Eating disorders in people with diabetes

People with diabetes are more likely to develop a eating disorder.

Eating disorders

« Eating disorders are complex, and are generally characterised by abnormal eating patterns, a strong fear of weight gain, and an intense preoccupation with body image » (ANEB Québec).

The main eating disorders (ED) are:

  • Anorexia nervosa (AN)
  • Bulimia nervosa (BN)
  • Binge eating disorder (BED)

What to watch for

In addition to major weight loss and an obsession about weight, these other behaviours should also ring alarm bells:

  • Eats very little, essentially only low-calorie foods (salads, vegetables, etc.)
  • Completely avoids certain food categories
  • Refuses to eat foods formerly liked
  • Skips meals
  • Eats alone
  • Takes laxatives 
  • Exercises excessively or compulsively
  • Doesn’t take insulin or cuts the dose to lose weight

A higher-than-normal level of glycated hemoglobin (A1C) that is difficult to explain can be a sign of restricted insulin doses. Repeatedly restricting one’s insulin can cause diabetic acidosis and increase the risk of developing diabetes complications later in life.

Some people with type 2 diabetes suffer from night eating syndome, which is characterized by the consumption of more than 25 % of one’s daily caloric intake after supper and by waking up at night to eat, at least 3 times per week. This syndrome can result in weight gain, poor glycemic control and an increase of diabetes complications. 

Diabetes: a risk factor

A multitude of factors contribute to the start, development and maintenance of eating disorders. Certain aspects of diabetes can be contributing factors.

Starting a diet can be a trigger for these disorders. Since a nutritional intervention is part of diabetes treatment, a teen already predisposed to developing an ED will be even more vulnerable if diabetic because managing the disease requires the intake of carbohydrates to be counted and the diet to be strictly controlled. (Pedwell, 2008, Diabetes Dialogue.)

Most people newly diagnosed with type 1 diabetes tend to gain weight when they begin treatment. Many of these people are simply regaining the weight lost because of the disease before their diagnosis. Insulin is a hormone that can promote the storage of body fat in sedentary people. It can also promote the development of muscle mass in physically active people, which can increase their weight on the scale. For some people, weight gain can be undesirable and make them feel that they are losing control of their bodies.

A chronic disease like diabetes can be stressful. Some mental health specialists believe that one of the functions of an eating disorder is to deal with painful emotions that are difficult to control. Thus, stress and emotions can play a role in the development or maintenance of an ED. (Pedwell, 2008, Diabetes Dialogue.)

Eating disorders in adolescents 

Body image and adolescence

People construct their identity in adolescence. How others perceive them and the desire to please become crucial issues. Adolescence is a time of life when many children have problems with body image. According to data from the Québec Health Survey of High School Students 2010-2011, approximately one in two high school students (51%) is satisfied with his/her appearance.

Dissatisfaction with body can lead to unhealthy behaviours. Among youth with diabetes, restricting food intake, or altering their diabetes treatment for the purpose of losing weight, can disrupt their blood sugar (glycemic) control and cause microvascular complications.

Eating disorders are more common in  adolescent females with type 1 diabetes

10 % of adolescent females with type 1 diabetes suffer from an eating disorder compared to 4 % in the ones who do not have diabetes.

How to prevent eating disorders in adolescents

Low self-esteem is often a precursor to the development of an eating disorder. Comments from, and the attitudes and behaviors exhibited by friends and family can affect an adolescent’s often fragile self-confidence.

Here are some ways to act with your teen:

  • Avoid comments or judgments about the weight or body image of your child. Instead, compliment your teen’s good qualities and skills to boost self-esteem.
  • Avoid teasing your child about the changes to his/her body during puberty, to avoid giving your teen a complex.
  • Be attentive without being overprotective.
  • Lead by example by adopting a healthy and balanced approach to body image and food.

If you suspect an ED, consult a healthcare professional.

Resources

Anorexia and Bulimia Québec (ANEB) helps people suffering from anorexia and bulimia. This excellent community resource offers a help line and information, as well as support groups for people and their families dealing with eating disorders.

The Douglas Mental Health University Institute offers an internationally renowned eating disorders program. Its professionals are used to treating diabetics with eating disorders.

 

Research and text: Diabetes Québec Team of Health Care Professionals

Scientific review: Josée Guérin, Dt.P., Nutritionist-Psychotherapist, President and founder of the Clinique psychoalimentaire and lecturer at the Université de Montréal.

October 2014 (updated on July 2018)

© All rights reserved Diabetes Québec

References:

ANEB Québec http://www.anebquebec.com (website consulted on June 20, 2014)

Robinson D, Coons M, Haensel H et al. Diabetes Canada 2018 Clinical Practice Guidelines for the Prevention and Management of Diabetes in Canada: Diabetes and Mental Health. Can J Diabetes 2018; 42 (Suppl 1): S130-S141.

Extenso (2012). “Les adolescentes et la nourriture : une relation difficile,” [Online]. Found at http://www.extenso.org/article/les-adolescentes-et-la-nourriture-une-relation-difficile/ Website in French only. (Web page consulted on June 20, 2014.)

Goebel-Fabbri, Ann (2008), “Treating People with Type 1 Diabetes and Eating Disorders – the Need for a Multidisciplinary Approach,”  [Online]. Found at http://www.idf.org/sites/default/files/attachments/2008_1_Goebel%20Fabbri_FR.pdfDiabetesVoice: Global perspectives on diabetes. (Web page consulted on June 20, 2014.)

Institut de la statistique du Québec (2012), Québec Health Survey of High School Students 2010-2011: Tome 1. Le visage des jeunes d’aujourd’hui : leur santé physique et leurs habitudes de vie, Québec, pp. 121-147. Available in French only.

Pedwell, Susan (2008), “Dangerous Dieting,” Diabetes Dialogue, vol. 55, number 2, pp. 20-24.