Disturbed eating behaviors in adolescents with type 1 diabetes. How to screen for yellow flags in clinical practice?

Minke M.A. Eilander, Maartje de Wit, Joost Rotteveel, Henk Jan Aanstoot, Willie M. Bakker-van Waarde, Euphemia C.A.M. Houdijk, Roos Nuboer, Per Winterdijk, Frank J. Snoek

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21 Citations (Scopus)


Background: Adolescents with type 1 diabetes are at an increased risk of disturbed eating behaviors (DEBs). Objective: The aims of this study are to (i) explore the prevalence of DEBs and associated ‘yellow flags’, and (ii) establish concordance between adolescents–parents and adolescents–clinicians with respect to DEBs. Methods: Adolescents (11–16 yr) and parents completed questionnaires. A stepwise approach was used to assess DEBs: only adolescents whose answers raised psychological yellow flags for DEBs completed the Diabetes Eating Problems Scale – Revised and questions from the AHEAD study. Parents and clinicians shared their observations regarding possible DEBs. Kruskal–Wallis tests, post hoc Mann–Whitney U test, and chi-squared tests were utilized to examine clinical yellow flags. Cohen's kappa was used to assess concordance. Results: Of 103 adolescents participated (51.5% girls), answers of 47 (46.5%) raised psychological yellow flags, indicating body and weight concerns. A total of 8% scored above cut-off for DEBs. Clinical yellow flags were elevated glycated hemoglobin A1c (p = 0.004), older age (p = 0.034), dieting frequency (p = 0.001), reduced quality of life (p = 0.007), less diabetes self-confidence (p = 0.015), worsened diabetes management (p < 0.001), and body dissatisfaction (p < 0.001). Body Mass Index (BMI) z-scores and gender were no yellow flags. Concordance between parents and adolescents was slight (k = 0.126 and 0.141), and clinicians and adolescents was fair (k = 0.332). Discussion: Half of the adolescents reported body and weight concerns, less than 1 in 10 reported DEBs. Screening for yellow flags for DEBs as a part of clinical routine using a stepwise approach and early assistance is recommended to prevent onset or deterioration of DEBs.

Original languageEnglish
Pages (from-to)376-383
Number of pages8
JournalPediatric diabetes
Issue number5
Early online date30 Jun 2016
Publication statusPublished - 1 Aug 2017


  • Adolescent
  • Adolescent Behavior
  • Body Dysmorphic Disorders/complications
  • Child
  • Child Behavior
  • Cost of Illness
  • Cross-Sectional Studies
  • DINO study
  • Diabetes Mellitus, Type 1/complications
  • Early Diagnosis
  • Feeding and Eating Disorders of Childhood/complications
  • Feeding and Eating Disorders/complications
  • Female
  • Humans
  • Longitudinal Studies
  • Male
  • Netherlands/epidemiology
  • Parent-Child Relations
  • Parents
  • Patient Compliance
  • Physician-Patient Relations
  • Prevalence
  • Psychiatric Status Rating Scales
  • Risk Factors
  • Self Concept
  • Self-Management
  • adolescents
  • disturbed eating behavior
  • quality of life
  • type 1 diabetes

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