The Daily Beet

09 Jul Tuesdays With Jeff: Insights Into Your Health: Does Dieting Lead to an Eating Disorder?

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©Jeff Novick, MS, RD © http://jeffnovick.com

QUESTION: I have been trying to follow this program and discussed it with my local RD.  She said that any program like this (i.e., a plant based, vegetarian, vegan diet, etc.) that restricts certain foods or food groups can trigger binge eating and overeating and even lead to an eating disorder.  Is this true?

Thanks for the question.   I have heard the same thing many times over the years, dieting, and especially any form of restrictive dieting, can lead to an eating disorder.  I was even told by a colleague during a similar discussion several years ago, that she has several clients who developed eating disorders from their stays at a renowned health center.

In fact, this topic just came up (again) in a recent discussion amongst my professional colleagues.  Upon requesting support information for the above statement, I was sent a brief description of the famous Ancel Keys starvation study which was done at the University of Minnesota in the 1940’s and was told by one of my colleagues that in the Keys study, “Some (of the men) engaged in bizarre food rituals and eventually cycles of binge eating and some purging.”

Keyes A, Brozek , Henschel A, et al.  The biology of human starvation. Vols 1 and 2. Minneapolis: University Press, 1950

In addition, I was sent this quote and reference,

“Starvation and self-imposed dieting appear to result in eating binges once food is available and in psychological manifestations such as preoccupation with food and eating, increased emotional responsiveness and dysphoria, and distractibility.  Caution is thus advised in counseling clients to restrict their eating and diet to lose weight, as the negative sequelae may outweigh the benefits of restraining one’s eating.”

Psychological Consequences of Food Restriction. J AM Dietetic Assoc. 1996: 96:589-592

So, is this true?  Can “dieting” and focusing on improving ones eating result in an eating disorder?


But let me clarify this important issue.

First, what happened in the Keys study was unique, because these subjects were truly “starving” and not dieting.  These were not overweight or obese subjects who were trying to lose excess weight and fat, but these were men who started out thin with few fat reserves. They were thin and fit men not like the typical overweight and/or obese sedentary man of today who is trying to lose weight.  During the study, these men used up all of their fat reserves and went below the level of essential body fat (5%).  Very careful records were kept. If you have ever seen the pictures of the subjects, they looked emaciated.

While the calorie level may not appear very low (1500 calories), the men in the study were also made to exercise intensely during the day.

They also lost over 25% of their initial body weight, which, started out relatively low, and remember, they started out thin and fit.

This situation is not the same as an overweight and/or obese person undergoing a healthful program of decreased caloric intake and increased physical activity and losing excess weight and body fat over time.  They are two completely different situations.

Dieting is not starvation and starvation is not dieting!

The following is from a review article that appeared in the September 25, 2000 Archives of Internal Medicine. It is an excellent review of this whole issue and also addressed the Keys starvation study done years ago and whether the Keys study is really applicable or not.

Dieting and the Development of Eating Disorders in Overweight and Obese Adults. Arch Intern Med. 2000;160(17):2581-2589.

From the review…

“Such concerns about the relationship of dieting to eating disorders originated with an experiment conducted during World War II with normal weight subjects. Young men who ate a semi-starvation diet for 6 months developed negative emotional reactions including depression, irritability, and anger, and a few engaged in binge eating behavior that persisted even after they had free access to food. These results are often assumed to apply to overweight and obese adults, among whom binge eating disorder (BED) is the most common eating disorder. A key question for the task force was whether weight-loss treatment leads to increased binge eating in these individuals.”

“Obese adults enrolled in weight-loss programs that focus on moderate energy restriction, increased physical activity, and group or individual counseling are unlikely to develop binge eating problems, concluded several studies. In contrast, the data suggest that this type of treatment reduces binge eating in those who had recurrent binge eating episodes prior to program enrollment.”

