Skip to main content
Log in

Diabetes, eating disorders and body image in young adults: an exploratory study about “diabulimia”

  • Original Article
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Purpose

The purpose of this study was to compare disordered eating (DE) and body image dissatisfaction (BID) among young adults with type 1 diabetes and their peers without diabetes, to investigate the consequences of diabetes for food, body image and weight in individuals with diabetes and to identify the behavior of insulin omission as a weight loss strategy.

Methods

Fifty-five young adults with diabetes and 73 without diabetes (ages 18–30) completed self-report questionnaires to evaluate their behaviors, attitudes and feelings related to eating disorders and their perceptions about body image. The participants with diabetes were asked to answer a questionnaire with open and closed questions developed specifically for this study.

Results

No significant differences between participants with and without diabetes in relation to BID and DE were found. The results demonstrated several changes resulting from diabetes in terms of food, body image and weight that interfere with the day-to-day life of individuals with diabetes; 7.3% of these participants reported insulin omission as a weight loss strategy.

Conclusions

This study emphasizes the importance of research on DE in the population with diabetes and their prevention, screening and treatment. In particular, it is essential to give more attention to insulin omission as a compensatory behavior that is inappropriate and harmful to health.

Level of evidence

Level III, case-control analytic study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. International Diabetes Federation (2013) IDF diabetes atlas, 6th edn. International Diabetes Federation, Brussels

    Google Scholar 

  2. Observatório Nacional da Diabetes (2014) Relatório anual do observatório nacional da diabetes [Annual report of the national diabetes observatory]. Sociedade Portuguesa de Diabetologia, Lisboa

    Google Scholar 

  3. World Health Organization (1999) Definition, diagnosis and classification of diabetes mellitus. World Health Organization, Geneva

    Google Scholar 

  4. Colton P, Rodin G, Bergenstal R, Parkin C (2009) Eating disorders and diabetes: introduction and overview. Diabetes Spectr 22(3):138–142. doi:10.2337/diaspect.22.3.138

    Article  Google Scholar 

  5. Menina A, Akers EM (2014) Diabulimia: not so secret-or shameful-anymore. Diabetes Health 23(1):14–19

    Google Scholar 

  6. Powers MA, Richter S, Ackard D, Gerken S, Meier M, Criego A (2012) Characteristics of persons with an eating disorder and type 1 diabetes and psychological comparisons with persons with an eating disorder and no diabetes. Int J Eat Disord 45(2):252–256. doi:10.1002/eat.20928

    Article  PubMed  Google Scholar 

  7. Weaver K (2012) Eating disorders in people with type 1 diabetes. Nurs Stand 26(43):43–47

    Article  PubMed  Google Scholar 

  8. Darbar N, Mokha M (2008) Diabulimia: a body-image disorder in patients with type 1 diabetes mellitus. Athl Ther Today 13(4):31–33

    Article  Google Scholar 

  9. Davidson J (2014) Diabulimia: how eating disorders can affect adolescents with diabetes. Nurs Stand 29(2):44–49

    Article  PubMed  Google Scholar 

  10. Shih GH (2009) Diabulimia. Diabetes Health 18(2):14–21

    Google Scholar 

  11. Shih GH (2011) Once a spokesperson for juvenile diabetes, Erin now suffers from diabulimia. Diabetes Health 20(4):10

    Google Scholar 

  12. Direção Geral de Saúde (2011) Diagnóstico e classificação da diabetes mellitus [Diagnosis and classification of diabetes mellitus]. Direção Geral de Saúde, Lisboa

    Google Scholar 

  13. Ackard DM, Vik N, Neumark-Sztainer D, Schmitz KH, Hannan P, Jacobs DR Jr (2008) Disordered eating and body dissatisfaction in adolescents with type 1 diabetes and a population-based comparison sample: comparative prevalence and clinical implications. Pediatr Diabetes 9(4 Pt 1):312–319. doi:10.1111/j.1399-5448.2008.00392.x

