Prevention and Recovery from Eating Disorders in Type 1 Diabetes: Injecting Hope sheds light on an often overlooked and misunderstood issue: the problem of eating disorders in women with type 1 diabetes – referred to by lay people and the media as "diabulimia" and characterized by insulin restriction as a means of calorie purging for weight loss. Drawing on a series of recent interviews and over 16 years of research and clinical experience with this unique phenomenon, author Dr. Ann Goebel-Fabbri provides groundbreaking insight into the lives of women who have recovered from eating disorders in type 1 diabetes. She explores the condition's origins, its effects on the lives of those affected, and possible paths to recovery. Also included are suggestions for prevention and treatment as well as practical and inspirational advice from now-recovered women. Prevention and Recovery from Eating Disorders in Type 1 Diabetes is a valuable guide for patients and loved ones, diabetes treatment teams, and eating disorder clinicians.
"Based on advances in medical and psychological science, and using real patients’ experiences, Dr. Ann Goebel-Fabbri offers clear and compelling lessons about strategies for preventing or treating eating disorders among individuals with Type 1 Diabetes. The book is a valuable resource for patients with Type 1 Diabetes and for those who care for them personally or professionally."
Ruth Striegel Weissman, professor of psychology, Wesleyan University
"Dr. Goebel-Fabbri has written a vital book that manages to speak equally well to those struggling with eating disorders in Type 1 Diabetes, their loved ones, and healthcare professionals. Utilizing the most comprehensive set of case studies published to date, this book incorporates the patient perspective in a way that most academic research misses, celebrating the gifts of recovery while remaining very scientific in its approach and application."
Dawn Lee-Akers, Family & Friends Liaison, Diabulimia Helpline
"Dr. Goebel-Fabbri provides us with an extraordinary guide to the problem of eating disorders in people with Type 1 Diabetes. She is one of the leading lights in this field, and her knowledge shines from every page. This book will help healthcare providers to understand this problem from the patient’s perspective and will provide patients with the information they need, with the realization that they are not alone, and with the hope they need to forge a path towards recovery."
William Polonsky, PhD, CDE, president, Behavioral Diabetes Institute, associate clinical professor, UC San Diego
"In this sensitively and clearly written book, Dr. Goebel-Fabbri seamlessly interweaves clinical information and guidance with the inspiring recovery narratives of and advice from twenty-five women who have found their own paths through this incredibly challenging illness. This will be an invaluable resource for individuals in recovery from an eating disorder and their loved ones, as well as for the health care providers supporting them in this process."
Patricia Colton, medical director, Eating Disorder Program, Toronto General
"By interweaving facts with the voices of women in recovery from this destructive dual diagnosis, Dr. Ann Goebel-Fabbri has broken new ground in the diabetes care realm as well as the eating disorder treatment world. From beginning to end, Goebel-Fabbri expertly examines the crucial factors that surround one of the most complex and misunderstood eating disorders that exist. Countless individuals will benefit from the knowledge and guidance this book provides."
Asha Agar Brown, founder and CEO, We Are Diabetes
"In this indispensable book, Dr. Ann Goebel-Fabbri presents a unique learning opportunity for clinicians, patients and families who work and live with Type 1 Diabetes and eating disorders. Through the use of patients’ narratives, we are able to understand more fully what led to their developing, maintaining and recovering from their eating disorder. This book is a valuable contribution to the clinical world of Type 1 Diabetes."
Marilyn Ritholz, PhD, senior psychologist, Joslin Diabetes Center, assistant professor of psychology, Harvard Medical School
"This enlightening book offers an in-depth study on the lives of diabetics with eating disorders, and Dr. Ann Goebel-Fabbri conveys a keen awareness of this over-looked population. By offering real sustainable goals for providers and patients, she has given both the diabetes and eating disorder communities something they’ve never had before, a real chance at treating this deadly co-occurring condition."
