Preoccupation with weight can become disorder
A study of more than 600 patients (both male and female) from the University of Essen in Germany showed these results:
• Of Type 1 patients, 16.7% had been anorexic at some point in their lives, 25% had been binge eaters, 30.6% had been bulimic, and 27.8% had other eating disorders.
• Of Type 2 patients, 59.4% reported binge eating and 100% of obese patients reported binge eating, 18.8% had a history of bulimia, and 21.9% had a history of another eating disorder.
The vast majority (89.3%) reported their eating disorders began between the ages of 15 and 35. And, for those who suffered from eating disorders, 80% had developed microvascular complications within four years.
"This preoccupation with slenderness has led to seriously unhealthy strategies, including underdosing on insulin to promote weight loss," says Marsha Marcus, PhD, associate professor of psychiatry at the University of Pittsburgh. Since intensive control in Type 1 diabetics frequently results in weight gain, Marcus says young women are particularly vulnerable to insulin underdosing.
One British study showed 30% of young women admitted underdosing insulin. Some withheld it for as much as two weeks to lose weight.
Researchers at the University of Toronto found that disturbed eating patterns almost inevitably led to poor metabolic control and early onset of microvascular complication, most notably, diabetic retinopathy.
Jennifer M. Jones, PhD, a research associate at Toronto’s Princess Margaret Hospital, says it is disturbingly common for young women to get themselves into metabolic trouble precisely because of the strict regimen required to manage Type 1 diabetes in adolescence. "They always have to think of calories, restrictive timing, and amounts and kinds of foods. When they get out of the regimen, it leads to overeating and then a binge-purge cycle evident of low self-esteem," Jones says.
Jones and fellow University of Toronto researchers called for a concerted research effort to understand the association between diabetes and eating disturbances.
She recommends clinicians take these steps:
• Be aware that eating disorders exist. They are common in teenage girls with diabetes.
• Look for a preoccupation with body weight or shape.
• Look for girls who ask about changing their diets to lose weight.
• Look for girls whose weights fluctuate.
• Look for unexplained poor metabolic control.
• Consider general noncompliance as a warning sign, and ask directly if you suspect your patients are omitting insulin.
• Refer your patient to a psychiatrist or psychologist if you think an eating disorder might exist.
"It’s really tough for these kids," Marcus says. "The psychology of teens is they don’t want to be different. Diabetes makes them different, and that’s really a bear for them." If you suspect an eating disorder, it’s not enough simply counsel them, she says. "Get someone who’s really got the expertise to help them."
[Contact Marsha Marcus at (412) 624-1513 and Jennifer Jones at (416) 340-4611.]
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