Binge Eating Habits And Diabetic Implications
Overview
This study was carried out to assess the prevalence and health outcomes associated with binge eating habits among adults suffering from diabetes mellitus. Data obtained from this study was assessed via an online survey from the diabetes MILES subsample in the Netherlands.
Binge eating prevalence was compared among diabetics (type 1 and 2), their treatment types, and health outcomes. Hierarchical analysis of linear regression was employed to evaluate the relationship between binge eating habits and physiological parameters in diabetics such as BMI and HbA1c.
308 (23%) people who participated in the study stated that they had binge eating habits, with 16% of them having these bouts of binge eating at least once monthly and 6% of them binge eating at least once weekly. The binge eating habits and prevalence did not significantly vary among type 1 and type 2 diabetics and their treatment regimens. Diabetics who were reported to have binge eating habits were noted to have higher scores in dietary restraint and higher BMI values. Type 1 diabetics particularly who binged were noted to have higher HbA1c levels.
Binge eating was shown to be independently related to higher BMI and HbA1c using hierarchical regression analysis.
This research demonstrated the association and effects of binge eating to eating styles, BMI and HbA1c.
Introduction
Diabetes
Diabetes mellitus is a metabolic disease characterized by a sustained rise in blood glucose or sugar levels above the normal threshold. In health, glucose metabolism is tightly regulated such that blood glucose level remains within normal limits irrespective of glucose intake. In diabetes mellitus, there is an abnormality in glucose metabolism which leads to inadequate glucose storage and excess glucose in blood circulation. On the basis of its etiology, diabetes mellitus is classified into several types, two of which are of importance in this study. The two types of diabetes covered in this study are type 1 diabetes and type 2 diabetes.
Type 1 diabetes is most common in younger people and is thought to be due to an autoimmune reaction that destroys the insulin-secreting beta cells of the pancreatic islet. Type 2 diabetes is seen more in overweight and older adults and is due to decreased sensitivity of the insulin receptors to insulin.
Binge Eating
Binge eating can be defined as recurring episodes of uncontrollably consuming food in abnormally large quantities within a discrete time period and a feeling of lack of control. This is a condition where a person compulsively consumes abnormally large amounts of food and is unable to stop. It is usually categorized as a mental health disorder that over time can be life-threatening. Type 1 and 2 diabetics have been suggested to commonly come down with binge eating.
Diabetics have a higher risk of coming down with disordered eating behaviors (DEB) and eating disorders (ED) when compared with non diabetics. In diabetics, the prevalence of eating disorders diverge and may range from less than 5% to greater than 50%. The reason for this are the inconsistencies surrounding the definitions and study methodologies. Some variations in eating disorder types may be seen across the different types of diabetes, age group and gender of diabetics. Men with diabetes are less likely to develop eating disorders or binge eating compared to women with diabetes. Type 1 diabetics are most times noted to have disordered eating behaviors (DEB) via insulin restriction to affect weight.
The relationship between diabetes and binge eating has been hypothesized to be built on two mechanisms. Firstly, type 2 diabetics specifically were seen to have previous binge eating symptoms which were implicated in weight gain and subsequent diabetes risk. Secondly, a mechanism called ‘dieting dilemma’ demonstrated the effect of weight or carbohydrates awareness and dietary restraint on the eating habits of diabetics.
In the general population and among diabetics, binge eating has been shown to be related to a higher BMI. The relationship between blood glucose levels and binge eating has not been well understood. Furthermore, several studies have shown that binge eating is associated with psychological problems including depression or negative affect among diabetics and the general population.
The primary aim of this study was to assess the binge eating prevalence among a large sample of diabetic adults which allows for comparisons between type 2 and type 1 diabetes and their treatment regimens. Also, variations were evaluated between participants with binge eating habits and participants without, with respect to their eating styles, treatment regimens, current weight, BMI, health outcomes and associated psychological problems. Additionally, there was an assessment between binge eating, HbA1c levels, diabetes distress and BMI.
Methods
This study is part of a national survey on the psychosocial effect of diabetes in the Netherlands called Diabetes Management and Impact for Long Term Empowerment and Success (MILES). Participants were obtained via the Dutch diabetes and health related publicity channel, and was approved by the Tilburg University psychological research ethics committee in the Netherlands. Those who were able to completely answer the core set of questions for the study were assigned randomly to one out of five sections containing more targeted questions.