    Article  PubMed  Google Scholar 

  14. Jones JM, Lawson ML, Daneman D, Olmsted MP, Rodin G (2000) Eating disorders in adolescent females with and without type 1 diabetes: cross sectional study. BMJ 320(7249):1563–1566

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Rydall AC, Rodin GM, Olmsted MP, Devenyi RG, Daneman D (1997) Disordered eating behavior and microvascular complications in young women with insulin-dependent diabetes mellitus. N Engl J Med 336(26):1849–1854. doi:10.1056/NEJM199706263362601

    Article  CAS  PubMed  Google Scholar 

  16. Umpierrez GE, Murphy MB, Kitabchi AE (2002) Diabetic ketoacidosis and hyperglycemic hyperosmolar syndrome. Diabetes Spectr 15(1):28–36. doi:10.2337/diaspect.15.1.28

    Article  Google Scholar 

  17. Wolfsdorf J, Craig ME, Daneman D, Dunger D, Edge J, Lee W et al (2009) Diabetic ketoacidosis in children and adolescents with diabetes. Pediatr Diabetes 10(Suppl 12):118–133. doi:10.1111/j.1399-5448.2009.00569.x

    Article  PubMed  Google Scholar 

  18. Wolfsdorf JI, Allgrove J, Craig ME, Edge J, Glaser N, Jain V et al (2014) Diabetic ketoacidosis and hyperglycemic hyperosmolar state. Pediatr Diabetes 15(Suppl 20):154–179. doi:10.1111/pedi.12165

    Article  CAS  PubMed  Google Scholar 

  19. American Diabetes Association (2013) DKA (ketoacidosis) and ketones. IOP Publishing Diabetes. http://www.diabetes.org/living-with-diabetes/complications/ketoacidosis-dka.html?loc=lwd-slabnav. Accessed 28 Novemb 2016

  20. Goebel-Fabbri AE, Fikkan J, Franko DL, Pearson K, Anderson BJ, Weinger K (2008) Insulin restriction and associated morbidity and mortality in women with type 1 diabetes. Diabetes Care 31(3):415–419. doi:10.2337/dc07-2026

    Article  PubMed  Google Scholar 

  21. Takii M, Uchigata Y, Tokunaga S, Amemiya N, Kinukawa N, Nozaki T et al (2008) The duration of severe insulin omission is the factor most closely associated with the microvascular complications of type 1 diabetic females with clinical eating disorders. Int J Eat Disord 41(3):259–264. doi:10.1002/eat.20498

    Article  PubMed  Google Scholar 

  22. Philippi ST, Cardoso MGL, Koritar P, Alvarenga M (2013) Risk behaviors for eating disorder in adolescents and adults with type 1 diabetes. Rev Bras Psiquiatr 35(2):150–156. doi:10.1590/1516-4446-2012-0780

    Article  PubMed  Google Scholar 

  23. Peveler R (2000) Eating disorders and insulin-dependent diabetes. Eur Eat Disord Rev 8(2):164–169. doi:10.1002/(SICI)1099-0968(200003)8:2<164:AID-ERV345>3.0.CO;2-V

    Article  Google Scholar 

  24. Gonçalves S, Barros V, Rui Gomes A (2016) Eating-disordered behaviour in adolescents with type 1 diabetes. Can J Diabetes 40(2):152–157. doi:10.1016/j.jcjd.2015.09.011

    Article  PubMed  Google Scholar 

  25. Balfe M, Doyle F, Smith D, Sreenan S, Conroy R, Brugha R (2013) Dealing with the devil: weight loss concerns in young adult women with type 1 diabetes. J Clin Nurs 22(13–14):2030–2038. doi:10.1111/jocn.12231

    Article  PubMed  Google Scholar 

  26. Peveler RC, Bryden KS, Neil HA, Fairburn CG, Mayou RA, Dunger DB et al (2005) The relationship of disordered eating habits and attitudes to clinical outcomes in young adult females with type 1 diabetes. Diabetes Care 28(1):84–88

