Doctors once thought that type 2 diabetes was mainly an adult disease because people tend to get it in midlife or later. Nearly 21 million Americans are now suffering from diabetes and 41 million more are prediabetic, with blood-sugar levels well above normal. Binge eating lurks behind a disproportionate number of type 2 diabetes cases. A team of Brazilian researchers led by Marcelo Papelbaum surveyed seventy type 2 diabetics aged 40 to 65 years. The researchers found that 20 percent of their patients, mostly female, had an eating disorder: mainly binge eating disorder, but also bulimia and EDNOS.
This percentage was more than three times higher than in the general population. Researchers have found a similar problem in the United States, where as many as a third of patients with type 2 diabetes are also plagued by an eating disorder. The connection between binge eating and diabetes seems simple: binge eating causes obesity, and obesity is linked to diabetes. But there may be a more direct link.
Susan Yanovski at the National Institute of Diabetes and Digestive and Kidney Diseases in Bethesda, Maryland, suggests that some diabetic patients, perhaps those with a certain predisposition, might be indulging in regular binges to rebel against the strict dietary restrictions needed to control their diabetes. Bingeing is dangerous for anyone. But a middle-aged woman who binges and has diabetes is endangering her life. She has three factors working against her: diabetes, an eating disorder, and obesity. Midlife aggravates all three ailments.
Studies show that after a woman reaches 40, she will gain more fat because her basal metabolic rate declines with age. But when a woman at this stage in life tries to diet and lose what normal aging has brought on, she often makes the problem worse. Statistics say that she eventually blows her diet. Now, with a sluggish metabolism, she resumes her normal eating habits - or she binges after having denied herself during the diet. Her body suddenly has to digest and store a glut of calories just when all its systems are tuned to managing on a minimum. Thus, she gains back the weight she has lost, and then some. She becomes more overweight.
Disgusted with her "failure," she may diet on and off again, picking up all the traps of a binge eating disorder. Weight gain also heightens her risk for diabetes. She can cross the line from prediabetes to the classic disease. She has three problems to treat, but treatment for one often worsens the symptoms of another. Studies show that the loss of 5 to 10 percent of body weight can significantly delay or prevent type 2 diabetes in persons at high risk. But if the doctor puts the woman on a diet, the diet may prompt more bingeing. If she does not lose weight, she increases her potential for complications from diabetes and obesity.
Consequently, eating disorders experts have realized that they cannot simply embrace the traditional approach: diet in combination with one or more antidiabetes drugs. When a woman has binge eating disorder, the weight-loss strategy has to be a second priority. "Treatment for binge eating is very unsatisfying in that regard," says Hudson. "Because you can get people completely better from their binge eating. And they sit there and they say, 'You know, I've only lost five pounds.'"
And yet that is better than a radical diet, aided by faddish weight-loss pills. Dieting, while necessary to impact obesity and diabetes, needs to be done very carefully - and with the guidance of a physician, preferably one experienced in eating disorders. Medication may help, but again, caution is advised. Most studies of weight-loss and related drugs for binge eating disorders are still in experimental stages.
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