Disordered Eating Behaviors
Disordered Eating Behavior in Teens with Type 1 Diabetes
From the research of Dr. Deborah Young-Hyman
What is Disordered Eating Behavior (DEB)?
Among youth with type 1 diabetes, Disordered Eating Behavior (DEB) is a complex issue that has been getting a great deal of attention. DEB is the result of negative feelings regarding one's body size, shape and weight. DEB encompasses a wide range of behaviors which interfere with daily living such as binge eating, extreme dieting, as well as unhealthy weight control behaviors such as use of laxatives or medicines to purge food.
Current research does not definitively show an increased risk for diagnosable eating disorders in these youth, however, Disordered Eating Behavior is commonly reported by teens with type 1 diabetes. There are reasons for this seeming contradiction: low rates of diagnosable eating disorders but high rates of DEB. Some of these reasons have to do with the disease and its treatment.
While the rate of diagnosable eating disorders in all youth is relatively low, and subclinical DEB relatively common, teens with type 1 diabetes frequently report subclinical (not displaying or reporting symptoms often enough to reach a diagnosable level) DEB which is specific to having diabetes. Examples of typical subclinical DEB include restricting the amount of food one eats and exercising in excess to lose weight. In addition to these symptoms, youth with type 1 diabetes often report skipping or reducing insulin doses, resulting in glycosuria (excess sugar in urine) and "glucose toxicity" which is a further risk to health for youth with diabetes. This reducing or skipping insulin doses prevents their bodies from metabolizing the food they eat, unlike youth without diabetes, whose bodies automatically produce insulin in response to food intake.
What is the risk for DEB?
Research indicates that the risk for DEB in youth with type 1 is associated with well-known factors that affect most teens. For instance, being depressed, wanting to be thin, having dieted before, having high standards for performance, and being Caucasian. These factors are not necessarily associated with diabetes. However in teens with type 1 diabetes who report DEB, this behavior is not only associated with depression, but also wanting good glycemic control and avoiding weight gain that is common with treatment with insulin. Further, diabetes self-management behaviors prescribe DEB: preoccupation with food, monitoring of carbohydrate intake and controlling weight when weight gain occurs secondary to successful treatment with insulin. Finally, having diabetes effects appetite regulation in various ways. Thus it is not a surprise that higher than expected rates of subclinical DEB are reported by youth with type 1 diabetes.
Signs to look for
Parents can look for signs of disordered eating behavior. Watch for depression, changes in eating patterns and changes in weight when there is a significant change in blood glucose control (i.e., weight gain associated with tight blood glucose control or weight loss associated with poor blood glucose control). Noticing that much less insulin has been used during a specified period of time is also another sign of possible DEB. Lessening interest in achieving good glycemic control can be fueled by weight concerns.
Preventing DEB starts early
For parents of younger children with type 1 diabetes, helping them make a positive association between food and a healthy lifestyle, rather than dwelling on weight, can help prevent Disordered Eating Behavior during the teenage years. It’s also important for parents to offer healthy food options in the home, make healthy choices themselves and to not assume blood glucose levels are automatically linked to food. For example, asking a child, “What did you eat?” after a high blood glucose reading can create conflict around food.
If you feel your teen is showing signs of Disordered Eating Behavior, it’s important to seek professional help for an accurate evaluation from a behavioral psychologist who is familiar with treatment of diabetes and of eating disorders. Visit the BRIDGE (Behavioral Research in Diabetes Group Exchange) website for help with finding a professional.
The information in this article is based on results of the study “Treatment and Weight Concerns in Type 1 Diabetes (TaWC)” by Deborah Young-Hyman, PhD, a behavioral health psychologist from the Georgia Health Sciences University’s Medical College of Georgia.