Strict diets required for chronic disease management may increase risk of unhealthy eating behaviors

Young women with diseases that require them to adhere to a strict diet may be more vulnerable to a range of eating disturbances that varies depending on the disease, according to the results of a small study.

Eating disturbances are unhealthy eating attitudes and behaviors that are not severe enough to qualify as full-blown eating disorders.

Previous studies noted that eating disorders occur more frequently in women with diabetes, but this study, which focused on women with phenylketonuria (PKU) as well as on women with Type 1 diabetes, attempts to take a broader look at the association between eating-disordered behavior and chronic diseases.

Individuals with both Type 1 diabetes and PKU, a hereditary condition in which an amino acid found in protein-containing foods can't be properly metabolized, must adhere to strict diet regimens. Since diabetics don't produce enough insulin, a hormone that helps the body regulate carbohydrate metabolism, they must carefully monitor food intake. Individuals with PKU have to restrict severely their consumption of protein-rich foods like meat, eggs, and milk, and also certain fruits, vegetables, and grains.

Deviation from diet regimens carries serious health risks for both groups. Diabetics who deviate are at increased risk for vascular complications like heart disease, and individuals with PKU who don't adhere to their diets can develop brain damage.

A statistically comparable number of the 54 study participants with diabetes and the 30 study participants with PKU demonstrated symptoms of eating-disordered behavior, according to authors Joan C. Chrisler, PhD, and Jeanne E. Antisdel, MA, of Connecticut College, in New London, CT. Specifically, 33 percent of those with diabetes and 23 percent of those with PKU exhibited such symptoms.

Certain types of eating problems were more common within each group. Preoccupation with avoiding fattening foods and with weight loss was more common among study participants with diabetes, whereas PKU sufferers were more likely to be preoccupied with self-control around food. They were also more likely to perceive that others were pressuring them to gain weight.

Diabetics with eating problems had lower self-esteem and a more negative body image compared to those without such problems. They were also less vigilant about monitoring blood sugar levels, following a meal plan, and properly treating hypoglycemia. PKU study participants with eating problems demonstrated poorer psychological judgement as well as lower self-esteem, the researchers found. Their study findings appear in the April issue of the Journal of Developmental and Behavioral Pediatrics.

"Although the symptoms of disordered eating among our participants were not as severe as those of patients with eating disorders, they were more intense than those reported by nonclinical samples," said Chrisler.

"Clinicians who work with adolescents and young women with diabetes or PKU should be alert for signs of disordered eating that might interfere with their patients' health status," she added.

This research was supported in part by the National Institutes of Health through a National Research Service Award Institutional Training Grant.

The Journal of Developmental and Behavioral Pediatrics is published bimonthly by the Society for Developmental and Behavioral Pediatrics. For information about the journal, contact Mary Sharkey at (212) 595-7717.

Posted by the Center for the Advancement of Health < http://www.cfah.org >. For information about the Center, call Petrina Chong, < pchong@cfah.org > (202) 387-2829.