Diabetes-Related Stress, Perceived Stress, Coping Strategies, and Eating Behavior in Type 2 Diabetes

Although nutrition therapy is considered a cornerstone of type 2 diabetes (T2DM) treatment, there are a limited number of studies examining whether eating behavior is important in the treatment of T2DM. The goal of this study is to determine the relationships among stress (perceived stress and/or diabetes-related distress), coping strategies (task-, emotion-, and/or avoidance-oriented coping), and eating behavior (restrained-, external-, and/or emotional- eating behavior) in people with T2DM; and to test whether coping strategies mediate the relationships among stress and eating behavior in people with T2DM. This study was based on the Transactional Model of Stress and Coping and the theory of stress-induced eating that suggest that the eating behavior of those with T2DM is influenced by stress and coping mechanisms. A cross-sectional study design provided valuable information about the relationships among stress, coping strategies, and eating behavior in people with T2DM. One hundred eighty three people with T2DM, age 30 to 70 years, were recruited from the Chicago area. Participants completed self-reported administrative questionnaires: the 17-item Questionnaire on Diabetes Distress Scale (DDS), the 14-item Perceived Stress Scale (PSS), the 48-item Coping Inventory for Stressful Situations (CISS), and the 33-item the Dutch Eating Behavior Questionnaire (DEBQ). Path analysis was used to test specific direct and indirect relationships among diabetes-related stress, perceived stress, coping strategies, and eating behavior in people with T2DM. Results of the study indicated that perceived stress and diabetes-related stresses were positively associated with restrained-, external-, and emotional- eating behaviors. In addition, the results of this study suggest that only emotion-oriented coping was a mediator in the relationship between stress and eating behaviors. The proposed study will be beneficial to providers treating people with T2DM by alerting them to recognize whether patients have restrained-, external-, and/or emotional- eating behavior. Additionally, this will provide the foundation for the development of interventions designed to modify dysfunctional eating behaviors to healthy eating behaviors.