Link Between Diabetes and Eating Disorders Explored
Controlling weight in the presence of diabetes is difficult, and for some patients impossible. Focus on food is a part of diabetes treatment and is explored by researchers in an effort to find ways to help diabetics manage the disease and control eating disorders.
Researchers from the Medical College of Georgia suggest that diabetics have a difficult time controlling weight because of the disease and also as a result of insulin treatment that wreaks havoc on appetite hormones.
Dr. Deborah Young-Hyman, pediatric psychologist at the Medical College of Georgia's Georgia Prevention Institute explains, "You can't use the same criteria to diagnose eating disorders that you use in non-diabetic populations because what we actually prescribe as part of diabetes treatment is part of disordered eating behavior. Food preoccupation is one example."
Studies of non-diabetics are needed for comparison to better understand what underlies eating disorders among diabetic patients. Insulin injections that lower blood sugar levels lead to hunger. The researchers say food metabolism becomes more complex for diabetics, making it difficult to control appetite and avoid weight gain. Leptin, the hormone that signals feelings of food satiety, also becomes dysregulated, leading to hunger with variable blood sugar levels.
It's not hard to see how the treatment of the disease can lead to disordered eating behavior to control weight gain," Dr. Young-Hyman said. Young women with Type I diabetes may be especially vulnerable, finding it difficult to control how much they eat, in turn leading to binging and purging behaviors and missed insulin doses in efforts to avoid weight gain.
"We need to document that these patients are experiencing dysregulation in satiety and that it's not only connected with factors one usually associates with disordered eating behaviors such as societal pressure, anxiety and depression," Dr. Young-Hyman said. "It's also associated with having diabetes."
As a psychologist, Dr. Young-Hyman has treated many diabetics diagnosed with an eating disorder. Diabetics initially lose weight. Once they start insulin therapy they gain weight quickly, making it difficult to control food consumption. The result is missed insulin doses, disordered eating behaviors that include skipped meals, and binging and purging, especially for young women, and increasingly more males, who are under pressure from society to remain thin.
More studies are suggested to uncover the incidence of eating disorders among Type I diabetics that could lead to better treatment options. For those with diabetes, weight gain and appetite control become difficult both from diabetes treatment and from the disease itself, leading to eating disorders and long term complications.
In an effort to find diabetes' link to eating disorders, Dr. Young-Hyman and colleagues are participating in a study of 90 children age 10 to 17 who are newly diagnosed with diabetes and transitioning to treatment with an insulin pump, funded by the American Diabetes Association. The study will look at eating behaviors and attitudes, and blood sugar response with insulin treatment and may answer questions about eating disorders among diabetics.
Diabetes Care: doi: 10.2337/dc08-1077