“Does dieting and weight loss in overweight and obese adults cause psychological problems, as early studies suggest? Numerous studies conducted over the last 25 years show reductions in symptoms of depression and anxiety—or at least no worsening of these conditions—in obese patients undergoing supervised weight loss treatment. Almost half of the men and women enrolled in the National Weight Control Registry (a registry of people who have lost at least 30 pounds and maintained the loss for more than a year) lost weight on their own without a formal program. Measures of mood, distress, restraint, disinhibition, binge eating, and purging among these individuals indicate that many people who have lost weight through a variety of methods do not experience significant psychological distress or disordered eating behaviors.”

“Based on these studies, the task force concluded that dieting does not induce eating disorders or other psychological dysfunction in overweight and obese adults.”

As we saw, dieting, in general does not lead to an eating disorder.   However, it is important to acknowledge that 1) there are some really unhealthy diets out there, 2) many people have really bad experiences with these bad diets, 3) many people do some crazy/dangerous things to lose weight, and 4) there are even some health professionals who recommend really bad diets.

But, that doesn’t mean that “all” dieting is bad, or that “dieting” per see is bad or that recommending a diet based on a variety of minimally processed, calorie dilute/nutrient rich foods (ie, fruits, vegetables, starchy vegetables, roots/tubers, intact whole grains and legumes) for someone trying to lose weight is somehow dangerous and will lead to an eating disorder.

In fact, it seems to me that the above article actually supports this distinction and agrees with such a recommendation.

So does this article, which appeared in the Southern Medical Journal.

Psychologic and physiologic effects of dieting in adolescents. 

South Med J. 2002 Sep;95(9):1032-41.

The article clearly states exactly that…

“Among these adolescent dieters, a significant percentage report unhealthy or dangerous weight-loss methods, including use of diet pills, fasting, skipping meals, or using very-low-calorie diets (Table 2). Dieting can be associated with both positive and negative consequences. Dieting adolescents report more health-promoting behavior, such as increasing fruit and vegetable intake, decreasing fat intake, and increasing exercise.”

It also noted that most all the negative consequences of dieting were associated with the above mentioned “dangerous” diet habits and not healthy dieting. The article states that many of the physical problems are associated with diets that are too low in calories and/or the low carb, high fat/protein diets….

“The common theme in many of the reports of morbidity and/ or mortality related to dieting practices is the use of diets that induce ketosis (very-low-calorie diets or low-carbohydrate/high-fat diets).”

And, it was the same for the negative psychological consequences also….

“The most negative patterns of psychosocial and health behavior were found among frequent dieters and purgers.”

” Seventy-four percent of patients with bulimia attributed the development of their eating disorder to the inability to maintain a low-carbohydrate diet, leading to carbohydrate craving and subsequent cycles of binging and purging. ”

As most of the negative comments about dieting is in relation to working with the obese and teenagers who are said to be most prone to developing eating disorders, I find the following comments from the article most interesting…

“Dieting and weight loss in obese teens have several potentially positive health outcomes.”

I also agree with the conclusion…

“When weight loss is necessary, the most appropriate method remains modest caloric restriction incorporating a balanced intake of macronutrients and micronutrients, along with increased physical activity.”

Lastly, a few more studies also found that dieting does not cause eating disorders. However, once again, we see “unhealthy dieting” (diet pills, laxatives, and diuretics) can lead to some problems both physically and psychologically but hopefully no health professional is recommending any such thing.

1) Dieting and the development of eating disorders in obese women: results of a randomized controlled trial. Am J Clin Nutr. 2004 Sep;80(3):560-8.

“During the first 20 wk, there were no significant differences among groups in the number of persons who had objective binge episodes or in reports of hunger or dietary disinhibition.”

“No differences, however, were observed between groups at weeks 40 or 65 (a follow-up visit).

“At no time did any participant meet criteria for binge-eating disorder.”

CONCLUSION: Concerns about possible adverse behavioral consequences of dieting should not dissuade primary care providers from recommending modest energy restriction to obese individuals.

2) Treatment of overweight in children and adolescents: does dieting increase the risk of eating disorders?  Int J Eat Disord. 2005 May;37(4):285-93.

“Significant improvements in psychological status also were observed in several studies.”

