Eating Disorders

Although community prevalence rates of 1% for anorexia nervosa and 3% for bulimia nervosa can occur among young women, these disorders are not common in the older age group (over 40 years) when type 2 diabetes typically emerges. However, BED is an eating disorder found among 70% of obese individuals, and 80% of type 2 diabetes patients are obese.

The diabetes clinician will likely uncover BED if he or she is actively looking for it and asks questions about uncontrolled eating binges. BED is different from binge-purge syndrome (bulimia nervosa), as individuals with BED usually do not purge afterward by use of vomiting, laxative abuse, diuretic abuse, or insulin omission.

In contrast to other eating disorders, where 90% or more of cases are female, one third of all patients with BED are men (82). In the general population the prevalence of BED is around 1% to 2%. Among mildly obese people in self-help or commercial weight-loss programs, 10% to 15% have BED.

A recent study found that among a sample of type 2 diabetics, 20% displayed eating disorders and BED was the prevailing diagnosis (10%) (83). A BED prevalence of 25.6% in a group of type 2 diabetes patients attending a diabetes clinic at an academic medical center has also been found, but BED remains a neglected area of clinical research in type 2 diabetes. BED does not appear to be associated with worse blood glucose control (49,84). However, people with BED are typically extremely distressed by their binge eating. Most feel ashamed and try to hide their problem. Often they are so successful at this that close family members and friends do not know they binge eat. Several methods are being used to treat BED (85). At this early stage of research we do not know which method or combination of methods is the most effective in caring for BED patients:

• Cognitive-behavioral therapy teaches patients techniques to monitor and change their eating habits, as well as to change the way they respond to difficult situations.
• Interpersonal psychotherapy helps people examine their relationships with friends and family and to make changes in problem areas.
• Treatment with antidepressants may be helpful for some individuals.
• Self-help groups also may be a source of support.

Garry W. Welch, Alan M. Jacobson, and Katie Weinger
Behavioral and Mental Health Research, Joslin Diabetes Center, Boston, Massachusetts, U.S.A.

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