Dieting: A Road to Better Health or Disordered Eating?

A recent survey found that 1/3 of all US adults reported being on a diet or following a specific eating pattern in the past year. The most frequently mentioned diets were intermittent fasting, restricting carbohydrate intake, paleo, low-carbohydrate, Whole30, high-protein and ketogenic/high-fat diets.

There are all sorts of reasons why people focus on changing their eating habits, including improving overall health, avoiding certain diseases, and losing weight. There is, however, a dark side. For individuals who might have a propensity towards eating disorders, engaging in diet changes that impose severe or overly strict guidelines on timing of meals, eliminating or avoiding certain foods or food groups, and especially weight loss dieting, can result in an unintentional slide into disordered eating patterns or even outright eating disorders.

It has been known for years that engaging in weight loss dieting is a risk factor for future disordered eating in both adults and adolescents. (1,2). A recent Mayo Clinic newsletter described how dieting for weight loss can cause the brain to respond as if the person was faced with starvation, noting “There is strong evidence that many of the symptoms of an eating disorder are actually symptoms of starvation. Starvation and weight loss may change the way the brain works in vulnerable individuals, which may perpetuate restrictive eating behaviors and make it difficult to return to normal eating habits.”(3)

However, non-weight loss diet programs can also be tricky to navigate for individuals whose genetics, temperament, and environment might put them at risk for disordered eating and developing an eating disorder. As documented in the survey, intermittent fasting is the current hottest diet fad out there, as shown by the attention it receives on social media. The basis of intermittent fasting program is the idea that restricting one’s intake to a certain time of day, or to a certain number of hours each day, can result in weight loss or health benefits. As with most such popular diet programs, they are frequently a mix of some science with a large helping of media exposure, which inflates what is actually known about the benefits of following such a regime.

An example of this is a recent pilot study that looked at the effects of intermittent fasting on the ability to reduce the risk of type II diabetes. In this preliminary study, eight men consumed all of their food for the day between 6:00 a.m. and noon. The rest of the day they consumed no food until 6:00 a.m. the next morning. The results showed improvements in some metabolic markers associated with blood sugar control, as well as improvements in blood pressure. Remember, this was an early study with a very small number of participants and much more work would need to be done to see if these results would hold true in larger, more diverse populations. The lead author of the study correctly pointed out that more work was needed to see if this approach was doable for most people. The issue here is not about whether changing when meals are eaten have health benefits for some people, but it is about the risk that this type of severe restriction presents to people in general (imagine the practical difficulties of implementing such a regime). This is a particularly important consideration for individuals who might have a biological or genetic predisposition towards either restriction and/or binging tendencies or have personality traits that would be triggered by a rigid black and white mandate.

There isn’t a clear break or line that one crosses when diets go from helpful to dangerous. Normal/healthy eating, disordered eating, and eating disorders run along a continuum. Frequently, individuals who struggle with an eating disorder start out with very well-intended, rationale, and reasonable changes to their eating habits or patterns. If you are thinking about changing the way you eat, it might be helpful to consider the following questions. How would the changes you are considering:

• Impact your ability to meet your body’s energy and nutritional needs?
• Impact your professional or social interactions?
• Create undue focus and stress around how, what, or when you eat?
• Impact your overall quality of life?

If you have made changes in your eating habits and feel concerned that it could be leading to difficulties in your relationship with food, the following questions might be helpful to consider:

• Do you worry about your weight and body shape more than other people? 
• Do you avoid certain foods for reasons other than allergies or religious reasons? 
• Are you often on a diet? 
• Do you feel your weight is an important aspect of your identity? 
• Are you fearful of gaining weight? 
• Do you often feel out of control when you eat? 
• Do you regularly eat what others may consider to be a large quantity of food at one time? 
• Do you regularly eat until feeling uncomfortably full? 
• Do you hide what you eat from others, or eat in secret? 
• Do you often feel fat? 
• Do you feel guilty or depressed after eating? 
• Do you ever make yourself vomit (throw up) after eating? 
• Do you use your insulin in ways not prescribed to manage your weight? 
• Do you take any medication or supplement to compensate for eating or to give yourself permission to eat? 
• Do you exercise for the sole purpose of weight control? 
• Have people expressed concern about your relationship with food or your body? 

If you answer “yes” to two or more questions on this informal survey, it strongly indicates the presence of disordered eating and you should reach out for an assessment. 

References

1. Psychiatry Res. 2014 Dec 15; 220(1-2): 500–506.

2. J Am Diet Assoc. 2006 Apr; 106(4): 559-68.

3. mayoclinic.org/diseases-conditions/eating-disorders/symptoms-causes/syc-20353603