Profiles of disordered eating behaviour in type 1 diabetes using the DEPS-R and behaviour and glycaemic outcomes in a real-life setting.

AIMS: The Diabetes Eating Problems Survey - Revised (DEPS-R) is commonly used to assess disordered eating behaviour (DEB) in individuals with type 1 diabetes and has advantages compared to other measures not specifically tailored to diabetes. A score ≥20 on the DEPS-R is used to indicate clinically significant DEB; however, it does not distinguish between eating disorder (ED) phenotypes necessary to guide treatment decisions, limiting clinical utility. METHODS: The current study used latent class analysis to identify distinct person-centred profiles of DEB in adults with type 1 diabetes using the DEPS-R. Analysis of Variance with Games Howell post-hoc comparisons was then conducted to examine the correspondence between the profiles and binge eating, insulin restriction and glycaemic control (HbA1c, mean blood glucose, and percent time spent in hyperglycaemia) during 3 days of assessment in a real-life setting. RESULTS: Latent class analysis indicated a 4-class solution, with patterns of item endorsement suggesting the following profiles: Bulimia, Binge Eating, Overeating and Low Pathology. Differences in binge eating, insulin restriction and glycaemic control were observed between profiles during 3 days of at-home assessment. The Bulimia profile was associated with highest HbA1c and 3-day mean blood glucose. CONCLUSIONS: There are common patterns of responses on the DEPS-R that appear to reflect different ED phenotypes. Profiles based on the DEPS-R corresponded with behaviour in the real-life setting as expected and were associated with different glycaemic outcomes. Results may have implications for the use of the DEPS-R in research and clinical settings.

The association between negative body talk and body shame on disordered eating symptoms among college students.

Negative body talk (NBT), defined as negative communication about one's body, is associated with disordered eating, yet factors that may enhance these effects are understudied. Using objectification theory as a framework, NBT may reflect a vocal manifestation of self-objectification and endorsement of body shame may enhance the association between NBT and disordered eating. Given relatively consistent NBT and objectification theory-based conclusions across male and female college samples, the current study hypothesized that for college students high in body shame, NBT would be more strongly associated with disordered eating than for those low in body shame. A total of 849 college students (77.4 % female) completed measures of NBT (sex-specific), body shame, and eating disorder symptoms. Negative binomial regressions tested hypotheses separately by sex. Moderation results identified that the association between NBT and eating disorder symptoms was stronger for females reporting lower body shame compared to higher body shame. Among males, only significant main effects of NBT and body shame were observed. Body image and disordered eating preventive interventions may benefit from targeting NBT and/or body shame in males and females, and college females reporting lower body shame may be at greatest risk for the negative impact of NBT.

Weight Stigma and Mental Health in Youth: A Systematic Review and Meta-Analysis.

OBJECTIVE: Over the past two decades, there has been a steady increase in research focused on the association between weight-based stigma and mental health outcomes in children and adolescents. The present study is a systematic review and meta-analysis of the associations between weight stigma and mental health in youth. METHODS: A systematic search of PubMed, PsychInfo, and Embase databases was conducted in January 2020. Inclusion criteria included the following: (a) examined an association between weight stigma and a mental health outcome, (b) mean sample age <18 (+1 standard deviation) years, (c) written in English, and (d) peer reviewed. Forty eligible articles were identified. The moderating effects of age, sex (percent female), weight status (percent with overweight/obesity), and study quality were examined. RESULTS: Overall, meta-analytic findings using a random-effects model indicated a statistically significant moderate association between weight stigma and poorer mental health outcomes (r = .32, 95% confidence interval [0.292, 0.347], p < .001). Age and study quality each moderated the association between weight stigma and mental health. Generally, the study quality was fair to poor, with many studies lacking validated measurement of weight stigma. CONCLUSIONS: Although there was a significant association between weight stigma and mental health in youth, study quality hinders the current body of literature. Furthermore, findings highlight the lack of consideration of internalized weight stigma in child populations, the importance of using validated measures of weight stigma, and the need for increased awareness of how these associations affect populations of diverse backgrounds.

Use of Ecological Momentary Assessment to Measure Self-Monitoring of Blood Glucose Adherence in Youth With Type 1 Diabetes.

