Disordered eating behavior in individuals with diabetes

Importance of context, evaluation, and classification

Deborah L. Young-Hyman, Catherine Lucy Davis

Research output: Contribution to journalReview article

87 Citations (Scopus)

Abstract

Limitations of current research findings: Gaps in understanding the association of DEB and diabetes include: lack of weightmatched control subjects when comparing the prevalence of eating disorders or subclinical DEB; evaluation of the contributions of an insulin dosing schedule and overinsulinization (19), loss of satiety mechanisms via hormonal dysregulation, and dietary prescriptions as potential causes perceived as loss of control over food intake; the intent of behavior in those seeking to prevent weight gain secondary to treatment; incomplete psychological characterization of samples, including psychological constructs such as loss of control, autonomy, and selfefficacy over blood glucose and weight; the potential for misclassification of behaviors and attitudes as reflecting DEB when they possibly reflect skills and attitudes learned as part of the diabetes care/self-management regimen; and the need for refinement of existing measurement tools and development of assessment methods that address diabetes-specific attitudes, concerns, and behaviors that are prescribed as part of treatment; as well as physiological mechanisms that are beyond the control of the patient. Most studied cohorts have consisted of subjects that were white, heavier than control samples, recruited from tertiary care centers, and often monitored more frequently and thoroughly than patients receiving care in the community. Sample selection bias may be operating to eliminate well-controlled well-adjusted individuals from clinical studies, potentially selecting individuals most vulnerable to the development of DEB. No studies were identified that monitored patients from the time of diagnosis to establish the temporal sequence of the onset of behavior considered maladaptive and whether weight gain occurs first or the care regimen is manipulated to prevent weight gain. Few studies could be found wherein the comorbidity of depression and other forms of psychological distress and DEB were evaluated. Directions for future research: Evaluation, characterization, and classifi-cation of DEB in individuals with diabetes have clinical importance. However, classification of these behaviors is less clinically informative if population-specific criteria and taxonomy are not established. Further, focusing on identified gaps in future investigations of DEB in this population could improve clinical care for this serious comorbid condition. Studies that chronicle the development of DEB prospectively from diagnosis will allow us to assess the contributions of the many factors that predispose individuals to the development of DEB, potentially identifying approaches to diabetes treatment with a lower risk of iatrogenic complications. It is clinically important to be able to identify those individuals who are at risk for this comorbid condition in association with and independent of the burden of diabetes care. In order to distinguish whether insulin reduction or omission is maladaptive, evaluation of the intent and context of this behavior is needed. Is it a means to regain control over excessive eating by using self-management skills or, in contrast, is it intended as a short-cut weight management strategy (purging via glycosuria)? Physiological mechanisms such as an insulin dose in excess of physiological requirement, hypoglycemia, and a hormonally driven imbalance in hunger, food intake, and experience of satiety appear to be critical factors in establishing diabetes-specific criteria that discriminate between maladaptive manipulations of the diabetes care regimen to control weight and potentially adaptive regimen modifications. Studies are needed that address these distinctions.

Original languageEnglish (US)
Pages (from-to)683-689
Number of pages7
JournalDiabetes Care
Volume33
Issue number3
DOIs
StatePublished - Mar 1 2010

Fingerprint

Feeding Behavior
Weight Gain
Eating
Insulin
Self Care
Psychology
Weights and Measures
Glycosuria
Hunger
Selection Bias
Hypoglycemia
Tertiary Care Centers
Population
Prescriptions
Blood Glucose
Cations
Comorbidity
Patient Care
Appointments and Schedules
Therapeutics

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing

Cite this

Disordered eating behavior in individuals with diabetes : Importance of context, evaluation, and classification. / Young-Hyman, Deborah L.; Davis, Catherine Lucy.

In: Diabetes Care, Vol. 33, No. 3, 01.03.2010, p. 683-689.