General questions using the DEBQ (Dutch eating behavior questionnaire) were used to assess binge eating habits. Three additional questions were included to assess the frequency of binges. Furthermore, diabetics who participated in this study were asked about the feeling of lack of control.
Participants who indicated that they had binges were placed in comparison with those who did not have binges based on their answers to the questionnaire given.
33 items in the DEBQ were used to assess eating styles like external eating (10), restrained eating (10) and emotional eating (13). External eating is eating provoked by food stimulus (e.g smell of food) despite being full. Restrained eating is the conscious restriction of food intake in order to manage weight. Emotional eating is eating provoked by emotions.
Data such as demographic profile, age, gender, height, weight (BMI), diabetes type, treatment regimen used, recent HbA1c and any recent hospitalizations or complications in the past year were documented. Questions on previous diagnosis of psychological problems such as depression, eating disorder, anxiety etc were used to assess any associated psychological problem. Those who have visited a psychiatrist or psychologist at least twice in the past year were categorized as ‘receiving psychological care’.
Depressive symptoms were assessed using PHQ-9 (9 item patient health questionnaire) likert scale. Anxiety symptoms were assessed using GAD-7 (7 item generalized anxiety disorder) likert scale. Diabetes distress was assessed using a 20 item diabetes scale problem area.
Statistical Analysis
This study employed the use of SPSS version 23. Chi square tests were used to compare binge eating frequencies and loss of control among diabetics of different types.
Three subgroups of diabetics were created to assess the differences in the variables associated with diabetes. These subgroups include the type 1 diabetics, type 2 diabetics who are non-insulin treated and type 2 diabetics who are treated with insulin.
The BMI, eating styles, weight, health outcomes, treatment regimen and associated psychological issues were compared in each subgroup between diabetics who binge eat and those who do not. Bonferroni corrections were used for multiple testing. Cohen’s d and chi square tests were used to calculate effect sizes for independent sample t-tests.
Three separate hierarchical analyses of linear regression were used to examine the relationship between binge eating with diabetes distress, BMI and HbA1c as dependent variables.
Results
A total of 1,1317 diabetics completed the DEBQ. Females constituted 55% of the participants, and had a mean age of 55 years, BMI of 28, diabetes duration of 16 years and glycosylated hemoglobin levels of 56 mmol/mol. 56% of participants had type 2 diabetes with 29% being treated with insulin and 72% not being treated with insulin. 61% of type 2 diabetics have no complications reported.
308 (28%) participants indicated that they had binge eating habits with 79 (6%) binge eating at least once weekly and 206 (16%) binge eating at least once monthly. Additionally, 215 (16%) of 308 of the participants also stated that they felt like they lost control while binge eating.
There were no significant differences in binge eating frequency and prevalence between diabetes types and treatment regimen.
Participants who stated that they binged were seen to have higher DEBQ scores on eating styles compared to people who did not binge eat. This observation had a small effect size of 0.1.
Females with type 1 or type 2 non insulin treated diabetes were more likely to binge eat. Type 1 diabetics who binge eat were mostly using insulin pumps compared to those who didn’t binge eat. This observation had a small effect size of 0.1.
Diabetics who binged were seen to have an increased rate of diabetic distress, depressive disorder diagnoses, antidepressant drug use and eating disorders.
Anxiety disorders were seen among type 1 diabetics in addition to eating disorders and are treated by a psychiatrist.
Using the hierarchical regression analysis, higher glycosylated hemoglobin levels and BMI were associated with diabetes.
Also, type 2 diabetes, female gender, higher PHQ-9 scores, higher PAID scores, higher GAD-7 scores and longer duration of diabetes were seen to be associated with higher BMI.
There was no significant relationship between diabetes distress and binge eating.
Conclusion
This study assessed the binge eating prevalence, its associations and health outcomes among diabetic Dutch adults based on the type of diabetes and treatment regimen involved.
A binge eating habits show a prevalence of 22-25%, as recorded among diabetics of both type 1 and 2.
Unlike previous studies, the reports from this study did not show the variations in the binge eating prevalence between type 1 and 2 diabetics.
This study is aimed to educate healthcare providers on the need to screen diabetic patients for eating disorders to enable early detection and management of eating disorders in diabetics.
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