OBJECTIVE: Daily self-monitoring of blood glucose (SMBG) is essential for type 1 diabetes management yet is challenging during adolescence. Ecological momentary assessment (EMA) is the repeated sampling of behaviors and experiences in real time in the natural environment. The purpose of this study was to evaluate 1) the validity of self-reported SMBG values via text message-delivered EMA surveys compared with objective SMBG values via glucose meters and 2) in-the-moment motivators and barriers to performing SMBG in a pediatric type 1 diabetes population. METHODS: Youth (n = 62, aged 11-21 years) with type 1 diabetes received three text messages daily for 10 days containing surveys inquiring about SMBG engagement. Objective SMBG values were downloaded from glucose meters. RESULTS: On average, participants reported performing SMBG 4 times/day. Of the self-reported SMBG values, 39.6% were accurate. Inaccurate values included additions (i.e., self-reported value with no objective value), omissions (i.e., objective value with no self-reported value), and alterations (difference between self-report and objective SMBG values ≥10 mg/dL). Of the matched pairs of self-reported and objective SMBG values, 41.3% were altered. Bland-Altman plots determined that the mean difference between self-reported and objective glucose data were -5.43 mg/dL. Participants reported being motivated to check their blood glucose because it was important for their health, and reported barriers included wanting to ignore the task, forgetting, and not having devices. CONCLUSION: Youth's self-reported SMBG values may not align with objective readings. The results of this study can facilitate future research to determine individual factors related to SMBG and accuracy of self-reporting.

The use of internet sources for nutritional information is linked to weight perception and disordered eating in young adolescents.

The internet serves as an accessible and confidential resource for young adolescents seeking nutritional information. However, the quality of information retrieved online is mixed and could have serious implications for users. Young adolescents who perceive themselves as overweight may be disproportionately affected as they are at greater risk for disordered eating. The current study aimed to (1) assess whether the frequency of use of different internet sources to obtain nutritional information differs between healthy weight young adolescents and those with overweight/obesity based on both objective and perceived weight status and (2) evaluate the relationships between different internet sources utilized for nutritional information and disordered eating. Young adolescents (n = 167; 10-15 years) completed the Children's Eating Attitudes Test (ChEAT; total disordered eating), indicated their perceived weight status, and reported how often they obtained nutritional information from the following internet sources: professional websites, personal websites, social media, commercial weight loss websites, and forums. Objective height and weight measurements were obtained. Young adolescents that perceived themselves to be a little overweight or overweight reported greater use of personal websites (p = .012), commercial weight loss websites (p = .011), and social media (p = .019) for nutritional information than those that did not perceive themselves to be a little overweight or overweight. The frequency of use of internet sources for nutritional information did not differ based on objective weight status. Greater use of each of the internet sources for nutritional information was related to greater disordered eating (p's < 0.05). While longitudinal research is needed to further examine these relationships, healthcare providers and teachers should provide young adolescents with guidance for interpreting and using online nutritional information to encourage valid and reliable health recommendations.

Family functioning mediates the relationship between child behavior problems and parent feeding practices in youth with overweight or obesity.

Parental feeding practices play a significant role in children's health behaviors. Given the high prevalence of childhood obesity, it is important to examine factors that may influence parental feeding practices. This study examined the role of family functioning on the relationship between child behavior problems and parent feeding practices. We hypothesized that higher problematic child behavior would correlate with lower parental engagement in healthy parent feeding practices, with greater family dysfunction mediating that relationship. Participants (n = 220) were rural-dwelling parents of school-aged children with overweight or obesity. Participants completed the McMaster Family Assessment Device, Child Behavior Checklist (CBCL), and Child Feeding Questionnaire at baseline. Mediation models were used with youth behavioral problems (CBCL) as the independent variable, parental feeding practices as the dependent variable, and family functioning as the mediator. Two significant mediation models revealed (a) family functioning mediated the relationship between child behavior problems and parental perception of responsibility taking for child eating, and (b) family functioning mediated the relationship between child behavior problems and parental monitoring of their child's eating. More child behavior problems were associated with unhealthier family functioning, which was associated with less parental monitoring of children's unhealthy food intake and reduced responsibility taking for feeding and meal planning of their children. These findings suggest the synergistic effect of child behavior problems with poorer family functioning may be a risk factor for unhealthy parent feeding practices in children with overweight or obesity. If these relationships are supported by longitudinal research, behavior interventions for children with obesity should consider poor family functioning and child behavior as potential barriers to parental monitoring and responsibility of children's feeding practices.

