Disordered Eating: Identifying, Treating, Preventing, and Differentiating It From Eating Disorders

141 The primary goals of this article are to define disordered eating (DE), to differentiate it from diagnosed eating disorders (EDs), and to provide information to aid in the diagnosis and treatment of DE among people with diabetes. This article will also demonstrate how to apply these concepts to diabetes education to assist patients in reaching and maintaining normal eating behaviors and proper diabetes management. Frustration can set in for both diabetes patients and educators when DE signs are ignored and continue to be untreated because this can negatively affect diabetes management outcomes. The importance of proper diagnosis and treatment of DE and EDs among people with diabetes cannot be overemphasized because these disorders can significantly increase diabetes morbidity and mortality1,2 and can also lead to weight gain, poor metabolic control, insulin omission, and an increased prevalence of microvascular complications.3 To diagnose DE and EDs, diabetes educators need to first clearly understand the definition of normal eating. Normal eating includes the ingestion of healthy foods, the intake of a mixed and balanced diet that contains enough nutrients and calories to meet the body’s needs, and a positive attitude about food (no labeling of foods as “good” or “bad,” “healthy” or “fattening,” which can lead to feelings of guilt and anxiety). Normal eating is related not only to health maintenance, but also to acceptable social behavior, and is both flexible and pleasurable.4 A definition of normal eating that patients can relate to is that it is “. . . flexible and varies in response to your hunger, your schedule, your proximity to food, and your feelings.”5 It is important for patients to understand that normal eating fluctuates; however, it should not fluctuate to the point of leading to a nutrient deficiency or excess or to weight loss or gain. Thoughts about desired foods and meal planning should be part of patients’ daily life, but should not dominate it (i.e., should not take a disproportionate amount of thought compared to other daily activities). In terms of behavior, the term “normal” can refer to “not deviating from a norm, rule, or principle; conforming to a type, standard, or regular pattern or occurring naturally.”6 Therefore, once disordered eating behaviors (DEBs) are performed by a large number of people, the perception may shift to an acceptance of DEBs as normal behaviors. The normalization of certain DEBs is dangerous to people susceptible to these behaviors, and both patients and diabetes educators Disordered Eating: Identifying, Treating, Preventing, and Differentiating It From Eating Disorders Disordered eating is prevalent among people with diabetes and can significantly increase diabetes mortality and morbidity. When disordered eating behaviors are culturally accepted and performed with significant frequency by a variety of groups, it can lead to the perception that these behaviors are “normal,” which can be detrimental to the prevention and treatment of diabetes. Diabetes educators are capable of improving their diagnostic skills and treatment methods to meet the special needs of people with diabetes who also suffer from disordered eating. It is important to integrate key questions into assessment interviews and to ensure that the diabetes care team has the skill, knowledge, and tools to diagnose and treat disordered eating to improve outcomes for individuals with diabetes. In Brief