“Concerns about potential ill effects of dieting should not dissuade overweight youth from pursuing sensible methods of weight loss.”

3) Obesity, disordered eating, and eating disorders in a longitudinal study of adolescents: how do dieters fare 5 years later? J Am Diet Assoc. 2006 Apr;106(4):559-68.

“Adolescents using unhealthful weight-control behaviors were also at increased risk for binge eating with loss of control and for extreme weight-control behaviors such as self-induced vomiting and use of diet pills, laxatives, and diuretics 5 years later.”

Lastly, to clarify the issue in regard to plant-based, vegetarian and/or vegan diets…  these diets do not lead to eating disorders.  However, about 12-25% of those who have an existing eating disorder (underlying, developing or manifested), may choose vegetarianism &/or veganism as a way of restricting their eating.   Dieting/restrictive eating does not lead to an eating disorder, but unhealthy dieting/restrictive eating may be a sign of someone with an eating disorder.

Vegetarianism: Risk for an Eating Disorder? 

Christopher D. Keiper, M.A.[1],[2], Lauren M. Cash, B.S.2, and David M. Garner, Ph.D.1  of River Centre Clinic

Vegetarianism, ED, and Dietary Restraint

Which comes first, the vegetarian or the ED? Bardone-Cone and colleagues (2012) found that 61 percent of current ED individuals who have had a vegetarian diet said they believe there was a relationship between their ED and choosing to be a vegetarian. These authors found vegetarianism in the history of about half of people who develop AN, and that more AN patients who were vegetarian struggled to complete ED treatment (Bardone-Cone, et al., 2012). However, they also found that people with an ED on a vegetarian diet reported ED symptoms before choosing to be vegetarian with an average of one year between the onset of ED symptoms and eating vegetarian. Consistent with earlier studies (for example, O’Connor, Touyz, Dunn, & Beumont, 1987), these authors suggest that though ED sufferers are more likely to be vegetarian, it seems that vegetarianism is not usually a specific precedent to an ED. Rather, it seems that people who are predisposed to risk for developing an ED are more likely to engage in vegetarian eating patterns (Bardone-Cone, et al., 2012).

So, there we have it.  Unhealthful and dangerous methods to lose weight and diet can lead to both psychological and physical problems.  Hopefully, that would not be a surprise to anyone and hopefully no one, especially any health professional, is recommending any unhealthy and/or dangerous methods to lose wight. Somehow though, because of the problems associated with dangerous diets, some people want to throw out all and any attempts to diet and/or lose weight.

However, a plan recommending an appropriate caloric intake through the consumption of healthful, low calorie dense & minimally processed plant foods along with a healthful plan of activity and exercise is still the best and safest way to lose weight and maintain a healthy weight.

In Health



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Jeff Novick
Jeff Novick

Jeff Novick, MS, RD, LD, LN is truly a unique dietitian and nutritionist. With over 24 years of experience in nutrition, health, fitness and natural living, he offers expert health advice distilled into powerful, easy-to-understand language on a variety of current topics.Novick’s insightful and humorous approach to nutrition and health has helped thousands worldwide make the transition to healthy living. He holds both undergraduate and graduate degrees from Indiana State University in nutrition, with a minor in exercise science.Novick serves as Vice President for Executive Health Exams International and lectures at the McDougall Program in Santa Rosa, California and at the Engine 2 Immersion program in Austin, Texas. He is also the Director of Nutrition for the Meals for Health program, which is helping empower low-income families to achieve optimal health.For almost a decade, Novick served as the Director of Nutrition at the Pritikin Center in Aventura, Florida, and as Vice President of the Board of the Directors for the National Health Association (NHA). He also served as the Director of Health Education for the NHA and as an Adjunct Professor in the School of Health Sciences for Kaplan University.Novick has taught nutrition classes at Indiana State University, Indiana University Medical School, the University of Miami Medical School and the Florida Academy of Family Physicians. He regularly lectures at medical conferences across the country. While in Indiana, he created and taught the Nutrition Education Initiative, a preventive medicine curriculum for medical doctors, residents and medical students. In recognition of this groundbreaking project, Indiana’s governor awarded Novick the Indiana State Public Health Excellence in Health Science Award and Indiana State University awarded him the Graduate-of-the-Last-Decade Award.He has been interviewed by Newsday, Parade, Men’s Health, Shape, Women’s World and has appeared on Fox News, Discovery Health, the Today Show and other media outlets nationwide. He recently appeared in the documentary Processed People and the movie Fatboy, which won the Best Documentary award at the Fort Lauderdale and Queens Film Festivals.