Perceptions of Health Behaviors and Mobile Health Applications in an Academically Elite College Population to Inform a Targeted Health Promotion Program.

BACKGROUND: College is a critical developmental time when many emerging adults engage in unhealthy behaviors (i.e., lack of exercise, poor diet, smoking) and consequently experience an increased risk for a decline in cardiovascular health. Understanding the beliefs and opinions of the target population is important to develop effective health promotion interventions. The goal of this study was to understand opinions regarding health and health-related mobile technology of college students at an academically elite Midwestern university in order to inform a mobile health promotion intervention following the integrated behavioral model framework. METHOD: Eighteen college students between the ages of 18 and 22 participated in one of four focus groups, where they discussed perceptions of health behaviors, technology use, and their college environment. Data were analyzed using inductive thematic analysis as well as consensus and conformity analysis. RESULTS: Students reported prioritizing academic success over health and believed in a cultural norm within the university that unhealthy behavioral practices lead to increased academic success. Other identified barriers to achieving good health were (a) low self-efficacy for engaging in healthy behaviors when presented with conflicting academic opportunities and (b) low estimation of the importance of engaging in health behaviors. Regarding mobile health applications (apps), students reported preferring apps that were visually attractive, personalized to each user, and that did not involve competing against other users. CONCLUSION: These results have implications for the development of mobile health promotion interventions for college students, as they highlight facilitators and barriers to health behavior change in an academically elite student body.

Objectively Measured Adherence in Adolescents With Type 1 Diabetes on Multiple Daily Injections and Insulin Pump Therapy.

Objectives: Type 1 diabetes (T1D) poses unique challenges to adherence-related behavior because of complex treatment regimens that vary by use of specific technologies. This study used objective data to determine (1) prevalence rates of adherence behaviors in adolescents with T1D, and (2) relationships between adherence and glycemic control. Methods: Data were downloaded for the past 30 consecutive days from glucose meters and multiple insulin pump models for 80 youth (11-17 years old; n = 40 on multiple daily injections (MDIs) and n = 40 on continuous subcutaneous insulin infusion [CSII]). Frequency of self-monitoring of blood glucose (SMBG; MDI and CSII users); carbohydrate entry (CSII users); daily insulin bolus delivery (CSII users); episodes of high, very high, and dangerously high hyperglycemia; and correction bolusing for hyperglycemia (CSII users) were calculated. Results: Participants completed SMBG ≥4 times/day on 46.13% of days (MDI users), 48.74% of days (CSII users nonmanual entries only), and 59.07% of days (CSII users; manual plus nonmanual entries). CSII users entered carbohydrates ≥3 times/day on 61.47% of days and bloused insulin ≥3 times/ day on 87.34% of days. Hyperglycemic readings were followed by a correction bolus in <70% of cases. Greater SMBG, carbohydrate entry, bolus insulin delivery, and correction bolusing for high and very high hyperglycemia predicted lower glycated hemoglobin (sample M = 8.74%, SD = 1.75%). Conclusions: Objective data from diabetes technology are helpful to differentiate adherence to specific domains of treatment but are complex in nature. Findings support a need for further research to elucidate predictive factors of suboptimal adherence in adolescents with T1D.

Physical activity: a synopsis and comment on "community-wide interventions for increasing physical activity".

In this synopsis, we summarize and comment on Baker and colleagues' Cochrane review of studies on the population-level impact of community-wide physical activity (PA) interventions. Insufficient PA remains a major public health problem. Community-wide interventions offer an opportunity to extend reach by increasing the proportion of the population experiencing the intervention. A previous Cochrane review of community-wide PA interventions concluded that evidence for effectiveness was mixed. Hence, Baker and colleagues incorporated new data about community-based PA interventions. This Cochrane review concluded there is an overall lack of evidence that community-wide interventions improve PA outcomes at the population level. Recommendations are that future research should use high quality research design, more explicitly test ways to increase reach, and utilize objective measurements of PA to increase validity. We suggest that future research should first optimize the intervention by systematically evaluating treatment components and selecting a maximally efficient and effective treatment package.