Expanding the conversation on Eating Disorders: Beyond Body Image
When people talk about eating disorders, the conversation often focuses on body image and diet culture. While these are important, they’re only part of the picture. Chronic medical conditions, such as Diabetes, Coeliac Disease and Irritable Bowel Disease (IBD) can significantly increase the risk of developing.
For Body Image And Eating Disorder Awareness Week (BIEDAW) 2025, Fill The Gap Counsellor Mark Hill unpacks the why and explores how chronic health conditions like diabetes or coeliac disease can contribute to eating disorder.
The Minnesota Starvation Experiment
In 1944, physiologist Ancel Keys and psychologist Josef Brozek conducted the Minnesota Experiment (1). Over 24 weeks, healthy men were placed on a semi-starvation diet, followed by a period. The results were striking. Participants became preoccupied with food – thinking about it, talking about it, and even dreaming about it. Concentration suffered. Some developed binge eating and purging behaviours during the rehabilitation phase, which persisted months later. Body image concerns emerged despite no prior issues.
The lesson is clear: without any pre-existing body image concerns, restriction alone, can trigger behaviours and thoughts seen in those with eating disorders. This demonstrates that medically necessary restrictions, like those required for conditions such as coeliac disease and diabetes, can also trigger disordered eating behaviours.
Diabetes
Anyone with diabetes can be at risk of developing an eating disorder, but the risks are higher for those with Type 1 Diabetes. Managing Type 1 Diabetes requires an emphasis on diet, meal planning, and being precise about food proportion size and monitoring of intake – all behaviours that can lead to fixation on food. Some people may also misuse insulin to control weight, a practice sometimes referred to as ‘diabulimia’ (3). Disordered eating affects roughly 28% of adolescent girls and 9% of adolescent boys with Type 1 Diabetes (3), and adolescent girls with Type 1 diabetes are twice as likely to develop an eating disorder compared to their peers without diabetes.
While less researched, Type 2 Diabetes can also intersect with eating disorders. Binge Eating Disorder is the most common eating disorder in people with Type 2 Diabetes (3). Following dietary regimens or experiencing weight fluctuations can increase the risk of disordered eating. Conversely, existing eating disorders can contribute to weight gain, which may in turn increase the risk of developing Type 2 Diabetes. People with diabetes who develop an eating disorder, particularly if insulin is misused, can face serious health risks, generally related to prolonged elevated blood glucose levels (3).
EDFA Executive Director Jane Rowan’s experience managing Type 1 Diabetes for 42 years, as well as Coeliac Disease, attests to the complex way medical conditions need to be managed. While unrelated to body image concerns, management typically involve careful planning and regimens around food and eating that can appear to be disordered.
Diagnosed with Type 1 Diabetes at age 11, Jane has come to understand that managing the condition often involves behaviours that resemble disordered eating. “You learn to eat when you’re not hungry, or stop yourself when you still are, just to keep blood glucose in range,” she says. “That constant monitoring, counting and controlling leaves little room for a natural, relaxed relationship with food. It’s easy to see how an eating disorder could take hold when these pressures are part of daily life.” She also reflects that for many people, especially teenage girls, the added influence of body image pressures could make insulin restriction seem like a tempting way to control weight, despite the serious risks involved.
Coeliac Disease
Coeliac Disease is an immune condition triggered by gluten, treated only with a strict gluten-free diet. This intense focus on food can increase the risk of disordered eating. Research shows women with Coeliac Disease are twice as likely to develop Anorexia Nervosa after diagnosis, and people with Anorexia are at higher risk of coeliac disease (2). Avoidant/Restrictive Food Intake Disorder (ARFID) is also common, often arising from fear of food-related symptoms (4).
Symptoms of Coeliac Disease – such as gastrointestinal issues, fatigue, delayed puberty, or unexplained weight loss – can overlap with eating disorder symptoms, making diagnosis tricky.
Tracey Adamson, EDFA National Marketing and Communications Manager, knows this first-hand. With a family history of coeliac disease, she grew up with anxiety around food. In her teens, disordered eating quietly took hold, accompanied by body image struggles that shaped how she saw herself. At her all-girls college of 2,000 students, these issues were magnified in an environment where many peers faced similar challenges. Her academic focus and emotional wellbeing suffered.
Looking back, Tracey wishes she could tell her younger self that help is not just out there, but within reach, and that speaking to someone she trusted, like a close friend, loved one or a professional in the eating disorder space, could have opened the door to recovery sooner. Tracey also says: “Recovery is possible. I know this because I am living proof.”
Eating disorders are complex and not caused by one single factor. Medical conditions can both mask and trigger disordered eating and eating disorders. Other health related factors that can increase the prevalence of an eating disorder are: allergies, polycystic ovarian syndrome (PCOS), weak or fragile bones (e.g., osteopenia, osteoporosis), low blood pressure (hypotension), digestive issues (e.g., irritable bowel syndrome), joint pains, headache and migraine, ), and sleep problems (5)
By expanding the conversation beyond body image and diet culture, we can better recognise these lesser-known risk factors, support earlier intervention, and provide more tailored support for those affected.
References:
- (1) InsideOut Institute, The Effects of Starvation fact sheet
- (2) Celiac Disease and Anorexia Nervosa: A Nationwide Study (2017)
- (3) National Eating Disorders Collaboration, Eating Disorders and Diabetes fact sheet
- (4) Avoidant/Restrictive Food Intake Disorder Characteristics and Prevalence in Adult Celiac Disease Patients (2022)
- (5) National Eating Disorders Collaboration, Eating disorders in Australia
- (6) Food Allergy, Eating Disorders and Body (2021)
Additional resources:
This study suggests that the risk of developing an eating disorder may be even higher for a person with Type II diabetes mellitus, with 55% of the people with T2DM included in this study displaying disordered eating behaviours (compared with 25% with T1DM).
Eating Disorders Families Australia (EDFA) provides support and services for carers supporting loved ones with eating disorders
EDFA’s FREE Online Support Groups offer a safe space for you to connect with other carers of a loved one with an eating disorder Australia-wide.
EDFA’s Fill The Gap counselling service offer free, one-on-one online counselling to support carers in navigating the challenges of caring for a loved one with an eating disorder or disordered eating concerns.
Please contact Administrative Assistant Bailey Wightman on 03 9125 5670 or email bailey.wightman@edfa.org.au if you need support accessing the service.
About Eating Disorders Families Australia
Eating Disorders Families Australia (EDFA) is the only national organisation solely for carers and families of those with an eating disorder. EDFA provides support, EDucation, advocacy, and FREE online counselling services and annual membership. EDFA has a private Facebook forum, providing a safe place for eating disorder carers and family members to share experiences, seek advice and assistance, and find hope.