Disordered Eating Behaviors and Psychological Distress in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study from Tunisia
9 affiliations
- 1Research Unit on Obesity UR18ES01, Faculty of Medicine, University Tunis El Manar, 15 Rue Jebel Lakhdar, Beb Saadoun, Tunis 1007, Tunisia
- 2Faculty of Medicine, University of Tunis El Manar, Tunis, 11 Rue Jebel Lakhdar, Beb Saadoun, Tunis 1007, Tunisia
- 3National Institute of Nutrition and Food Technology of Tunis, 11 Jbal Lakhdar Street, Tunis 1007, Tunisia
- 4Higher Institute of Sport and Physical Education of Ksar Said, University of Manouba, Manouba 2010, Tunisia
- 5Physical Activity Research Unit, Sport and Health (UR18JS01), National Observatory of Sports, Tunis 1003, Tunisia
- 6Physical Education and Sports Teaching Department, Faculty of Sports Sciences, Atatürk University, Erzurum 25240, Türkiye
- 7Health Services Vocational School, Atatürk University, Erzurum 25240, Türkiye
- 8Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
- 9Department of Physical Education and Sport, Faculty of Sciences, Physical Education and Informatics, National University of Science and Technology Politehnica Bucharest, Pitești University Center, 060042 Pitești, Romania
Abstract
Background: Disordered eating behaviors (DEBs) and psychological distress may complicate type 2 diabetes mellitus (T2DM) care. Objective: To estimate the frequency of DEB screening positivity and examine associated characteristics in a Tunisian T2DM clinic sample. Methods: This cross-sectional study included 400 adults assessed between January and April 2023 using the Sick, Control, One stone, Fat, Food (SCOFF) questionnaire; Bulimic Investigatory Test Edinburgh (BITE); four-item Perceived Stress Scale (PSS-4); and Hospital Anxiety and Depression Scale (HADS). Exploratory analysis estimated crude prevalence ratios (PRs). Adjusted odds ratios (aORs) came from a logistic model including age, sex, body mass index (BMI), diabetes duration, and PSS-4. Separate secondary models replaced PSS-4 with the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) or depression subscale (HADS-D). Results: DEB positivity was 26.8% (107/400; 95% confidence interval [CI], 22.6–31.3%). Crude DEB prevalence was higher in women than men (30.4% versus 19.2%; PR, 1.58; 95% CI, 1.06–2.35), in participants with HADS-A ≥11 versus <11 (PR, 2.28; 95% CI, 1.64–3.17), and with HADS-D ≥11 versus <11 (PR, 1.49; 95% CI, 1.08–2.05). In the primary adjusted model, DEB positivity was associated with younger age (aOR per year, 0.952; 95% CI, 0.922–0.982), higher BMI (aOR per kg/m2, 1.083; 95% CI, 1.042–1.126), and higher PSS-4 (aOR per point, 1.133; 95% CI, 1.067–1.203). HADS scores were positively associated in separate adjusted models. Glycated hemoglobin (HbA1c) was high in both groups (10.36% versus 9.91%; difference, 0.45 percentage points; 95% CI, −0.01 to 0.92). Conclusions: Approximately one-quarter of this clinic sample had a positive DEB screen. Associations with psychological symptoms support attention to eating concerns and emotional well-being in diabetes care. However, cross-sectional data limit causal interpretation, and future longitudinal studies are warranted.
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BibTeX
@article{othman2026disordered,
title = {{Disordered Eating Behaviors and Psychological Distress in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study from Tunisia}},
author = {Rym Ben Othman and Syrine Trabelsi and Ismail Dergaa and Halil İbrahim Ceylan and Deniz Öztürk and Nicola Luigi Bragazzi and Yasmine Jallouli and Valentina Stefanica and Henda Jamoussi},
journal = {Journal of Clinical Medicine},
year = {2026},
month = oct,
doi = {10.3390/jcm15208115},
url = {https://www.mdpi.com/2077-0383/15/20/8115},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Disordered Eating Behaviors and Psychological Distress in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study from Tunisia
AU - Rym Ben Othman
AU - Syrine Trabelsi
AU - Ismail Dergaa
AU - Halil İbrahim Ceylan
AU - Deniz Öztürk
AU - Nicola Luigi Bragazzi
AU - Yasmine Jallouli
AU - Valentina Stefanica
AU - Henda Jamoussi
PY - 2026
DA - 2026/10/01
JO - Journal of Clinical Medicine
DO - 10.3390/jcm15208115
UR - https://www.mdpi.com/2077-0383/15/20/8115
AB - Background: Disordered eating behaviors (DEBs) and psychological distress may complicate type 2 diabetes mellitus (T2DM) care. Objective: To estimate the frequency of DEB screening positivity and examine associated characteristics in a Tunisian T2DM clinic sample. Methods: This cross-sectional study included 400 adults assessed between January and April 2023 using the Sick, Control, One stone, Fat, Food (SCOFF) questionnaire; Bulimic Investigatory Test Edinburgh (BITE); four-item Perceived Stress Scale (PSS-4); and Hospital Anxiety and Depression Scale (HADS). Exploratory analysis estimated crude prevalence ratios (PRs). Adjusted odds ratios (aORs) came from a logistic model including age, sex, body mass index (BMI), diabetes duration, and PSS-4. Separate secondary models replaced PSS-4 with the Hospital Anxiety and Depression Scale anxiety subscale (HADS-A) or depression subscale (HADS-D). Results: DEB positivity was 26.8% (107/400; 95% confidence interval [CI], 22.6–31.3%). Crude DEB prevalence was higher in women than men (30.4% versus 19.2%; PR, 1.58; 95% CI, 1.06–2.35), in participants with HADS-A ≥11 versus <11 (PR, 2.28; 95% CI, 1.64–3.17), and with HADS-D ≥11 versus <11 (PR, 1.49; 95% CI, 1.08–2.05). In the primary adjusted model, DEB positivity was associated with younger age (aOR per year, 0.952; 95% CI, 0.922–0.982), higher BMI (aOR per kg/m2, 1.083; 95% CI, 1.042–1.126), and higher PSS-4 (aOR per point, 1.133; 95% CI, 1.067–1.203). HADS scores were positively associated in separate adjusted models. Glycated hemoglobin (HbA1c) was high in both groups (10.36% versus 9.91%; difference, 0.45 percentage points; 95% CI, −0.01 to 0.92). Conclusions: Approximately one-quarter of this clinic sample had a positive DEB screen. Associations with psychological symptoms support attention to eating concerns and emotional well-being in diabetes care. However, cross-sectional data limit causal interpretation, and future longitudinal studies are warranted.
SN - 2077-0383
ER -