Development of a Weight Management Program for Teens With Type 1 Diabetes and Overweight/Obesity

Background: The prevalence of overweight and obesity among youth with type 1 diabetes mellitus (T1D) exceeds that of youth in the general population. Behavioral weight management interventions (BWIs) are evidence-based, first-line treatments for pediatric obesity, however there are unique challenges to T1D management that require thoughtful adaptations to BWIs. The purpose of this mixed-method study was to identify desired features for a BWI targeted to teens with T1D from key stakeholders (patients, caregivers, and providers). Methods: Individual semi-structured interviews were conducted with teens between the ages of 13-17 (n=12, mean age=15yrs, 58% female) with T1D and BMI>85th percentile, caregivers (n=12, 67% female), and providers (n=9, 56% male). Teens completed the Diabetes Eating Problem Survey Revised (DEPS-R) and Problem Areas in Diabetes (PAID-T). Descriptive statistics were calculated for quantitative data and qualitative data were analyzed using applied thematic analysis. Results: One-fourth of teens reported moderate to severe diabetes related distress on the PAID-T, and 67% reported clinical disordered eating behaviors on the DEPS-R. On the DEPS-R, 58% of teens endorsed "when I overeat, I don't take enough insulin to cover the food," and 92% endorsed "I feel that it's difficult to lose weight and control my diabetes at the same time." Qualitative analysis revealed that nearly all stakeholders expressed high interest in a future BWI for T1D. Teens and caregivers wanted a BWI to incorporate a) a peer-group format with opportunities to speak individually with a healthcare provider; b) topics related to mental health (e.g., diabetes burnout), c) tips for healthy eating and exercise engagement; and d) content that is not entirely framed around T1D. Out of all providers and caregivers, 18% expressed concern about discussing weight, while most teens reported interest in discussing weight and body image. Providers also expressed concern about the risk of disordered eating (i.e., insulin omission). Conclusions: Patients, caregivers, and providers are interested in a future BWI for T1D. Careful consideration of disordered eating behaviors and diabetes distress will be important to include in a future BWI for this population. Results from this study will inform the next steps in adapting a standard BWI specific to teens with T1D.