This issue of The Thought Compass will continue to focus on Disordered Eating Behaviors in Diabetes, or DEB-D, specifically how DEB-D escalates. This escalation is even more evident with the rise in anxiety due to the COVID-19 pandemic.
The goal is to add to your understanding of DEB-D, from the winter issue, which explained what it is and how it affects up to 40% of patients with type 2 diabetes mellitus. This sobering statistic is from Dr. Garcia-Mayer’s 2017 research on Disordered Eating and Diabetes. How could so many clients slip under the radar? There are a number of reasons, including clients who are currently coping with increased stress because of the pandemic.
Interestingly, the predominant clinical forms of disordered eating are actually the lesser-known concerns, including Other Specific Feeding or Eating Disorder (OSFED), Night Eating Syndrome (NES), and Binge Eating Disorder (BED).
The presence of DEB-D is inescapable. Recently, while providing telemedicine to a client, the issue presented in the last 10 minutes of the appointment. While summarizing, the client mentioned, “Well, I’m binging after the kids are in bed.” When we circled back on this comment, I asked, “What is it about the binge eating concerns you?” The client explained she was doing it to cope with the many changes in her life–including working full time while homeschooling her two children and assisting her older parents. Now more than ever, DEB-D is likely to increase.
The impact that Disordered Eating Behaviors (DEB) have on diabetes care is challenging to quantify because disordered eating isn’t a static occurrence. Inconsistent blood sugars result from erratic eating, limited consistency with medication, fear and guilt from adverse reactions to medication, eroded provider/client trust, and a decreased desire to seek medical care due to shame, self-blame, and guilt. These things obscure the issue, complicate the scope, and contribute to clinical inertia.
Understanding DEB-D takes time because it impacts care in overt and subtle ways. This issue of The Thought Compass will explore why DEB-D escalates by unpacking weight stigma, and the impact of restriction in diabetes care. For more information, check out “Understanding Stigma Theory,” “How to spot DEB-D,” “Can We Create A Model Visualizing DEB-D?” “Interested in learning about Medication? The Missing Piece in Weight Neutral Diabetes Care,” “Five Ways To Make Diabetes Worse,” and other blogs of interest at https://wn4dc-symposium-2019.teachable.com/blog
