Diabetes, Eating Disorders, and Obesity: Navigating the Complexities of Treatment
People with diabetes are at a higher risk of developing eating disorders. Things get even more complicated when obesity is involved. Here’s why compassionate care and specialized treatment are so important.
Sugar, cigarettes, weed, alcohol, cocaine, and then food. Monica Romano, a 55-year-old living in Bellingham, Washington, lists her “drugs” in order of addiction.
Romano quit drugs like cocaine at the age of 30 but then developed another addiction.
“Food became my new drug,” she said. She described her first time binge eating feeling as natural as breathing. Now she identifies as a food addict, with obesity as one of the symptoms.
Looking back, she realizes she had binge eating disorder – a chronic condition marked by compulsive overeating – but never discussed it with doctors.
Due to her weight, family history, and diagnosis of metabolic syndrome, Romano worries about the ever-present threat of diabetes. Metabolic syndrome increases the risk for health conditions like diabetes, heart disease, and stroke. Many people with metabolic syndrome also have insulin resistance, which over time may lead to type 2 diabetes.
“I have luckily managed to escape it so far. But the threat is always at the back of my mind,” she said.
Identifying and treating each of her conditions, while working to avoid a diabetes diagnosis, has been a long and difficult journey, fraught with stigma and challenges.
Three complex, intertwined conditions
Dealing with the ups and downs of one medical journey can be daunting. Dealing with three simultaneously can seem downright impossible.
But that’s exactly where some people are, as they navigate complications and conflicting advice on living with and treating obesity, eating disorders, and diabetes. This is becoming a more prevalent issue as clinical obesity rates continue to rise – almost 41% of Americans live with obesity, according to the Centers for Disease Control and Prevention (CDC).
Clinical obesity is a disease defined by the CDC as someone who has a body mass index (BMI) of 30 or higher. It’s important to note that BMI doesn’t accurately measure body fat content; while it can be used as a screening tool, BMI is not a reliable measure for diagnosing obesity.
Along with the rising obesity rates, diabetes cases have doubled in the last 20 years, with overweight and obesity being a major risk factor for type 2 diabetes. Even though not everyone with diabetes has excess weight, 80-90% of the type 2 diabetes population has overweight or obesity.
People with diabetes also have higher rates of eating disorders than the general public, with 20% experiencing an eating disorder at some point. Bulimia nervosa is a more common eating disorder in type 1 diabetes and binge eating without purging is more common with type 2 diabetes.
The need for awareness and understanding around treatment
People with obesity, diabetes, and eating disorders can experience dilemmas in treatment that contradict each other – what helps with one condition might fuel another.
Dr. Ann Goebel-Fabbri is a clinical psychologist who works with people managing these conditions (sometimes all three at once). She recalled an instance of one patient with overweight and type 2 diabetes who sought treatment to stabilize her binge eating disorder.
However, the recommended weight management meal plan they recommended to help with her eating disorder conflicted with the recommended treatment for diabetes and obesity.
“The problem was her meal plan at the treatment center completely ignored that to improve health in diabetes, a modest amount of weight loss is actually indicated,” Goebel-Fabbri said.
“So the question is, how do we approach those concepts in ways that allow enough complexity, variation in foods, enjoyable foods, and prevent concepts and feelings like deprivation, shame, and failure?” she said.
Goebel-Fabbri added that treatment must involve an understanding that deprivation doesn’t work. Eliminating a whole food group, as is the case with very low-carb diets, intermittent fasting, and other trendy fad diets, is actually more likely to increase the likelihood of binging. She said that it also only focuses on short-term success, rather than a long-term plan.
“We need to help people develop modest and realistic goals for weight loss,” she said.
Pursuing multi-faceted, meaningful treatment
Romano is getting treatment at a clinic specializing in obesity and is also in counseling to help her better understand the link between trauma, post-traumatic stress disorder, and eating disorders.
“That was eye-opening because it explained why I felt compelled to binge as a response to others noticing my weight loss,” she said. “In some strange way losing weight became synonymous with losing control. I’m still grappling with that one – this hasn’t been an easy fix.”
“Sure, weight loss drugs and even bariatric surgery, which I considered for a while, can help but they are tools. Eating disorders are multifaceted and without mindset work, we miss the complete picture,” Romano said.
Alle C. Hall lives with prediabetes and has had binge eating disorder her whole life. At times, she’s also dealt with bulimia and exercise compulsion.
Along the way, Hall said that some primary care doctors and OB-GYNs have impeded progress in getting treatment. Their weigh-ins and lectures about diet and exercise have led to sometimes days-long binging episodes, she said.
Instead, she hopes digging into past trauma will get to the root cause and help with healing. For her, writing a book was a part of healing. She encourages others to pursue a project or creative endeavor as it could be a valuable part of the healing process.
“There is no need to spend your time feeling like you have no willpower,” Hall said. “I know this to be true: get the help you need.”
If you live with diabetes and an eating disorder, here are some organizations with resources that can help:
The Crisis Text Line, which includes help with eating disorders
We Are Diabetes for those with type 1 and disordered eating
Learn more about diabetes, eating disorders, and mental health here: