How Extreme Dieting Leads To Eating Disorders

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Most people in their life have gone on some sort of diet to lose or modify their weight. 

In fact, it was estimated that 45 million Americans go on a diet each year!

Although restrictive diets can produce rapid reductions in body weight, the reality remains that weight loss diets are not very effective in the long-term. Research suggests that, for most people, any initial weight that is lost through a restrictive diet is all regained within five years ¹Wing, R. R., & Phelan, S. (2005). Long-term weight loss maintenance–. The American journal of clinical nutrition, 82(1), 222S-225S.

Making matters worse, restrictive weight loss diets are also associated with many different physical and psychological complications, including mood changes, low self-esteem, poor quality of life, lowered body temperature, constipation, and concentration difficulties ²Lowe, M. R., & Timko, C. A. (2004). Dieting: really harmful, merely ineffective or actually helpful?. British Journal of Nutrition, 92(S1), S19-S22..

What’s most concerning is the potential for dieting to lead to eating disorders or other disordered eating features. 

To highlight this with an example, severe dieting increases the risk of eating disorders by 1,800% ³Patton, G. C., Selzer, R., Coffey, C. C. J. B., Carlin, J. B., & Wolfe, R. (1999). Onset of adolescent eating disorders: population based cohort study over 3 years. Bmj, 318(7186), 765-768.!

Dieting and Eating Disorders: What’s the Link? 

Even though in this section I’m going to talk about how restrictive diets can lead to eating disorders, it is worth pointing out straight away that not everyone who goes on a diet will develop an eating disorder.

Unfortunately, we have yet to precisely pinpoint why some people who diet do and do not develop an eating disorder. 

This is probably explained by the fact that eating disorders are complex, heterogeneous illnesses that have numerous biological, psychological, and cultural causes. 

Nevertheless, it seems that there are certain weight loss diets that put people most at risk for an eating disorder, diets that are extreme and rigid. 

By this, I mean the diet consists of multiple demanding and, at times, unrealistic food rules that dictate what, when, and how much you are and are not “allowed” to eat. 

Examples of these food rules include:

• Completely avoiding carbohydrates because you fear they’ll make you fat
• Not eating anything after 6 PM
• Eating fewer than 1,000 calories even though you require much more energy to optimally function
• Allowing yourself only one “bigger” meal a day

The question, then, is how extreme and rigid diets can lead to eating disorders?

Well, there are three primary mechanisms that explain this relationship. 

Mechanism 1: Hunger 

Extreme diets make us hungry, and intense feelings of hunger send a signal to the brain that more energy is needed for the body to function. 

Eventually, the hunger will take over and preoccupy your thoughts, and a lot of the time people succumb to the hunger and “go all out” and binge on all the foods they have been avoiding. 

Over time, these recurrent episodes of restriction and binge eating can morph into a clinically significant eating disorder, like bulimia nervosa, binge eating disorder, or anorexia nervosa. 

Mechanism 2: Abstinence Volitation

Mechanism 2 occurs at the cognitive level. 

If you have a bunch of different and strict food rules, chances are that you will break one of these rules soon enough. 

For example, you might eat a piece of cake at a party when you promised yourself no carbs. 

In extreme dieters, this “rule break” is often interpreted as a failure in self-control, which can feel demoralizing because you have put in so much hard work during the week.

The common consequence of this is the “what-the-hell” effect (or the abstinence volitation effect), which means that the person says to themselves “what the hell, I ruined my diet already – I may as well go all out now and start my new diet on Monday”. 

This black-and-white thinking style is the primary driver of bulimic behaviours. 

Mechanism 3: Disinhibition 

Extreme dieters use most of their self-control and willpower on keeping their diet in check. 

This leaves them vulnerable when something else gets in the way of exercising self-control. 

Things like alcohol, drugs, and sudden mood shifts are common stimuli that can cause extreme dieters to binge, because these stimuli or experiences make it much harder for people to exercise their self-control or exert willpower. 

This can explain why it is easy to binge after a relationship breakup or after a night out in the town. 

After all, we only have a limited amount of cognitive capacity. 

What about Flexible Dieting?

Many people are promoting flexible dieting as a healthier way to lose weight and potentially prevent any eating disorder behaviours.

Flexible dieting reflects a more graded approach to dieting, defined by behaviours such as eating a wide variety of foods in moderation while still paying close attention to your weight. 

In theory, this approach sounds healthy, but what does the research say about flexible dieting and eating disorders?

Well, the evidence is mixed.

Some studies show that flexible dieting is associated with lower levels of disordered eating, body image concerns, and psychological distress ⁴Westenhoefer, J., Stunkard, A. J., & Pudel, V. (1999). Validation of the flexible and rigid control dimensions of dietary restraint. International Journal of Eating Disorders, 26(1), 53-64.

While other studies show that flexible dieting is associated with higher levels of these outcomes ⁵Westenhoefer, J., Stunkard, A. J., & Pudel, V. (1999). Validation of the flexible and rigid control dimensions of dietary restraint. International Journal of Eating Disorders, 26(1), 53-64.

Unfortunately, we don’t know yet whether flexible dieting is good for our mental health. 

Clearly, we need more higher quality, experimental and longitudinal research to study this so that we can make some stronger conclusions

But, in my view, flexible dieting is much safer than rigid and extreme diets – we just don’t know whether it can prevent or stop eating disorder behaviours. 

Breaking through the Diet Cycle

To end off, I want to touch two strategies you could implement to help you break free from the diet-binge cycle. 

These strategies form part of cognitive-behavioral therapy, and have been proven to help people overcome this vicious cycle. 

1. Structured, Regular Eating

You need to get some control back with your eating.

No more periods of restriction followed by bouts of binge eating.

The simple, most effective way to do this is to eat at regular, structured intervals. 

This means, each day, eating 3 meals and at least 3 snacks per day, spaced evenly apart. 

This pattern of eating will stop you from severely undereating and will directly address those types of food rules that tell you “when” you are allowed to eat. 

Regular, structured eating is the strategy that results in the quickest reductions in binge eating, so it is highly recommended. 

2. Exposure to Forbidden Foods

Forbidden foods are trigger foods – they cause you to binge even if you had a tiny taste of it.

In order to prevent this from happening (refer to mechanism 2 above for a refresher), you need to reintroduce these foods back into your lifestyle.

This needs to be done slowly, though.

So, you want to generate a list of your forbidden foods.

Rank them from least forbidden to most forbidden. 

Start off with the least forbidden foods (i.e., those that you perceive will be the safest to eat). 

Incorporate a small amount of this one food type back into your daily routine, while keeping everything else relatively constant (if you change too much too quickly, chances are things will spiral out of control). 

With gradual exposure, you will soon come to realize that nothing catastrophic will happen if you allow yourself this particular food, and that you need not binge on it because it will be available for you to eat the next day.

Over time, you will be able to enjoy this food with no ill-feelings.

After this, move your way down the list to the next food type. 

It will be a long process, but worth it in the end once you have no fears associated with certain foods!