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One Bite at a Time

Apr 26, 2016

Woman, 42 years of age, class III obesity, type 2 diabetes diagnosed in the past year, binge eating disorder. Very motivated to change lifestyle when first diagnosed. She goes off and on her medication. When off, she binges. As an hcp, I wondered about the severe changes from totally “on” to totally “off.” Yes, this patient is receiving counseling, CBT.

Asked patient to take her meds as prescribed and keep a food log. When I assessed it, it was obvious to me this patient was eating so little, at most 500 calories/day, eating once daily, thinking this is the way she is supposed to eat when she is “on the diet.”

She admitted to being hungry when she was “on.” She was reported taking increased doses of her medication when she was “on.”

Patient was referred for nutritional counseling. Plan was to eat more and eat more often. A low carb meal plan does not mean NO carbs. Discussed a plan where she can feel more satisfied, and not be hungry.

She returned having reported she took her medications as prescribed, glucose levels in her target range, coinciding with her A1C, and her weight was going down. She said her appetite was not out of control. In fact, she now felt satisfied and was no longer starving then bingeing.

Lessons Learned:

  • Teach patients that ​diabetes is a chronic condition. There’s no quick, easy fix that will last long.
  • Taking higher doses of medications, then none can be dangerous.
  • Teach how small steps can add up to big changes in the long run.
  • Realize it’s hard for people to try to lose weight if they are hungry.
  • Work with patients using a multidisciplinary approach to not only prescribe medicine, but to also provide the support they need, such as dietary and psychological support.


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