Considering Dietary Restraint During Nutritional Treatment

Dr. David Wiss

June 25, 2021

Eating Disorders

As anyone who has ever tried it can attest, dieting is stressful! This may explain why dieting behaviors aimed at losing weight can actually have the opposite effect [1–3]. Many people are surprised to learn that their diet efforts may have contributed to weight gain over time, and even worsening body image over time.

It seems some people assume that their energy balance is a simple 24-hour ordeal (likely due to calorie counting apps) rather than a dynamic life course process. These math-centric approaches overlook one’s relationship with food and the importance of individual neurochemistry in the quest to find eating disorder recovery. For some people, counting calories and tracking macros is a primary reason they experience loss of trust in themself as eaters, and loss of control around food.

While it may seem counterintuitive, data has implicated dietary restraint as a causal factor in binge eating disorder as well as obesity. Of course, these relationships are bidirectional since many people start engaging in restrained eating after the onset of overeating [4]. It then becomes a vicious cycle. Thus, it is critical to acknowledge the role of diet culture and weight stigma in perpetuating eating disorder symptoms.

Restrained eating is generally defined as a cognitive effort to eat less in order to lose weight [5], which has been viewed both as the problem and solution to obesity [6]. However, recently it has become clear that theories of weight loss based on low-calorie dieting are failing, likely due to neurochemical, endocrine, and gastrointestinal factors, which simple models of energy balance do not adequately capture. Thus, we must consider dieting history in assessing weight status and in conversations about weight-related goals.

A classic study conducted by Ancel Keys in the 1940s examined the link between starvation and changes in human biology and behavior [7]. The study showed that significant (intentional) weight loss produced binge eating in 30% of participants. Many individuals who were reduced to 50% of their baseline caloric intake for extended periods (months) began collecting recipes and cookbooks. Dietary restraint led to an obsession with food for many of these men, which was persistent after the weight was regained!

The finding that caloric restriction leads to preoccupation with food has been widely cited in eating disorder circles. The argument that follows is that “diets don’t work.” Meanwhile, it is less clear if deliberate efforts to eat differently (focusing on dietary quality rather than quantity) should be classified as pathological restraint. However, overemphasis on dietary quality can also be very stressful. For example, “clean” diets intended for health reasons which impair daily function have been described as “orthorexia nervosa” which is also a growing problem in society [8]. Nutrition is tricky!

There is considerable debate on how to approach the concept of food addiction from a nutritional standpoint. It has been stated that “dietary restraint does not have to be dysfunctional as long as flexible elements are added” [9]. Furthermore, individuals who meet the criteria for food addiction and engage in dietary restraint may experience different effects on their weight status, depending on whether the restraint is successful, unsuccessful, pathological, or part of a restrictive eating disorder.

More research is needed to determine what types of dietary restraint are helpful or harmful when criteria for food addiction are met. In the meantime, an 8-step process for discerning dietary restraint from food addiction was recently published in an open-access journal [10].

Many people turn to comfort food when feeling stressed. Improving food choices and eating habits is one form of treatment, and should be done with a registered dietitian nutritionist. But it is equally important to learn principles of mindful eating and address issues of internalized weight bias.

It is crucial to establish if someone would benefit from a more exclusive (i.e., removal of foods) versus inclusive (i.e., integrate foods) nutritional approach. We predict that very-low-calorie diets will always be dangerous over the long run. Stopping dieting is one of the most straightforward ways to stop stress eating and binge eating. For people with binge eating disorder, it is critical to develop new coping skills, and may require a whole treatment team.

At Wise Mind Nutrition, we believe that one size does not fit all and that no single food philosophy works for all people. For this reason, we undergo a careful assessment process to guide nutrition interventions. Our approach is on the cutting edge of the “nutrition for mental health” revolution. The truth will set you free–find out what is true for you today!

References
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2. Siahpush M, Tibbits M, Shaikh RA, Singh GK, Kessler AS, Huang TT-K. Dieting Increases the Likelihood of Subsequent Obesity and BMI Gain: Results from a Prospective Study of an Australian National Sample. Int J Behav Med. 2015;22(5):662–71.
3. Lowe MR, Doshi SD, Katterman SN, Feig EH. Dieting and restrained eating as prospective predictors of weight gain. Front Psychol. 2013;4:577.
4. Brewerton TD, Dansky BS, Kilpatrick DG, O’Neil PM. Which comes first in the pathogenesis of bulimia nervosa: Dieting or bingeing? International Journal of Eating Disorders. 2000;28(3).
5. Meule A. Chapter 16 An Addiction Perspective on Eating Disorders and Obesity. Eating Disorders and Obesity in Children and Adolescents. 2019;99–104.
6. Monnier L, Schlienger J-L, Colette C, Bonnet F. The obesity treatment dilemma: Why dieting is both the answer and the problem? A mechanistic overview. Diabetes Metab. 2020;
7. Keys A, Brožek J, Henschel A, Mickelsen O, Taylor HL. The Biology of Human Starvation, Vols. 1 & 2. University of Minnesota Press; 1950.
8. Dunn TM, Bratman S. On orthorexia nervosa: A review of the literature and proposed diagnostic criteria. Eating Behaviors. 2016;21:11–7.
9. Meule A. A Critical Examination of the Practical Implications Derived from the Food Addiction Concept. Current Obesity Reports. 2019;8(1):11–7.
10. Wiss D, Brewerton T. Separating the Signal from the Noise: How Psychiatric Diagnoses Can Help Discern Food Addiction from Dietary Restraint. Nutrients. 2020;12(10):2937.