Eating disorders are most often associated with female teenagers or young adults. But did you know it’s more common than you think in patients living with diabetes. The Incidence of eating disorders among type 1 DM is 2.5 times more likely than those without diabetes. Type 2 DM has an increased risk of Binge Eating Disorder. What has become a startling trend is disordered eating among women between the ages of 45-70 with diabetes.
There are three main types of eating disorders (ED); Anorexia nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorder (BED). All are recognized by the Diagnostic criteria of Mental health disorders. Other mental health diagnoses may co- exist such as depression, manic depression, anxiety, bi polar disorder, mood disorders, obsessive compulsive disorders (OCD), etc. AN is a behavior of restriction of fluid and energy from food which leads to starvation and eventually death. Although AN is rare, it has the highest mortality of all the types of ED. BN is when an individual consumes large quantities of food (binge), in a short period of time followed by a compensatory behavior to rid the body of the excess calories/food intake. These behaviors may include purging in the form of vomiting, laxatives, diuretics, diet pills, appetite suppressants, restrictive food behaviors, starvation, manipulation of diabetes medication and excessive exercise. BED is the most common type of eating disorder. BED is very much like BN without the compensatory activities and can lead to fluctuations in blood glucose, weight gain, heightened anxiety, dyslipidemia, hypertension or exacerbation of these.
So how can you spot disordered eating or a possible eating disorder in a person living with diabetes? Red flags include frequent hypoglycemia, recurrent episodes of DKA with hospitalization, purging behaviors, significant changes to weight or self-harm behaviors. Other clues include comments such as “I need to lose weight/ I need to control my weight”, “I need to control my eating/food intake”, “ I feel fat”. Explore dietary changes recently made such as following the latest diet trends ( keto, low carb, etc.) or exercise programs. (PX 90, Cross fit, etc.) Ask patients if they struggled with or have ever been diagnosed with an eating disorder.
Providing weight-neutral education and training and referring to appropriate specialists is key for this population. Weight-neutral care focuses on establishing self-care behaviors. It doesn’t promote restriction, endorse unsustainable exercise, or encourage disordered eating as a way to “get healthy.”
To gain more insight on this topic, visit Weight Neutral 4 Diabetes at: https://wn4dc.com