A Narrative Review on Eating Disorders and Disordered Eating in Inflammatory Bowel Diseases: Need for Increased Awareness

Abstract

Recent evidence suggests a link between Inflammatory Bowel Disease (IBD) and eating disorders, an emerging complex bidirectional association. Indeed, the overlap of symptoms and signs can lead to delayed diagnosis and misdiagnosis of both conditions, but also the fear of food-induced symptoms, commonly observed in patients with IBD, determines dietary restrictions which in predisposed individuals may induce an overt eating disorder. ARFID (Avoidant Restrictive Food Intake Disorder) and anorexia nervosa are the eating disorders more frequently reported, while disordered eating and orthorexia nervosa are emerging conditions. Disease worsening due to refusal of therapies in patients with anorexia is also a matter of concern and an increased awareness of the possible association of these conditions by gastroenterologists and dietitians is strongly warranted in order for patients to receive the appropriate counseling.

Weighing the scales: Taking a balanced approach to diet therapies in pediatric inflammatory bowel disease

“…To ensure a safe experience, DTs should be carefully deliberated in patients with risk factors for EDs and DEBs, such as patients who are female-identifying, underweight, diagnosed with IBD in childhood, and adolescent age; in addition to patients with greater disease activity and/or symptoms, extraintestinal disease manifestations, psychological distress, and body image dissatisfaction. 3,9,10 DTs should also be reconsidered for patients experiencing food insecurity or significant pre-existing dietary restrictions. Factors that may be supportive or unsupportive of a positive DT experience are described in Table 1.…”

“…While resource-intensive, all patients with IBD, particularly those considering DT, benefit from a universal "screen and intervene" approach that is ideally performed in a calm setting by nutrition and MH professionals. 9,12 Many patients with IBD adaptively self-restrict their diet for symptom control and subsequently face nutritional, psychological, and medical risks. Research demonstrates how limited knowledge of diet and IBD can lead to negative coping, social and eating challenges, and burdensome food-related preparation and activities.…”

“…The "unsupportive factors" column reviews factors in the aforementioned domains that may hinder a positive and successful DT experience. 3,9,10 Abbreviations: DT, diet therapy; GI, gastroenterology; IBD, inflammatory bowel disease.…”

“… Note : The “supportive factors” column reviews factors in clinical, psychosocial, socioeconomic, cultural, and familial domains that may support positive and successful DT experiences for pediatric patients with IBD. The “unsupportive factors” column reviews factors in the aforementioned domains that may hinder a positive and successful DT experience 3,9,10 …”

“…Determining appropriateness of DT is necessary but often challenging due to limited clinical time. While resource‐intensive, all patients with IBD, particularly those considering DT, benefit from a universal “screen and intervene” approach that is ideally performed in a calm setting by nutrition and MH professionals 9,12 . Many patients with IBD adaptively self‐restrict their diet for symptom control and subsequently face nutritional, psychological, and medical risks.…”