Teens are a unique bunch. Their brains are not yet fully developed and they are vulnerable to a host of temptations. During this age of selfies and constant photo-sharing, it is easy for young people, especially girls, but also boys, to be highly susceptible to vanity and self-esteem issues.
From the moment they wake up until they go to sleep, they are bombarded with messages promoting largely unattainable body types. Add to this a diagnosis of diabetes and the obvious need for focused attention on food choices, calories, and food timing; it’s no wonder that according to research, rates of disordered eating are significant among teens with both types of diabetes.
Type 1 diabetes (T1D) can occur at any age, but is typically diagnosed from infancy through the late 30s. In this case, the pancreas produces little or no insulin. This is likely due to the body’s immune system destroying the insulin-producing cells in the pancreas.
Type 2 diabetes (T2D) used to be more prevalent in adulthood but now occurs with greater frequency in children and teens as well. In this case, the pancreas does produce insulin, but quantities become too low over time or the body’s response to increasing levels of insulin is poor.
T2D will often respond to weight loss, since insulin resistance is largely driven by the presence of excess fat. T1D requires daily insulin. In both situations, diet is a focal point, and in order to get good control, intense focus on calories, quality of foods, and timing of meals and snacks is common.
Of course, in the case of T2D, weight loss is a core component. Given these treatment parameters and the teen focus on body image, it is not surprising to find eating disorders a big risk among both types of patients.
Research presented at the American Diabetes Association (ADA) 2017 Scientific Sessions examined the prevalence of disordered eating among teens and young adults diagnosed with diabetes. Data from the SEARCH for Diabetes in Youth, a surveillance study that began in 2002 assessing the prevalence of diabetes in kids from five states (South Carolina, Ohio, Colorado, Washington, and California) provided specific survey data. The SEARCH study was one of the largest of its type and is considered an excellent source of information.
The researchers identified 2,156 subjects with type 1 diabetes and another 161 subjects with type 2 diabetes from the SEARCH data sets. Patients were ten years of age or older and had participated in SEARCH during 2011 through 2015, specifically completing the Diabetes Eating Problem Survey-Revised (DEPS-R). A score of 20 or higher indicated some type of disordered eating.
Approximately 21 percent of patients with type 2 diabetes and 52.5 percent of patients with type 2 diabetes showed evidence of an eating disorder.
The average age of the subjects in this specific study was 17.9 years (T1D). Among this group, the subjects more likely to have an eating disorder were female and tended to have a higher BMI, higher HbA1C levels and were likely to have had at least one episode of diabetic ketoacidosis within the last six months. They also identified higher rates of depression and lower measures of quality of life.
The average age of the subjects with T2D was 21.9 years old, and among this group, a score of 20 or higher was associated with a higher BMI, lower levels of insulin sensitivity, higher HbA1c and also higher rates of depression and lower life satisfaction.
The researchers indicated a worrisome trend of disordered eating among youth with diabetes. They also share concern that this phenomenon is under-recognized and under-reported.
Based on their findings, they stressed the need for eating disorder screening among older children, teens, and young adults as a regular part of the diabetes diagnosis and treatment program. They also identified risk factors including:
- The food and weight focus that treating diabetes typically requires, which can easily cross the line from “healthy treatment” to “obsession”
- Self-esteem issues that would normally crop up in this age group
- Self-esteem issues that can accompany a chronic disease like diabetes
- The higher risk of having depression or mood disorders which can accompany a chronic disease like diabetes.
Recommendations included the regular use of the DEPS-R survey by clinicians who screen and treat youth for diabetes, as well as identifying red flags like unexplained weight gain or weight loss beyond recommendations (in T2D), or an abrupt change in HbA1c readings.
It’s clear that mental health support in the treatment of diabetes may be warranted in this age group to help reduce the risk of eating disorders. Prior studies have suggested that teens with T1D may withhold insulin treatments in order to lose weight, a disorder known as diabulimia.
Common signs of an eating disorder can include:
- Hiding food or food wrappers
- Unexplained sudden weight loss or weight gain
- Signs that an individual is eating in secret
- Sudden consumption of large quantities of food followed by going to the bathroom
- An individual going to the bathroom after each feeding
- Excessive exercising
- Laxative use
- Recognizing that an insulin schedule is not being maintained (T1D)
It’s clear that clinicians and parents need to be aware of the risk of an eating disorder in an older child, teen or young adult diagnosed with diabetes. If weight loss is necessary, the emphasis should be on healthy eating and not extreme dieting. Just knowing that the risk of an eating disorder exists should have you consider intervention strategies that can get ahead of this issue before it develops or entrenches.