Assessing the Prevalence of and Risk Factors for Disordered Eating Attitudes and Behaviors in Adolescents with Inflammatory Bowel Disease

Adolescents living with inflammatory bowel disease (IBD) have a higher incidence of internalizing disorders, lower quality of life, and impaired social functioning relative to healthy peers. ¹ Medical and psychosocial risk factors for eating pathology and body image concerns also affect youth with IBD, including medical hyperfocus on weight, medically related food restriction, body image uncertainty, and societal praise of thinness despite health issues. ² Treatment-related risk factors may increase vulnerability to eating pathology and poor body image, including adverse effects of steroids and psychosocial sequelae related to surgery/medical devices (eg, body dissatisfaction after surgery).

Adults with IBD have reported high rates of body image dissatisfaction (BID) ³ ; however, few studies have examined prevalence rates among adolescents with IBD. In a review of BID and disordered eating behaviors in pediatric chronic illnesses, 53% and 16% of patients with cystic fibrosis were found to have disordered eating attitudes and disordered eating behaviors, respectively, and patients with type 1 diabetes were more than twice as likely as healthy peers to engage in disordered eating behaviors. ² A recent study of BID in newly diagnosed pediatric IBD found that older age, worse patient-reported disease status, and greater depressive symptoms were associated with higher levels of BID. ⁴ The understanding of BID concerns in pediatric IBD beyond initial diagnosis is unknown and remains essential to care planning for medications and surgery. In addition to BID, young people with IBD may be at risk for disordered eating behaviors, though there is little known about this prevalence.

Adolescents with IBD who experience BID and disordered eating are vulnerable for poor outcomes given their need to maintain healthy nutritional status for growth and disease management. The current study assessed the prevalence of disordered eating attitudes and behaviors in adolescents with IBD and factors associated with disordered eating. Determining the prevalence in adolescents with IBD may help clinicians understand the extent of this problem. Discerning the contributions of the unique psychosocial and medical risk factors to this population may provide a framework for developing screening measures and interventions.