Does my child have an eating disorder?
It’s a little known fact that young people with diabetes are more at risk of developing an eating disorder. In this special report we look at the issue and how friends and family can help. By Caroline Wood.
It’s something of a hidden problem in the community but people with diabetes are two to three times more likely than the non-diabetes population to have an eating disorder.
People living with type 1 diabetes are most likely to be affected, with young T1D women at most risk. While less common, people with type 2 diabetes can also develop an eating disorder, for example binge eating is more common among T2Ds.
“It’s really important that people get early help,” says Dr Roger Mysliwiec, one of New Zealand’s leading experts in the field of eating disorders.
Dr Mysliwiec is trying to raise awareness about eating disorders and type 1 diabetes in particular because he’s worried that young people aren’t being offered the help they need.
He is calling for more screening and early intervention as treatment is much harder the longer someone has an eating disorder.
“Young people with diabetes can fall through the cracks. On the one hand they may not be getting screened at their diabetes clinic, and on the other their symptoms may not be obvious so they don’t get access to eating disorder services,” he says.
“With diabetes, even if your eating disorder isn’t very severe, if it leads to elevated blood sugars then that is a concern regarding potential complications.
“If it’s severe they should go and see an eating disorder service and make sure they closely collaborate with diabetes treatment.”
The most common eating disorder found in people with diabetes is EDNOS (Eating Disorder Not Otherwise Specified) where someone displays eating behaviours that have a significant impact on their psychological and physical health. Other eating disorders include diabulimia, bulimia, and anorexia, which is less common.
Diabulimia, where a person reduces their insulin in order to reduce their weight, is a particular eating disorder that is only found in people with type 1 diabetes.
“Young people with
diabetes can fall through
the cracks. On the one
hand they may not be
getting screened at their
diabetes clinic, and on
the other their symptoms
may not be obvious so
they don’t get access to
eating disorder services.”
Dr Roger Mysliwiec
Dr Roger Mysliwiec can be contacted at the New Zealand Eating Disorders Clinic, in Grey Lynn, Auckland.
“Omitting insulin functions as a kind of purging behaviour, getting rid of calories. By omitting, or taking less, insulin, glucose doesn’t get into the cells and therefore prevents weight gain or even leads to weight loss,” explains Dr Mysliwiec.
“But doing this predisposes the individual to the acute complications of high blood sugar levels and the severe long-term complications of elevated HbA1c.”
Prevalence studies show that eating disorders are two to three times more common in people with diabetes, compared with the non-diabetes population.
For example, one study of 12 to 19 year olds found that 10% of the patients with diabetes had an eating disorder, compared with 4% of the non-diabetic subjects.
And there will be many more people who have problems with eating but their symptoms don’t meet the diagnostic criteria for eating disorders and treatment.
There is thought to be a strong genetic factor predisposing some people to eating disorders. For example, a large genome-wide study showed there was an association between anorexia and diabetes, which could mean a person with this particular gene will have a genetic predisposition to developing anorexia.
Dr Mysliwiec says that once someone has developed an eating disorder it’s a race against time. “I would unfortunately see most patients at the very severe end, which is the ‘bottom of the cliff’ scenario.
“Once the behaviours have become so entrenched and the complications are severe, it’s so much harder to help people, it’s very challenging. The ideal is always early intervention.
“By investing in screening and early support, one can prevent the very high cost to both the individual’s health and to society.”
TIME FOR ACTION
People with diabetes often have a number of risk factors that come together, which mean they are more likely to develop an eating disorder.
Hypoglycaemic (low blood sugar) episodes can lead to disinhibited eating, which over time can lead to regular over-eating of highly palatable foods and unwanted weight gain, increasing the risk for risky weight loss behaviour. The hormone insulin also leads to higher fat building in the body.
Diabetes management also requires a preoccupation with weight, carbohydrate and fat intake. And the onset of diabetes often co-occurs with adolescence with its common concerns about weight and shape.
It’s thought the Waikato Diabetes Service is the only district health board currently screening people with diabetes for eating disorders. When it sent out a questionnaire, more than 20% of respondents reported some kind of eating issue, according to Dr Roger Mysliwiec.
Heather Verry Diabetes NZ Chief Executive