Guidelines, Quibbles and Quirks — Part 4

This continues the description of some uncommon but dangerous eating disorders, brought to public attention by the National Eating Disorders Association during National Eating Disorders Awareness Week. Today’s post describes two more of the lesser-known eating disorders which are not yet officially deemed to be such.


Diabulimia is something that afflicts only Type 1 diabetes patients, especially adolescents, who fear that the insulin that keeps them alive also makes them overweight. They will limit or skip their required insulin injections, which leads to nothing good.


Pregorexia is also limited to certain patients, in this case, the pregnant ones. The expectant mother wants to control the amount of weight she gains during pregnancy. This behavior can turn into an eating disorder like anorexia or bulimia. The possible consequences affect not only herself but the unborn child. The infant may suffer restricted growth, fetal development irregularities, or low birth weight, as well as outright miscarriage, or the risks incurred by prolonged labor. For the mother, the possibilities also include bone loss, abnormal fatigue, dizziness, electrolyte abnormalities, and dehydration.

Along with calorie counting and food intake restriction, the prospective mother might insist obsessively on a demanding exercise routine. Several other warning signs should be watched for:

— Self-induced vomiting
— Laxative use
— Feeling shame or guilt about weight gain
— Weighing yourself several times a day or doing other things to measure the size of your body
— Fear or intense distress about gaining weight
— Avoid going to doctor’s appointments
— Feel disconnected from the baby growing inside them
— Avoid social situations with friends or family

Why have these unusual disorders been brought up here? Because one of the major objections to the new American Academy of Pediatrics guidelines for childhood obesity treatment is that the beliefs and intentions expressed therein are in danger of inspiring a new wave of eating disorders, especially among the young.

National Public Radio’s “All Things Considered” interviewed eating disorder specialist Nooshin Kiankhooy, who points out that there have been no long-term studies of how a child may be impacted by either weight-loss drugs or bariatric surgery.

There is also the psychological angle. When many adults barely grasp how these treatments could affect them, how are children supposed to understand what they are letting themselves in for? Kiankhooy says,

The fact that we are placing such an emphasis on the size of a child’s body, to me, is a huge concern — and how that not only is going to impact a child’s body from a physical standpoint but how it’s really going to impact them from a mental standpoint in — this is what your body is, and we must now change it…

Also for NPR, journalist Kaitlyn Radde wrote,

[W]hen adult patients stop taking the class of weight loss drugs recommended in the guidelines, they often gain the weight back, which means kids might be on the medication for the rest of their lives. But supporters say the updated guidance will help destigmatize obesity precisely because it treats it as a disease — like cancer or COVID — that requires medical intervention and isn’t the patient’s fault.

Your responses and feedback are welcome!

Source: “NEDA National Eating Disorder Awareness Week 2023,”, undated
Source: “This eating disorder expert is worried by new guidelines to treat childhood obesity,”, 02/17/23
Source: “New childhood obesity guidance raises worries over the risk of eating disorders,”, 02/15/23
Image by Enzymlogic/CC BY-SA 2.0

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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