Eating disorders and body image in cystic fibrosis

Amy Darukhanavala; Lina Merjaneh; Kelly Mason; Trang Le

doi:10.1016/j.jcte.2021.100280

Eating disorders and body image in cystic fibrosis

J Clin Transl Endocrinol. 2021 Nov 26:26:100280. doi: 10.1016/j.jcte.2021.100280. eCollection 2021 Dec.

Authors

Amy Darukhanavala¹, Lina Merjaneh², Kelly Mason³, Trang Le⁴

Affiliations

¹ Division of Pediatric Endocrinology, University of Massachusetts Medical Center, 55 Lake Ave North, Worcester, MA, USA.
² Division of Pediatric Endocrinology and Diabetes, Seattle Children's Hospital, Seattle, WA, USA.
³ Division of Pediatric Endocrinology and Diabetes, University of Virginia, Charlottesville, VA, USA.
⁴ Department of Internal Medicine and Pediatrics, Division of Pediatric Endocrinology, Diabetes, and Metabolism, Virginia Commonwealth University, Richmond, VA, USA.

Abstract

Eating disorders and disturbed body image have been reported in individuals with cystic fibrosis (CF) and may contribute to poor weight gain, reduced lung function and increased mortality. CF individuals often look and feel different from their peers and bear the additional burden of body-altering side effects of treatment. As a result, the impact of disorders such as binge eating, anorexia nervosa, and bulimia nervosa may adversely affect the social, emotional, and physical development of those with CF. Multiple risk factors may contribute to the development of an eating disorder in CF. Growth failure is affected by the physical impairments of CF, including pancreatic insufficiency, high energy demands, respiratory infections, and delayed and stunted growth and puberty. Psychological factors, such as CF associated depression and anxiety, intense focus on BMI, lack of control in a chronic disease, and preoccupation with morbidity and mortality, likely further contribute. Exercise inefficiency, secondary to poor lung function, low BMI and pulmonary exacerbations, and the potential for medication manipulation are also additional risk factors. The intense scrutiny around BMI may lead to a poor relationship with food, including disordered eating habits, abnormal mealtime behaviors, and stressful caregiver-patient interactions regarding meals. This further contributes to a discrepancy between ideal CF nutritional standards and the reality of the challenges of appropriate daily energy intake for an individual with CF. It is imperative that CF providers are equipped to identify potential eating disorders and disturbed body image in their CF patients. Improved screening and monitoring practices should be developed and implemented, with multidisciplinary support from all CF care team members, including dietitians, mental health professionals, and social workers, to best support holistic care and optimize outcomes. Increased attention to these concerns may help reduce CF related morbidity and mortality.

Keywords: Anorexia Nervosa; Binge eating disorder; Bulimia nervosa; Cystic fibrosis; Eating disorder; Food; Weight.

Grants and funding

P30 DK089507/DK/NIDDK NIH HHS/United States