Erin M. Akers, CEO, Diabulimia Helpline
"Based on years of clinical experience and the testimonies of individuals who are living or have lived with an eating disorder in the context of Type 1 Diabetes, Dr. Ann Goebel-Fabbri provides the reader with a road map for treatment that makes use of evidence-based approaches that have proven potential to improve both eating disorder and diabetes outcomes. This book is a must-read for mental health providers who serve these individuals."
Mary de Groot, PhD, HSPP, associate professor, Indiana University School of Medicine
"When I have a question about eating disorders and Type 1 Diabetes, I ask Dr. Goebel-Fabbri. With this new book, I now have answers. Her writing is clear, knowledgeable, and evidence-based, and her compassion for people with diabetes exudes from the text. The book is also very accessible to people with diabetes, their caregivers, and healthcare providers. It is a must-read for anybody who works with, cares about, or is a person with diabetes."
Korey K. Hood, PhD, professor and staff psychologist, Stanford University School of Medicine
"This is a valuable book for people with eating disorders complicating Type 1 Diabetes, their loved ones, and their diabetes and mental health care providers. Dr. Goebel-Fabbri asks compelling questions of women who have achieved recovery. These women enlighten us about eating disorder triggers, the impact on family and loved ones, the deep sense of loss of quality of life and the most effective strategies for recovery. Dr. Goebel-Fabbri thoughtfully synthesizes and shares the insights of these women."
Florence M. Brown, MD, co-director, Diabetes in Pregnancy Program, Joslin Diabetes Center and Beth Israel Deaconess Medical Center
"Dr Goebel-Fabbri eloquently and compassionately gives voice to patients’ experiences, hopes and fears. She shows how easily the insidious pattern of insulin restriction can take hold. She also offers thought-provoking challenges to the health care community, increasing their awareness of both the overt and covert messages offered to patients and their families – those that facilitate health and those that can increase the risk for poor outcomes."
Jill Weissberg-Benchell, PhD, CDE, Ann and Robert H. Lurie Children’s Hospital of Chicago
"In this much needed new book Dr Ann Goebel-Fabbri, widely regarded as the leading behavioral clinician in the field of eating disorders and type 1 diabetes, distills her experience and insight to provide empathetic, wise and practical guidance. A must read for patients and their care-givers."
Howard Wolpert, MD, senior physician, Joslin Diabetes Center
Table of Contents
List of Figures and Text Boxes
Foreword by Barbara J. Anderson
Foreword by Kamryn T. Eddy and Jennifer J. Thomas
1 What We Know So Far About Eating Disorders in Type 1 Diabetes
2 Learning From the Experts
3 Ideas About Risk and Prevention
4 What Did and Didn’t Help
5 Motivators and Challenges to Recovery
6 The Treatment and Recovery Process
7 The Gifts of Recovery
8 Lingering Symptoms and Diabetes Complications
9 Advice for Those Still Struggling
10 Practical Applications of Expert Teaching
11 Realistic Hope
Appendix: Helpful Resources
About the Author
Ann Goebel-Fabbri worked for 16 years as a clinical psychologist and researcher in the Behavioral and Mental Health Unit at Joslin Diabetes Center. She is a former assistant professor in psychiatry at Harvard Medical School. During her time at Joslin, her work involved teaching, research, and treatment focused on disordered eating behaviors in patients with type 1 and type 2 diabetes. It covered the spectrum of eating problems from food and insulin restriction to binge eating and obesity. Dr. Goebel-Fabbri’s work is published in numerous research papers and academic book chapters, and she regularly speaks at professional conferences. She currently runs her own practice in which she treats individual patients and also consults with healthcare teams and organizations to help them in their work with diabetes patients with and without eating disorders. She teaches health professionals about psychosocial aspects of diabetes, especially eating disorders and behavioral weight management. Her clinical and research activities have been featured in the popular media, including BBC Radio, Good Morning America, National Public Radio, the Huffington Post, CNN, and the New York Times.