Examination and expansion of the entire modified dual pathway model of disordered eating among individuals with type 1 diabetes

Objective Disordered eating behaviors (DEB) are more common among adolescents with type 1 diabetes (T1D) relative to the general population, potentially influenced by disease-specific risk factors. This study aims to examine associations among proposed risk factors in the modified dual pathway model and to identify literature-supported adaptations to improve the model’s fit for adolescents with T1D. Methods The study included 215 adolescents and young adults with T1D (age 13–21years; 51.2% female). Data were collected from medical charts, diabetes device data, and self-report questionnaires assessing diabetes-specific dietary regimen, dietary restraint, body dissatisfaction, hunger disruption, diabetes-specific negative affect, and DEB. Multiple group path modeling tested the hypotheses. Results The original modified dual pathway model showed poor fit. However, adding a well supported, theory-based path and omitting nonsignificant paths improved model fit. Dietary restraint and diabetes-specific negative affect were significantly associated with DEB. Significant indirect paths to DEB emerged from a diabetes-specific dietary regimen via dietary restraint, and from body dissatisfaction via both dietary restraint and diabetes-specific negative affect. Conclusions This study supports the associations proposed in the modified dual pathway model and highlights the potential for targeted interventions addressing disease-specific risk factors for DEB, including diabetes-specific dietary regimen, dietary restraint, accelerated weight gain since T1D diagnosis, body dissatisfaction, and diabetes-specific negative affect in adolescents with T1D. These findings underscore the need for strategies that focus on the unique psychological and physiological challenges faced by this population. Longitudinal studies are needed to test the temporal ordering of constructs and identify mechanistic pathways for intervention.