Research output: Contribution to journalReview article

@article{c53cbabbb6f24ff5842863ddbcc3f11e,
title = "Disordered eating behavior in individuals with diabetes: Importance of context, evaluation, and classification",
abstract = "Limitations of current research findings: Gaps in understanding the association of DEB and diabetes include: lack of weightmatched control subjects when comparing the prevalence of eating disorders or subclinical DEB; evaluation of the contributions of an insulin dosing schedule and overinsulinization (19), loss of satiety mechanisms via hormonal dysregulation, and dietary prescriptions as potential causes perceived as loss of control over food intake; the intent of behavior in those seeking to prevent weight gain secondary to treatment; incomplete psychological characterization of samples, including psychological constructs such as loss of control, autonomy, and selfefficacy over blood glucose and weight; the potential for misclassification of behaviors and attitudes as reflecting DEB when they possibly reflect skills and attitudes learned as part of the diabetes care/self-management regimen; and the need for refinement of existing measurement tools and development of assessment methods that address diabetes-specific attitudes, concerns, and behaviors that are prescribed as part of treatment; as well as physiological mechanisms that are beyond the control of the patient. Most studied cohorts have consisted of subjects that were white, heavier than control samples, recruited from tertiary care centers, and often monitored more frequently and thoroughly than patients receiving care in the community. Sample selection bias may be operating to eliminate well-controlled well-adjusted individuals from clinical studies, potentially selecting individuals most vulnerable to the development of DEB. No studies were identified that monitored patients from the time of diagnosis to establish the temporal sequence of the onset of behavior considered maladaptive and whether weight gain occurs first or the care regimen is manipulated to prevent weight gain. Few studies could be found wherein the comorbidity of depression and other forms of psychological distress and DEB were evaluated. Directions for future research: Evaluation, characterization, and classifi-cation of DEB in individuals with diabetes have clinical importance. However, classification of these behaviors is less clinically informative if population-specific criteria and taxonomy are not established. Further, focusing on identified gaps in future investigations of DEB in this population could improve clinical care for this serious comorbid condition. Studies that chronicle the development of DEB prospectively from diagnosis will allow us to assess the contributions of the many factors that predispose individuals to the development of DEB, potentially identifying approaches to diabetes treatment with a lower risk of iatrogenic complications. It is clinically important to be able to identify those individuals who are at risk for this comorbid condition in association with and independent of the burden of diabetes care. In order to distinguish whether insulin reduction or omission is maladaptive, evaluation of the intent and context of this behavior is needed. Is it a means to regain control over excessive eating by using self-management skills or, in contrast, is it intended as a short-cut weight management strategy (purging via glycosuria)? Physiological mechanisms such as an insulin dose in excess of physiological requirement, hypoglycemia, and a hormonally driven imbalance in hunger, food intake, and experience of satiety appear to be critical factors in establishing diabetes-specific criteria that discriminate between maladaptive manipulations of the diabetes care regimen to control weight and potentially adaptive regimen modifications. Studies are needed that address these distinctions.",
author = "Young-Hyman, {Deborah L.} and Davis, {Catherine Lucy}",
year = "2010",
month = "3",
day = "1",
doi = "10.2337/dc08-1077",
language = "English (US)",
volume = "33",
pages = "683--689",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "3",

}

TY - JOUR

T1 - Disordered eating behavior in individuals with diabetes

T2 - Importance of context, evaluation, and classification

AU - Young-Hyman, Deborah L.

AU - Davis, Catherine Lucy

PY - 2010/3/1

Y1 - 2010/3/1

N2 - Limitations of current research findings: Gaps in understanding the association of DEB and diabetes include: lack of weightmatched control subjects when comparing the prevalence of eating disorders or subclinical DEB; evaluation of the contributions of an insulin dosing schedule and overinsulinization (19), loss of satiety mechanisms via hormonal dysregulation, and dietary prescriptions as potential causes perceived as loss of control over food intake; the intent of behavior in those seeking to prevent weight gain secondary to treatment; incomplete psychological characterization of samples, including psychological constructs such as loss of control, autonomy, and selfefficacy over blood glucose and weight; the potential for misclassification of behaviors and attitudes as reflecting DEB when they possibly reflect skills and attitudes learned as part of the diabetes care/self-management regimen; and the need for refinement of existing measurement tools and development of assessment methods that address diabetes-specific attitudes, concerns, and behaviors that are prescribed as part of treatment; as well as physiological mechanisms that are beyond the control of the patient. Most studied cohorts have consisted of subjects that were white, heavier than control samples, recruited from tertiary care centers, and often monitored more frequently and thoroughly than patients receiving care in the community. Sample selection bias may be operating to eliminate well-controlled well-adjusted individuals from clinical studies, potentially selecting individuals most vulnerable to the development of DEB. No studies were identified that monitored patients from the time of diagnosis to establish the temporal sequence of the onset of behavior considered maladaptive and whether weight gain occurs first or the care regimen is manipulated to prevent weight gain. Few studies could be found wherein the comorbidity of depression and other forms of psychological distress and DEB were evaluated. Directions for future research: Evaluation, characterization, and classifi-cation of DEB in individuals with diabetes have clinical importance. However, classification of these behaviors is less clinically informative if population-specific criteria and taxonomy are not established. Further, focusing on identified gaps in future investigations of DEB in this population could improve clinical care for this serious comorbid condition. Studies that chronicle the development of DEB prospectively from diagnosis will allow us to assess the contributions of the many factors that predispose individuals to the development of DEB, potentially identifying approaches to diabetes treatment with a lower risk of iatrogenic complications. It is clinically important to be able to identify those individuals who are at risk for this comorbid condition in association with and independent of the burden of diabetes care. In order to distinguish whether insulin reduction or omission is maladaptive, evaluation of the intent and context of this behavior is needed. Is it a means to regain control over excessive eating by using self-management skills or, in contrast, is it intended as a short-cut weight management strategy (purging via glycosuria)? Physiological mechanisms such as an insulin dose in excess of physiological requirement, hypoglycemia, and a hormonally driven imbalance in hunger, food intake, and experience of satiety appear to be critical factors in establishing diabetes-specific criteria that discriminate between maladaptive manipulations of the diabetes care regimen to control weight and potentially adaptive regimen modifications. Studies are needed that address these distinctions.

