Body image relates to how we think and feel about our bodies - how content or discontented we are. Many factors affect our body image and one of them is the presence of an illness. When managing diabetes, the focus on food intake and weight management can have an effect on body image.

The challenge of weight management in women with diabetes

A woman's weight influences her body image. In diabetes, weight concerns are often present. Being overweight is a contributing factor for the development of type 2 diabetes. Managing diabetes is more difficult when you are overweight and this is especially true for the woman with type 2 diabetes. For some women with type 1 diabetes, desirable weight gain may be difficult to achieve, particularly at times when blood glucose is elevated. Weight and diabetes are intertwined. Women with diabetes are often advised to "maintain a healthy weight." If you struggle with this issue, it may be helpful to separate the issue of how much you weigh from the behaviours you want to adopt to stay healthy. It may help if you work with a dietitian or other health professional to develop a plan of action that will help you to stay healthy. Then try to focus on this and not just your body size. Are you able to meet your goals for eating and activity? Let this be the measure of your success, not how your body looks.

If you find that you have stopped being active, are over-eating or regularly bingeing on certain foods, think about the reasons for this. Sometimes our lifestyles are unhealthy because of the time demands we face in our daily lives. Sometimes we use food to relax, for comfort, or to help us cope with negative feelings such as anger, boredom, fear, loneliness or a sense of inadequacy. What are the issues for you? Do you think that you need more help and support to deal with these concerns? In some cases, these issues can be resolved by prioritizing the time you need to care for yourself, while in other situations it can be useful to have professional counselling to help you examine the barriers to your health and how you can change your thinking and behaviours. If this is the case for you, talk to your doctor or the diabetes health care team and ask them to recommend a therapist to help you resolve some of these issues.

Eating Disorders in Women with Diabetes

Research suggests that eating disorders are probably more common among women with diabetes than women who do not have diabetes. Bulimia (binge eating followed by some form of purging, or excessive exercising) is the most common eating disorder in women with type 1 diabetes. Among women with type 2 diabetes, binge eating is more common.

Eating disorders of any type can result in higher blood glucose and hemoglobin A1c (a test that measures your average blood glucose over a 2-3 month period). No one knows exactly what causes eating disorders, but we do know that those most at risk are young women between the ages of 12-25 years. We also know that young women who are very conscious of their eating and exercising schedules are at greater risk.

How does an eating disorder affect diabetes?

When someone has an eating disorder, it is difficult if not impossible to maintain a healthy blood glucose level, which in turn increases the risk for diabetes complications. Please connect with your doctor and other web sites for further information and support.

What to do about eating disorders?

An article by psychologist Dr. Richard Rubin offers some ideas on positive steps to deal with this difficult problem. Below are his suggestions.

Suggestions for Young Women with Type 1 Diabetes

Here are some ideas for making positive health steps for young women with type 1 diabetes:

• Try to reduce your focus on how you think your body looks and build your self-esteem based on other personal qualities you have. The young woman with diabetes may question how having diabetes affects her image of herself. If you struggle with this issue, ask your health care provider for a referral to a social worker, psychologist or psychiatrist who will help you look at yourself in a different light. This could be one of the most important steps you take to stay healthy and feel good about yourself.
• Find healthy ways to manage weight, especially through enjoyable physical activities that give you pleasure and are not excessive. If you are not sure what is a healthy level of physical activity, consult with your doctor or diabetes educator for suggestions. Women with diabetes may feel pressure to control food intake and this in turn puts an unhealthy emphasis on food and weight.
• Seek family counselling. A recent study indicated that lots of conflict and little warmth in the ways families interact are much more common in the families of young women with diabetes who have eating disorders than in the families of those who don't have eating disorders.

If you are a mother reading this, the last point does not mean that you should blame yourself. Parents, with the best intentions, can find it difficult to overcome both their own past experiences and their concern over the future health of their children with diabetes. By seeking counselling to address your ways of coping, and encouraging your daughter to participate in family counselling, you may be able to support her along the pathway to overcoming an eating disorder.

If you have an eating disorder or think you might have one, please get the professional help you need to deal with the problem. Even if your eating is not a sufficiently serious problem to warrant calling it an eating disorder, some of the suggestions above could help you control your weight and blood glucose. And that could help you lead a longer, healthier life with diabetes.

Suggestions for Women with Type 2 Diabetes

Here are some ideas for making positive health steps for women with type 2 diabetes:

• Find healthy ways to manage eating. Consult a dietitian for ideas.
• Find other sources of satisfaction besides eating. Binge eating is often an attempt to satisfy needs other than physical hunger.
• Increase physical activity. Not only does this help control weight and blood glucose, it also improves body image and self-esteem.

If you have an eating disorder or think you might have one, please get the professional help you need to deal with the problem. Even if your eating is not a sufficiently serious problem to warrant calling it an eating disorder, some of the suggestions above could help you control your weight and blood glucose. And that could help you lead a longer, healthier life with diabetes.