Ultimate Eating Disorder? Lose Weight Instantly But Risk Death

(AP photo/Reed Saxon)

(AP photo/Reed Saxon)

You could say it began with a big bowl of chocolate pudding. After days on a starvation diet, 14-year-old Maryjeanne broke down and devoured the whole bowl, spooning the forbidden chocolate sweetness into her mouth straight from the fridge.

Then the regret hit, and the shame. She had failed her 600-calorie-a-day diet. What to do now? She’d had Type 1 diabetes since age 10, and knew she should take some extra insulin to counterbalance all the pudding she’d just eaten. Or she could make a darker choice. She writes in her recent memoir, Eating to Lose:

I skipped my insulin that night. It was my penance.

The next day I lay in my hospital bed with five intravenous tubes connecting the insides of my arms, ankles, and neck to the stark walls of that room. There was not a single ounce of energy left in me. My mouth was drier than Arizona sand. My stomach felt as though it had expelled every morsel of food I had ever eaten. The muscles along my torso felt bruised from endless violent heaving; my insides now entirely evacuated. The combination of this torturous diet and the resulting chocolate pudding binge had cost me two collapsed lungs and nearly ten pounds of weight loss, consisting not of fat, mind you, but primarily of essential bodily fluids.

Maryjeanne had entered the world of “diabulimia,” an eating disorder specific to people with Type 1 diabetes, usually young women. The “bulimia” in the name refers to a diabetic method for purging calories: Instead of vomiting up food as typical bulimics do, someone with diabulimia skips or skimps on insulin, so that blood sugar is “purged” in urine instead of being absorbed and used for energy by the body’s tissues.

The effect can be instant weight loss. Also instant medical crisis, and devastating long-term damage.

Diabulimia offers perhaps the starkest example there is of the harsh “logic” of an eating disorder, an urge to lose weight so overwhelming that health no longer seems to matter. And young women with Type 1 diabetes are two to three times more prone to eating disorders than those without, research finds. The overall prevalence of diabulimia is estimated at up to 1.4 million Americans.

If a young woman is already at risk for an eating disorder, and then she experiences weight loss in a day or two from skipping insulin, “It’s outrageously reinforcing,” said Dr. Ann Goebel-Fabbri of the Joslin Diabetes Center. “That’s a more powerful and dangerous calorie purge than any other eating disorder symptom.”

The price is also exceptionally high. Continue reading

Call To Consider ‘Diabulimia’ As A Mental Illness

Insulin pump (mbbradford/Wikimedia Commons)

Insulin pump (mbbradford/Wikimedia Commons)

Diabulimia? At first I thought it might refer to purging with laxatives. But no, it refers to young women with diabetes who cut back on the insulin they need in order to lose weight. “Diabetes Health” offers some excellent background here, including the explanation that “when insulin is omitted, calories are purged through the loss of glucose in the urine.”

The BBC reports today that a British charity called Diabetics with Eating Disorders is now pushing to have diabulimia recognized officially as a mental illness. The report warns that side effects of not taking enough insulin can range from “eye sight loss to kidney damage and if left untreated can even kill.”

Leading doctors and psychiatrists say diabulimia is most common with young women who have type 1 diabetes…

Figures show, in the 12 months up to last March, more than 8,000 people were admitted to hospital in England and Wales, with symptoms of not taking enough insulin. Continue reading

When An Eating Disorder Takes Over A Teenager’s Life

Because so many women in this country are obsessed with their weight, and carry around a sad sense that their bodies are never good enough (bolstered by social pressure and the proliferation of unrealistic images of beauty) stories about eating disorders resonate profoundly. The crazy drumbeat of “thinner is better” is so very familiar to most of us, it’s the soundtrack we live with: “If I just lost 10 or 20 or 30 pounds, my life would fall into place — I would finally be in control.” But for some, that low-level fixation grows and grows, until it takes over, crossing a line into illness and true despair.

Dr. Annie Brewster notes that about 10 million people in the U.S. have an eating disorder, according to the National Institutes of Health, and 90% are women. Approximately 4.5% of all American high school students reported in a recent survey that they’d vomited or used laxatives as a means to lose weight in the past 30 days, and approximately 4% of college-aged females have bulimia. According to the 2007 Youth Risk Behavior Survey, 35% of adolescent girls believed they were overweight, 60% were trying to lose weight. The vast majority of eating disorders go untreated.

But the numbers don’t get at the atrocity of what an eating disorder involves. For our Listening to Patients series, Dr. Brewster, a Boston internist, recently conducted and edited an interview with Elizabeth, a 19 year-old college student with bulimia. “To fully grasp that terror of an eating disorder would take much more than an hour long interview,” Elizabeth said. “The struggle for perfection is destructive and unbearable. Not only is this goal an impossible one, but the process is crippling and fatal. An eating disorder needs you to feel imperfect, unworthy, ugly, fat, disgusting, wrong, horrible. It strips you of your health, your self worth, your life, your soul. It blames you for everything that goes wrong and berates you if you can’t fix it. You do not need to fix everything. It is not your fault. You don’t need to be perfect. You just need to be the best you can be and not be afraid of who you are. That is true beauty.”

Here, Elizabeth speaks openly about her bulimia, which started in childhood as an internal battle over control, self-identity and growing up. As her weight fluctuated, she describes the desperate journey from eating food out of the garbage, throwing up several times a day and punishing 4-hour daily stints at the gym, to her recent, still-fragile emergence into a kind of peace with her own body and her self.