  • Doran
    Posted at 18:30h, 09 July

    DIETING does lead to eating disorders! I grew up in the 60’s and 70’s and went on a diet at age 14. I was not overweight but according to Seventeen Magazine I was! This starvation/binge cycle made me obese-I am not meant to be 110lbs or 310lbs!!! Young women today still suffer from this crap! I’m in my late 50’s and only going plant-based saved me from dying of heart disease. I still needed counseling to help me understand this was NOT a DIET but a healthy way to eat and live in order to save my life. I’m no longer obese or sick but it took a lifetime to heal. That’s why I don’t like to see the word DIET in Rip’s book. And Jeff, what world are you living in! Food becomes an enemy to women who buy into a culture that’s wants them to look a certain way! Dieting IS BIG BUSINESS and makes a lot of people rich off other people’s misery. I never lied to myself-when I was too thin I knew it, and when I was obese I knew it. That’s why I’m glad I read Rip’s father’s book first. I was so sick of DIETS that I would never have read Rip’s books without knowing he was Dr. Esselstyn’s son. Thanks for listening Doran

  • Liz
    Posted at 10:45h, 10 July

    A whole food plant based (WFPB) lifestyle is the only way I have been able to loose and maintain the weight loss, improve my lab numbers, and reduce my list of medications. At 14 I weighed about 124 lbs. gradually increased after that. I tried many diets, would lose, but then end up gaining back. For a time I used purging to control my weight, until I realized that this was very unhealthy. My top weight was 230 in 2008 when I developed a rare lung disease. While spending four months in a nursing home I lost nearly 40 lbs. because I could not stand the horrible food. At home I lost even more because I was too tired to cook. As I became stronger, I started to gain again until I was 172. Fortunately a friend introduced me to the WFPB lifestyle. I took classes which taught that many chronic diseases can be reversed and even cured by eating WFPB. Each evening before class, we were served a healthy but tasty meal. I cannot say it has been difficult to follow this lifestyle, because I feel so much better, do not go hungry, and do not need to measure my food. I have been fortunate to be part of a group of WFBP friends who meet together every week for a pot luck. When people try to tempt me with foods I use to love, I focus on what they will do to my body and say, “No thank you”. Did this “diet” lead to an eating disorder. Far from it, it has eliminated my urges to binge. I now weigh 122 lbs., but more important my health has improved.

  • healthygirlskitchen
    Posted at 14:04h, 10 July

    What comes first, the chicken or the egg?

    Most people do not start dieting because they are at a healthy weight and have a great relationship with food. We start dieting because we are overweight and/or have a strange relationship with food that we then start trying to “control.” So for many, many people who have dieted and failed, it does seem like dieting makes their already messed up relationship with food FAR worse than it how it started out. Why? Because the cycle of restriction and bingeing is almost certain to start with a diet plan that is calorie and nutrient restricted.

    Hence the beauty of a whole foods plant based diet based on the principles of caloric density. You have none of the feelings of restriction. You are full. Nourished. No need to binge because you are lacking something physically.

    It doesn’t mean the eating disorder magically disappears. You still have to work very hard on your emotional connection to yourself to overcome that. But at least you are not eating in a way that is exacerbating your underlying eating disorder.

    I hope I am making sense and adding to the conversation!

  • asb
    Posted at 15:16h, 27 July

    I have to say that I have dieted in what you would term a healthy way – no fads, no excesses and I have always binged afterwords. It truly is a problem and makes me fear more effort. Apparently I am not alone – my doctor says this is a very common reaction to weight loss.

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