Managing type 2 diabetes or prediabetes and binge eating disorder: a qualitative study of patients' perceptions and lived experiences

BACKGROUND: The overlap in prevalence between type 2 diabetes and binge eating disorder is substantial, with adverse physical and mental health consequences. Little is known about patients' efforts at managing these two conditions simultaneously. The research objective was to explore patients' experiences managing co-existing type 2 diabetes or prediabetes and binge eating disorder. METHODS: This is a qualitative descriptive study using semi-structured interviews. Participants included 21 women with type 2 diabetes or prediabetes (90% non-Hispanic White; mean age 49 ± 14.8 years, mean BMI 43.8 ± 8.4; 48% with type 2 diabetes and mean HbA1c was 8.4%). Interviews were analyzed using thematic analysis and NVivo software. RESULTS: Qualitative analysis revealed that participants reported binge episodes frequently started in childhood or adolescence and went undiagnosed for decades; notably, they recalled that diabetes diagnosis preceded the binge eating disorder diagnosis. They also described trying to lose weight throughout their lives and how feelings of deprivation, shame, and failure exacerbated binge eating. Participants further reported how binge eating made diabetes self-care and outcomes worse. Finally, participants observed that when binge eating disorder treatment and diabetes management were synergistically integrated, they experienced improvements in both binge eating and glycemic outcomes. This integration included reframing negative thoughts surrounding binge eating disorder and diabetes self-management and increasing their understanding of how the two disorders were inter-related. CONCLUSION: Findings highlight the importance of increasing healthcare providers' awareness of and screening for binge eating disorder in the treatment of diabetes and inform specific integrated interventions that address both diagnoses. From this study where we interviewed 21 women with binge eating disorder (BED) and type 2 diabetes/prediabetes, we learned how binge eating impacted diabetes management and how diabetes impacted BED. Most participants reported receiving the diabetes diagnosis before being diagnosed with BED despite the earlier onset of binge eating, pointing to the need for BED screening. Participants described trying to lose weight throughout their lives and reported feelings of failure and shame, which made binge eating worse. Binge eating made diabetes management harder, but when diabetes and BED treatment were aligned, participants experienced improvements in binge symptoms and diabetes outcomes.Dudley Allen Sargent Research FundPublished versio

Women's perceptions of weight stigma and experiences of weight-neutral treatment for binge eating disorder: a qualitative studyResearch in context

Summary: Background: The detrimental effects of weight stigma are a growing concern as a contributor to negative physical and mental health outcomes, disparities in care, and healthcare avoidance. Research exploring the impact of weight-neutral healthcare is limited but suggests weight-neutral interventions are associated with positive psychological and behavioral outcomes. Little is known about patients’ lived experiences receiving weight-neutral healthcare. Methods: We conducted semi-structured interviews between Feb 5, 2019 and Feb 25, 2020 with 21 women (90% non-Hispanic white, mean age 49 ± 14.8 years) who had type 2 diabetes or prediabetes and high body weight (mean body mass index 43.8 ± 8.4, range: 30.2–63.9) and previously attended a specialized treatment program for binge eating disorder. We recruited individuals with type 2 diabetes or prediabetes who completed of >2 weeks of a specialized binge eating disorder treatment program with the ability to participate in an English-spoken interview and did not have cognitive impairment or severe psychopathology that would limit recall or engagement in the interview. Interviews were analysed using thematic analysis and Nvivo software. The main outcome we studied was patients’ lived experience in healthcare settings and in a weight-neutral eating disorder treatment program. Findings: Participants reported experiencing weight stigma in healthcare encounters and believed this decreased the quality of care they received. While participants frequently attempted to lose weight, they experienced embarrassment, internalized a sense of failure, and felt blamed for their weight and health conditions. In describing experiences within a weight-neutral paradigm, participants reported that helpful elements included consistency in the eating pattern (emphasizing adequate, varied, and nourishing intake), sufficient and specific education, and comprehensive support. Reported impacts included decreased binge episodes, experiencing less shame, and increased resiliency following treatment. Some participants experienced the weight-neutral treatment recommendations and the absence of the pursuit of weight loss as challenging. Interpretation: Weight-neutral treatment may improve psychological and behavioral outcomes regarding binge eating, and longitudinal, quantitative research is warranted. These findings are useful to decrease weight stigma in provider–patient interactions. Funding: The Dudley Allen Sargent Research Fund, Boston University

Causal and Associational Language in Observational Health Research: A Systematic Evaluation.

We estimated the degree to which language used in the high profile medical/public health/epidemiology literature implied causality using language linking exposures to outcomes and action recommendations; examined disconnects between language and recommendations; identified the most common linking phrases; and estimated how strongly linking phrases imply causality. We searched and screened for 1,170 articles from 18 high-profile journals (65 per journal) published from 2010-2019. Based on written framing and systematic guidance, three reviewers rated the degree of causality implied in abstracts and full text for exposure/outcome linking language and action recommendations. Reviewers rated the causal implication of exposure/outcome linking language as None (no causal implication) in 13.8%, Weak 34.2%, Moderate 33.2%, and Strong 18.7% of abstracts. The implied causality of action recommendations was higher than the implied causality of linking sentences for 44.5% or commensurate for 40.3% of articles. The most common linking word in abstracts was "associate" (45.7%). Reviewers' ratings of linking word roots were highly heterogeneous; over half of reviewers rated "association" as having at least some causal implication. This research undercuts the assumption that avoiding "causal" words leads to clarity of interpretation in medical research