Q&A: How to address eating disorders in type 1 diabetes
Click Here to Manage Email Alerts
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, talks with Erin Phillips, MPH, RD, CDCES, about how diabetes care and education specialists can address the risk for eating disorders after a diagnosis of type 1 diabetes.
Weiner: Why might someone newly diagnosed with type 1 diabetes be susceptible to developing an eating disorder?
Phillips: A key characteristic of eating disorders is preoccupation with food and/or a preoccupation with body shape and size. When someone receives a diagnosis of type 1 diabetes, they are also given a heightened awareness of both the food they eat and the body they’re in. It’s also common to feel like their body failed them, creating a strain in a relationship with their body that might otherwise have been just fine.
Another factor is that weight loss, which is common before a type 1 diabetes diagnosis, can trigger an eating disorder on a neurobiological level for those with a genetic predisposition. All of these things put together are a perfect storm eating disorder risk after a new type 1 diabetes diagnosis.
Weiner: What are specific dangers of an eating disorder for someone with type 1 diabetes?
Phillips: Eating disorders and disordered eating are associated with increased difficulty with diabetes management, as well as increased risk for diabetic ketoacidosis, hospitalization, retinopathy and neuropathy.
Weiner: How might insulin, nutrition and normal growth interact to contribute to weight gain for someone, particularly an adolescent, with type 1 diabetes?
Phillips: This is a great question, and the answer is nuanced. First, it is imperative to note that adolescence is a time of rapid weight gain that is a normal, healthy part of human development. This occurs before the increase in height, so it is common for families — and some medical professionals — to see this weight change as negative rather than a normal part of development.
In addition, when insulin is initiated in the setting of severely elevated glucose levels, as with a new type 1 diabetes diagnosis, weight regain is to be expected due to the presence of glycosuria and tissue catabolism while the body was insulin deficient. Therefore, weight re-gain upon initiation of insulin is a welcome sign of renourishment after insulin deficiency, and if this is also happening in the setting of weight gain around menarche, it can feel quite dramatic. But both of these are normal.
Weiner: Might traditional diabetes care and education contribute to an eating disorder? If so, how?
Phillips: Unfortunately, yes, it can. Eating disorder prevention is not something that most clinicians learn about in our education — I know I didn’t. I don’t want anyone to feel shamed or blamed by learning this. If there’s one thing I know about diabetes care and education specialists, it is that we are some of the most caring clinicians out there.
Traditional diabetes care and education focuses on concrete management strategies, which can come across as all or nothing if not offered with great care. Some examples include, “This food is high in carbohydrates” or “It’s important to stay under X grams of carbs per meal or per day.” All-or-nothing thinking is a hallmark of eating disorders, so for someone already at risk, hearing a health professional encourage this type of thinking can contribute to the development of an eating disorder.
Even statements like “Try to focus on high-quality carbohydrates” can insinuate that there are good and bad foods, which promotes perfectionism and off-limit foods — two other key features of eating disorders.
Weiner: What diabetes care and education strategies do you recommend to prevent eating disorders among people with type 1 diabetes and even help someone with type 1 diabetes recover from an eating disorder?
Phillips: There are a few key tools in our toolbox that, when used as the foundation for diabetes care and education, can help prevent eating disorders and support someone who is in recovery. These are trauma-informed care, self-compassion, person-centered care and neutral language.
Trauma-informed care is an approach to care that recognizes the human experience of trauma and works to build safety and reduce re-traumatization. Trauma-informed care is a bit of a buzzword lately, but the way I think about this one is in terms of universal precautions. In the hospital, we assume that everyone has something super contagious, like Clostridioides difficile, or C. diff, to take universal precautions for decreasing transmission of bacteria to other patients. This is the same with trauma-informed care. Assume that everyone has experienced trauma in their lives to help avoid re-traumatization for those who have experienced it. There are a lot of wonderful resources for learning about trauma-informed care, including those from the Substance Abuse and Mental Health Services Administration, available at www.samhsa.gov/resource/dbhis/infographic-6-guiding-principles-trauma-informed-approach.
Self-compassion is the process of turning compassion inward. Studies link increased self-compassion with improved physical and mental health outcomes. This is something we can demonstrate and teach to our patients or clients. A great way to start is by thinking about “What would I say to a friend/pet/small child in this instance?” This is very different from self-esteem, which says, “I am good when I am doing good,” and ultimately “I am bad when I am doing bad.” Self-compassion offers a framework of “when things are hard, I am still worthy of respect and kindness.”
Person-centered care requires us to focus on what the individual wants and needs rather than our own agenda as clinicians. We are aligning with goals of the person with diabetes. We are ensuring that we are collaborating with the person rather than pressuring. This helps with preventing eating disorders and body image distress because it helps us decrease our own biases from showing up in clinical interactions.
Neutral language means exactly that: We can be careful to use factual statements about food, weight, insulin, etc, to avoid judgment or implying that one is better than the other. Examples include, “This food has X grams of carbohydrates” instead of “This food is high/low in carbs,” or “There is no one right way to eat for diabetes” instead of “Try to focus on high-quality carbohydrates.” Pairing this with open-ended questions and person-centered care can help with the discomfort of changing our language. There’s a lot more nuance to this but this is a good start.
For more information:
Erin Phillips, MPH, RD, CDCES, is a registered dietitian and diabetes specialist and owner of Erin Phillips Nutrition LLC. She can be reached at erin@erinphillipsnutrition.com.
Susan Weiner, MS, RDN, CDN, CDCES, FADCES, is co-author of The Complete Diabetes Organizer and Diabetes: 365 Tips for Living Well. She is the owner of Susan Weiner Nutrition PLLC and is the Endocrine Today Diabetes in Real Life column editor. She can be reached at susan@susanweinernutrition.com; Twitter: @susangweiner.
Collapse
Read more about
Click Here to Manage Email Alerts