    Article  PubMed  Google Scholar 

  27. Grylli V, Wagner G, Hafferl-Gattermayer A, Schober E, Karwautz A (2005) Disturbed eating attitudes, coping styles, and subjective quality of life in adolescents with type 1 diabetes. J Psychosom Res 59(2):65–72. doi:10.1016/j.jpsychores.2005.02.010

    Article  PubMed  Google Scholar 

  28. Colton PA, Olmsted MP, Daneman D, Rodin GM (2013) Depression, disturbed eating behavior, and metabolic control in teenage girls with type 1 diabetes. Pediatr Diabetes 14(5):372–376. doi:10.1111/pedi.12016

    Article  PubMed  Google Scholar 

  29. Heckathorn D (1997) Respondent-driven sampling: a new approach to the study of hidden populations. Soc Probl 44:174–199. doi:10.2307/3096941

    Article  Google Scholar 

  30. Fairburn CG, Beglin SJ (1994) Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 16(4):363–370

    CAS  PubMed  Google Scholar 

  31. Machado PP, Martins C, Vaz AR, Conceição E, Bastos AP, Gonçalves S (2014) Eating disorder examination questionnaire: psychometric properties and norms for the portuguese population. Eur Eat Disord Rev 22(6):448–453. doi:10.1002/erv.2318

    Article  PubMed  Google Scholar 

  32. Thompson MA, Gray JJ (1995) Development and validation of a new body-image assessment scale. J Pers Assess 64(2):258–269

    Article  CAS  PubMed  Google Scholar 

  33. Francisco R, Alarcão M, Narciso I (2012) Body image (dis)satisfaction among Portuguese adolescents and adults: contribution to the validation process of the Contour Drawing Rating Scale. Revista Iberoamericana de Diagnóstico y Evaluación Psicológica 34(1):61–88

    Google Scholar 

  34. Fairburn CG, Cooper Z (1993) The eating disorder examination. In: Fairburn CG, Wilson GT (eds) Binge eating: nature, assessment and treatment, 12th edn. The Guilford Press, New York, pp 317–331

    Google Scholar 

  35. Diabetes Control and Complications Trial Research Group (2001) Influence of intensive diabetes treatment on body weight and composition of adults with type 1 diabetes in the diabetes control and complications trial. Diabetes Care 24(10):1711–1721

    Article  Google Scholar 

  36. Striegel-Moore RH, Bulik CM (2007) Risk factors for eating disorders. Am Psychol 62(3):181–198

    Article  PubMed  Google Scholar 

  37. Striegel-Moore RH, Debra FL (2002) Body image issues among girls and women. In: Cash T, Pruzinsky T (eds) Body image: a handbook of theory, research and clinical practice. Guilford Press, New York, pp 183–191

    Google Scholar 

  38. Fairburn CG, Harrison PJ (2003) Eating disorders. Lancet 361(9355):407–416. doi:10.1016/S0140-6736(03)12378-1

    Article  PubMed  Google Scholar 

  39. Custal N, Arcelus J, Agüera Z, Bove FI, Wales J, Granero R et al (2014) Treatment outcome of patients with comorbid type 1 diabetes and eating disorders. BMC Psychiatry 14:26–37. doi:10.1186/1471-244X-14-140

    Article  Google Scholar 

  40. Olmsted MP, Daneman D, Rydall AC, Lawson ML, Rodin G (2002) The effects of psychoeducation on disturbed eating attitudes and behavior in young women with type 1 diabetes mellitus. Int J Eat Disord 32(2):230–239

    Article  PubMed  Google Scholar 

  41. World Health Organization (1994) Prevention of diabetes mellitus: report of a WHO study group. World Health Organization, Geneva

    Google Scholar 

Download references

Acknowledgements

This study was partially supported by the Research Center for Psychological Science (UID/PSI/04527/2013) of the Ministry of Science and Technology (FCT, Portugal). The authors would like to express appreciation to all the participants.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Rita Francisco.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Falcão, M.A., Francisco, R. Diabetes, eating disorders and body image in young adults: an exploratory study about “diabulimia”. Eat Weight Disord 22, 675–682 (2017). https://doi.org/10.1007/s40519-017-0406-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-017-0406-9

Keywords

Navigation