AB - Limitations of current research findings: Gaps in understanding the association of DEB and diabetes include: lack of weightmatched control subjects when comparing the prevalence of eating disorders or subclinical DEB; evaluation of the contributions of an insulin dosing schedule and overinsulinization (19), loss of satiety mechanisms via hormonal dysregulation, and dietary prescriptions as potential causes perceived as loss of control over food intake; the intent of behavior in those seeking to prevent weight gain secondary to treatment; incomplete psychological characterization of samples, including psychological constructs such as loss of control, autonomy, and selfefficacy over blood glucose and weight; the potential for misclassification of behaviors and attitudes as reflecting DEB when they possibly reflect skills and attitudes learned as part of the diabetes care/self-management regimen; and the need for refinement of existing measurement tools and development of assessment methods that address diabetes-specific attitudes, concerns, and behaviors that are prescribed as part of treatment; as well as physiological mechanisms that are beyond the control of the patient. Most studied cohorts have consisted of subjects that were white, heavier than control samples, recruited from tertiary care centers, and often monitored more frequently and thoroughly than patients receiving care in the community. Sample selection bias may be operating to eliminate well-controlled well-adjusted individuals from clinical studies, potentially selecting individuals most vulnerable to the development of DEB. No studies were identified that monitored patients from the time of diagnosis to establish the temporal sequence of the onset of behavior considered maladaptive and whether weight gain occurs first or the care regimen is manipulated to prevent weight gain. Few studies could be found wherein the comorbidity of depression and other forms of psychological distress and DEB were evaluated. Directions for future research: Evaluation, characterization, and classifi-cation of DEB in individuals with diabetes have clinical importance. However, classification of these behaviors is less clinically informative if population-specific criteria and taxonomy are not established. Further, focusing on identified gaps in future investigations of DEB in this population could improve clinical care for this serious comorbid condition. Studies that chronicle the development of DEB prospectively from diagnosis will allow us to assess the contributions of the many factors that predispose individuals to the development of DEB, potentially identifying approaches to diabetes treatment with a lower risk of iatrogenic complications. It is clinically important to be able to identify those individuals who are at risk for this comorbid condition in association with and independent of the burden of diabetes care. In order to distinguish whether insulin reduction or omission is maladaptive, evaluation of the intent and context of this behavior is needed. Is it a means to regain control over excessive eating by using self-management skills or, in contrast, is it intended as a short-cut weight management strategy (purging via glycosuria)? Physiological mechanisms such as an insulin dose in excess of physiological requirement, hypoglycemia, and a hormonally driven imbalance in hunger, food intake, and experience of satiety appear to be critical factors in establishing diabetes-specific criteria that discriminate between maladaptive manipulations of the diabetes care regimen to control weight and potentially adaptive regimen modifications. Studies are needed that address these distinctions.

UR - http://www.scopus.com/inward/record.url?scp=77649240691&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77649240691&partnerID=8YFLogxK

U2 - 10.2337/dc08-1077

DO - 10.2337/dc08-1077

M3 - Review article

VL - 33

SP - 683

EP - 689

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 3

ER -