Newbridge House Medical Director Dr Tony Winston has been interviewed by the British Medical Journal about the relationship between diabetes and eating disorders.

Dr Winston, who is also Medical Director for Schoen Clinic UK (mental health), set up the country’s first clinic in 2011 for people who have diabetes and an eating disorder.

In an edition of the BMJ published in March, Dr Winston explains that diabetes professionals may not have the confidence to discuss possible eating disorders affecting the patients they see. An eating disorder may be the cause of poor diabetes control.

Eating disorders are twice as prevalent in people with diabetes as in the wider population. Around two in five men and one in five women with type 1 diabetes are believed to omit or reduce their insulin in order to try to lose weight. Among those with type 2 diabetes, up to 10 per cent are estimated to have an eating disorder (compared with around four per cent in the general population).

The problem has been termed ‘diabulimia.’ It is described as the most dangerous eating disorder because of the high risk of causing serious complications including amputations and blindness due to poor diabetes control.

The theory is that people with diabetes may be more susceptible to eating disorders because they must focus closely on their food intake; this can become confused with body image and mental health issues. People with type 1 diabetes often lose a lot of weight before diagnosis, then gain weight once they start taking insulin.

In the article, Dr Winston explains eating disorders occur to a similar extent in both type 1 and type 2 diabetes.

At Dr Winston’s NHS service in Warwick, the Aspin Clinic, they support many people with type 2 diabetes. Typically, these patients have binge eating disorder and may be severely overweight.

The clinic’s approach is based on first identifying and addressing the underlying emotional issues, then introducing a tailored weight management programme.

All specialists featured in the article agree that a multi-disciplinary approach is essential: diabetes specialists need to work together with eating disorders specialists to identify whether poor diabetes control could indicate an eating disorder and to provide effective, comprehensive support.