Have you or a loved one been treated for an eating disorder alongside an additional illness? How can two simultaneous diagnoses impact treatment? What do you do when treatments seem to contradict? In this podcast episode, Dr. Cristina Castagnini speaks about diabetes and eating disorders with Esther Tambe.


Esther Tambe is a Registered Dietitian and Certified Diabetes Care and Education Specialist based in Long Island, NY. She received her Master’s degree in Nutrition with a concentration in Exercise Science from Long Island University. She also received her bachelor’s degrees in Nutrition from Long Island University and Health Science-Public Health from Stony Brook University.
Esther has spent her career working in underserved communities providing nutrition education and counseling to individuals with chronic illnesses such as diabetes, hypertension, chronic kidney disease, and HIV/AIDS.
Visit Esther's website and connect on Instagram.


  • The balance of managing diabetes without risking ED
  • Make sure that you understand your healthcare providers
  • Health is multifaceted and personal

The balance of managing diabetes without risking ED

Some forms of diabetes treatment can look very similar to eating disorder behaviors, and since there are two different types of diabetes, one form of treatment or management might not work for the other.
I think with diabetes there’s a lot of shame that comes with this diagnosis, and the lengths that people will go to just to prove that they are the “best” type of diabetic [in treatment] is alarming. (Esther Tambe)
Something similar between people that struggle with diabetes and eating disorders can be a streak of perfectionism, which is an all-or-nothing mindset, where they may berate themselves for “failing” when they make one mistake. A rigid way of looking at food in absolutes is a classic symptom of eating disorders, but it is sometimes required – in one form or another – when it comes to treating diabetes. So, it becomes a fine line to walk but perfectionism and absolutism don’t help in any case.
Is it an eating disorder or is it diabetes management? Which one is it? And sometimes it gets very blurry and they become the same. (Esther Tambe)

Make sure that you understand your healthcare providers

Of course, people want to do what their doctor, physician, dietician, and therapist tell them, but they need to make sure that they understood what was said. A lot of damage can occur when people go with what they think their healthcare provider said instead of asking for clarification until they are both on the same page with one another.
[For healthcare providers] try to understand what [your clients] understood because a lot of times, depending on where you are, it just might be too much information … but I think [importantly] it’s about understanding that restriction isn’t going to help. (Esther Tambe)

Health is multifaceted and personal

What works for you might not work for someone else, and what works for someone else might not work for you. Don’t look for quick fixes or follow the crowd, and instead work closely with your trusted team of health professionals to figure out how you can best take care of your body. So many things can impact your health, like your hydration, what type of exercise you do, and how regularly you do it – not just your meals.
There are so many factors in the increase or decrease of blood sugar. (Esther Tambe)
Remember again that health looks different, and health cannot be equated to a certain body shape or form. A smaller or thinner body does not mean health more than a bigger body. That type of rhetoric is outdated and dangerous.
I know people of all sizes and weights and shapes [that] have type 1 or type 2 diabetes and yet only the people in larger bodies are told, “Oh, if you lose weight this will help manage your diabetes”. (Dr. Castagnini)
Always remember that fad diets are fads for a reason. They are not sustainable, and holistic health that can help you to live a full and happy life needs to be built sustainably over time.



  I am a licensed Psychologist and Certified Eating Disorder Specialist. While I may have over 20 years of clinical experience, what I also have is the experience of having been a patient who had an eating disorder as well. One thing that I never had during all of my treatment was someone who could look me in the eye and honestly say to me "Hey, I've been there. I understand". Going through treatment for an eating disorder is one of the hardest and scariest things to do. I remember being asked to do things that scared me. Things I now know ultimately helped me to get better. But, at the time, I had serious doubts and fears about it. If even one of my providers had been able to tell me "I know it's scary, but I had to go through that part too. Here's what will probably happen...." then perhaps I would not have gone in and out of treatment so many times. My own experience ultimately led me to specialize in treating eating disorders. I wanted to be the therapist I never had; the one who "got it". I will be giving you my perspective and information as an expert and clinician who has been treating patients for over 2 decades. But don't just take my word for it...keep listening to hear the truly informative insights and knowledge guest experts have to share. I am so happy you are here!


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