Dr. Ann Goebel-Fabbri, a renowned expert on eating disorders and diabetes at Joslin Diabetes Center in Boston, has graciously answered a few questions about this complex and very dangerous problem for National Eating Disorders Awareness Week, sponsored by the National Eating Disorders Association.

According to Joslin’s website:

Dr. Goebel-Fabbri is an Instructor in Psychiatry at Harvard Medical School and an Investigator in the Section on Behavioral and Mental Health at Joslin Diabetes Center… Dr. Goebel-Fabbri is a clinical psychologist whose research focuses on the relationship between diabetes and eating disorders. In her own studies and in collaboration with others, Dr. Goebel-Fabbri seeks to better understand how eating disorders affect long-term medical complications in women with diabetes and what types of interventions might help improve health outcomes in these high-risk patients.

Dr. Ann Goebel-Fabbri of Joslin Diabetes Center, Expert in Diabetes and Eating Disorders

What is the latest understanding about whether or not diabetics are at higher risk for developing eating disorders? What are the latest findings on the incidence of EDs and ED behavior amongst diabetics?

Well-designed studies indicate that women and girls with T1DM are over twice as likely to develop eating disorders than age-matched peers who do not have diabetes. While not diagnostic of a formal eating disorder, up to 30% of women with T1DM report restricting insulin doses during their lifetime. The majority of these women will identify weight and body image concerns as driving this behavior.



What are some of the more important research findings to date?

Insulin restriction and disordered eating in T1DM are strongly associated with heightened risk of diabetes complications like eye, nerve, and kidney damage (retinopathy, neuropathy, and nephropathy). These complications tend to occur at a younger age and a shorter diabetes duration in insulin restrictors. Insulin restriction has also been implicated as raising the risk of death at a younger age in these women.



What are some of the more pressing areas of research inquiry at this time?

Research on effective treatment and prevention strategies targeted at eating disorders in type 1 diabetes are critically needed.



What recommendations can you give to families who suspect their child (or other family member) might be manipulating their insulin?

Raise their concerns directly with the diabetes team and with the person with diabetes. While attempts to discuss this problem cannot insure that the person with diabetes will feel ready to recognize a problem, at the very least open communication conveys a level of concern and caring and an openness to discussing these problems and a willingness to help when the patient is ready.



What recommendations can you give to people seeking treatment in places without specialized services like those available at Joslin or BDI?

Once a person with diabetes is ready to engage in treatment for an eating disorder, the first step is establishing a comprehensive treatment team that the person trusts. Such a team should include an endocrinologist (diabetes specialist), a diabetes educator, a nutritionist who understands diabetes and eating disorders (ideally – or at the very least understands eating disorders), and a mental health specialist. Finding a mental health treater with diabetes understanding is difficult, but at the very least this treater should have eating disorders expertise and a willingness to learn about T1DM from both the patient and the medical team. Close communication between patient and all providers is essential in order to insure that treatment goals are shared and understood.



Do you have any advice for patients and especially families with diabetic children regarding prevention?

To the degree possible, perfectionistic goals for blood glucose management should be diminished and the focus should be on realistic and attainable goals – fostering this attitude can help decrease family conflict about diabetes management and help patients to feel less criticized and blamed for blood glucose variability. Meal planning for diabetes management should include flexible approaches to food in which no food groups or types of food are “off limits.” Focusing on calories or weight concerns should be discouraged, because the goal is to foster a family environment and approach to eating and diabetes management that focuses on overall health and wellness as well as positive body image.

Thanks so much to Dr. Goebel-Fabbri for taking the time to share her expertise in the field of eating disorders and diabetes as a way of increasing awareness during National Eating Disorders Awareness Week. For more information about Dr. Goebel-Fabbri and her research on eating disorders and diabetes, please visit the Joslin Diabetes Center website.