Dr Ann Goebel-Fabbri Clarifies Misconceptions on Concurrent Eating Disorders, T1D


Ann Goebel-Fabbri, PhD, a clinical psychologist in Boston, Massachusettes, dispels common misconceptions involving eating disorders among patients with type 1 diabetes.

There's not a particular skin color or economic demographic that falls prey to eating disorders, said Ann Goebel-Fabbri, PhD, a clinical psychologist practicing in Boston, Massachusetts.


What are some misconceptions about eating disorders in patients with type 1 diabetes (T1D)?

So I would say there's a lot of misconceptions about eating disorders in general, and then also, when you add T1D to the mix. In general, eating disorders are assumed to be sort of a wealthy, White, teenage girl phenomenon and what we know now is that that's just absolutely not true, that there's not a particular size, there's not a particular skin color, there's not a particular economic demographic that falls prey to these disorders.

I think the biggest misconception is that if you have T1D and an eating disorder, you must be underdosing your insulin. That's not always the case. So if a patient has T1D and has anorexia nervosa, they are restricting their food and not necessarily restricting their insulin. And by restricting their food, they may go under the radar diagnostically because their glucose levels are doing just fine. They're in a healthy range, they're taking appropriate insulin. Oftentimes, their numbers are directly in the target range, and they're getting all kinds of congratulations and high fives from their endocrinology team, when in fact, they're starving themselves to death. That's another misconception, that if the person has a healthy A1C [glycated hemoglobin], they can't possibly have an eating disorder. It's just not true.

What steps need to be taken to improve care for these patients?

I think we need more research—first of all, we need to design treatments, and then evaluate those treatments that are specifically tailored toward the needs of patients with T1D and eating disorders, evaluate their efficacy. Then we need to raise awareness and raise the level of services so that they're available to more people. I always say I have a very, very unusual and strange specialty. Because there's probably about maybe 5 or 10 people who even know that this is a phenomenon and a problem. And yet, women with T1D have 2 and a half times the likelihood of having an eating disorder. So clearly, there's a huge need, and they're developing medical problems, and they're dying at younger ages and we need to figure out how best to help them.

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