or gender. Furthermore, participants with self-reported DM and comorbid ED or DEB had impairments of both mental and physical HRQoL. Assessing an individual's sense of control over eating along with other DEB is likely important for identification of these mental health problems.