Chronic Illness and Disordered Eating : A Discussion of the Literature 1 , 2

This paper describes the prevalence of eating disorders and disordered eating behaviors, the reasons why these practices are endorsed, and the potential consequences in youths and young adults with selected diet-related chronic health conditions (DRCHCs) and provides recommendations for eating disorder prevention interventions and research efforts. Although it remains unclear whether the prevalence of eating disorders is higher in those with DRCHCs compared with the general population, overall findings suggest that young people with DRCHCs may be at risk of endorsing disordered eating behaviors that may lead to diagnosis of an eating disorder and other health problems over the course of their treatment. Thus, health care providers should be aware that young people with DRCHCs may be at risk of eating disorders and carefully monitor psychological changes and the use of unhealthy weight control methods. It is also important to develop and evaluate theory-based interventions and disease-specific eating disorder risk screening tools that are effective in halting the progression of eating disorders and negative health outcomes in young people with chronic health conditions. Adv. Nutr. 4: 277–286, 2013. Introduction Chronic illnesses are increasing and constitute a major public health problem (1). The increased incidence and prevalence of chronic illnesses is in part due to medical advances that have increased the life expectancies of young people with chronic diseases (i.e., 85% of children with congenital or chronic health conditions now survive to adolescence) (2). Chronic health conditions are defined as having a biological, psychological, or cognitive basis, as lasting or are expected to last for at least 1 y, producing signs and symptoms that may limit function and activities, and requiring medical care or related services (3). Currently, 1 of 10 inschool adolescents have a chronic illness or disability that limits their ability to perform daily functions (4–6). Coping with chronic health conditions during the adolescent years, a time of rapid growth and development that accompanies key socialization and individuation processes, is a critical challenge for adolescents and their family members and health care teams (7). For instance, medical treatments may retard normal growth and result in shorter stature, delayed onset of puberty, and malnutrition (i.e., poor weight management) (2,6,7). Visible signs of illness may cause embarrassment, which can lead to body image disturbances that have harmful consequences, such as the development of disordered eating behaviors (8,9), eating disorders (10), and other harmful outcomes (9,11). Treatment and optimal management of diet-related chronic health conditions (DRCHCs) [e.g., cystic fibrosis, type 1 diabetes, inflammatory bowel disease (IBD), irritable bowel syndrome (IBS)] necessitate that patients adhere to a prescribed dietary regimen, usually on a lifelong basis. Compliance with these regimens presents many pressures that may cause youths to develop destructive attitudes toward food and body weight as well as unhealthy eating habits. Individuals with these health conditions likely need to be more concerned about their body weights and/or dietary prescriptions than healthy peers if they are to engage in practices that protect their health (12). However, increased concern may precipitate disordered eating (e.g., binge eating, strict 1 Financial support: Kappa Omicron Nu Research Fellowship and the Eunice Kennedy Shriver National Institute of Child Health and Human Development Intramural Research Training Award to V. M. Quick. 2 Author disclosures: V. M. Quick, C. Byrd-Bredbenner, and D. Neumark-Sztainer: no conflicts