Eating disorders can be prevented
By Carine El Khazen Hadati
Eating disorders can be life threatening. In fact, they are the deadliest of all mental health disorders: 5 to 20 percent of anorexics will die from this illness. The causes of eating disorders are numerous and intertwined; they are usually an interplay of several factors: biological vulnerability, psychological traits, cultural and social pressures that usually act as triggers.
Among those triggers, dieting is the number one risk factor for developing an eating disorder. All eating disorders start with a diet and 35 percent of occasional dieters progress to pathological dieting (disordered eating) and as many as 25 percent progress to full-blown eating disorders.
Who can say that they have never attempted dieting? Perhaps no one! In our culture, dieting has become the norm. Up to 50 percent of women are on a diet at any given time. Up to 90 percent of teenagers diet regularly, and up to 50 percent of younger kids have tried a diet at some point. Each year, more and more adults are trying to lose weight: in 2000, 24 percent of American adults were dieting; in 2004, 33 percent were dieting and in 2015 roughly 50 percent of the American population is on a diet, with every adult making, in general, four dieting attempts per year.
Why do we all diet? Because we are the victims of an industry that depends on body insecurities. This “dieting industry” promotes ‘one ideal body’ through images in order to turn around and sell diets, diet pills, cosmetic surgeries, body treatments, health magazines, and ad memberships in gyms, that has a growth rate of USD 1 billion a year.
Furthermore, according to an article published recently in Fortune Magazine, the U.S. weight loss market totaled $64 billion in 2014.
The media message is a promise to attain happiness by being slim and looking a certain way, when thinness and physical appearances are not even variables that are correlated to happiness, according to happiness studies. Self-worth, happiness, and success are not determined by body shape and weight. Yet we are bombarded with images of thin, young girls as being the most attractive, hence the happiest. These images are photo-shopped or made-up by taking the best features from various women and we are told we are going to be happy and have all our problems solved if we look like them.
To summarize, many people spend time, energy and lots of money on dieting and weight loss programs in an attempt to achieve an unobtainable look- to be happy. The result is that dieting is not only ineffective for weight loss—90 to 95 percent of all dieters regain the weight they lost within 1 to 5 years —but it actually promotes weight gain, and in 35 percent of the cases leads to developing the deadliest of all mental disorders: eating disorders.
A Finnish study on teenage twins found that dieting, independently from genetics, is associated with accelerated weight gain and increased risk of becoming overweight, creating a destructive relationship with food and triggering multiple psychological, physical and cognitive symptoms as shown by the Ancel Keys Starvation experiment. This includes feelings of depression, anxiety, lowered self-esteem, physical exhaustion, lower energy levels, restlessness and issues with concentration and memory.
This is because we still have primitive bodies designed to resist starvation, and for survival purposes, our bodies are designed to trigger multiple and complex physiological reactions that will store fat, put us in an agitated state until we curb our hunger and trigger very strong drives to overeat. Studies have shown that both humans and rats have the tendency to overeat after food restriction, as it stimulates the brain to activate feelings of hunger cravings and binge eating for survival purposes.
As a clinical psychologist specializing in the treatment of eating disorders I frequently see patients who would like to treat their problems with ‘emotional eating.’
Every single patient is convinced they are binge eating due to emotional issues, which might be the case although might not be the primary cause. The first reason for binge eating is dieting and food restriction, which leads to physiological reactions in the body such as low blood sugar, and will trigger the NPY hormone that causes food cravings. Additionally, dieting practices such as having food rules, food labelling and food demonizing can cause you to fantasize about all the unhealthy and bad options.
A starvation experiment by renowned physiologist Dr. Ancel Keys in the 1940s recruited healthy, non-eating disordered young males who were put on a supervised 1600 kcal a day diet, when normally a weight loss diet is usually around 1200 calories a day. This resulted in the development of traits such as intense food cravings, food obsessions, an interest in cookery, body image problems, long lasting binge-eating and excessive rebound weight-gain exceeding their initial intake weight. Also, note that the only ones who dropped from the experiment did so because they broke the rules and binge ate during their free unsupervised time outside the study quarters.
From personal experience, when someone you know starts a new ‘fad’ diet, the first few days or weeks are almost always easy, successful and even euphoric sometimes. But then cravings, food obsessions, the binging and the weight gain are as guaranteed as the few shed pounds of the first few days to weeks. If diets worked, why would anyone need to diet again?
Before blaming the emotional reasons, we should stop a second and consider the role of our weight loss attempts play in our binge-eating problems. I often tell my patients, “You are gaining weight and not losing any due to binge eating caused by weight loss attempts. You need to stop dieting if you want to stop binging, there is no other way.”
The first treatment for an eating-disorder is not psychotherapy for emotional problems, it is food. Food is medicine, and eating nutrient-dense food regularly, creating a structured meal plan and never letting yourself get hungry is the first and most important step towards recovery.
Psychotherapy can help you implement this nutritional rehabilitation but there is no emotional strategy that can help eating disorders if you are starved. Only after you are well fed can you start with psychotherapy work that will tackle the emotional reasons underlying the eating disorder. With around 20 percent of my patients suffering from binge eating, nutritional rehabilitation is enough to stop the binging and with 90 percent of them, it is enough to reverse all the adverse psychological symptoms without any other intervention.
The best way to prevent an eating disorder is to never diet and to work on implementing a sustainable, enjoyable lifestyle aimed at health rather than weight loss that will have as a natural consequence, weight stabilization. When eating you can try the 80/20 percent ratio, which includes 80 percent nutrient-dense food and 20 percent fun food; enjoy your food and think of food as the fuel your body needs to function. Eat slowly, mindfully, intuitively; listen and follow your hunger and satiety cues and try to move regularly.
Take the time to re-examine your current dieting strategies and see if they are working for you or if they are destroying you. Understand that it is truly insane to repeat the same behaviors and expect different outcomes: “If you keep on doing what you always did, you will keep on getting what you always got.” You have given diets their chance, and if it didn’t work it is time to try something different: a normalized relationship with food. If you understand this, then yes, it gets brighter.
Ms. Carine El Khazen is a clinical psychologist, at American Center of Psychiatry and Neurology.