This week I have done an obesity training. One of the delegates said I should not be teaching therapists to help people lose weight or restrain their eating. I should be helping people to be healthy at any weight, even very large weights.
There is no doubt that dieting has consequences. Many writers say that dieting leads to compulsive eating and disconnects people from their real appetites. They are right. The first research into the effects of dieting was done by Ancel Keys in the 1950’s. He showed that dieting is linked to food cravings and to abnormal hungers for fattening foods.
A few years later, researchers (Herman and Polivy) have linked dieting to "eating dysregulation and disinhibition". These big words mean that dieters start eating in response to cues like food just being there, or any kind of emotion. People call this kind of eating "comfort eating". Dieters think about food a lot of the time and another researcher called Kelly Vitousek - in her work with anorexics, concentration camp survivors, and people who restrain their eating for longevity - has shown that this kind of preoccupation is common among food restrainers.
We are all familiar with the kind of thinking that accompanies food restraint. One slip or lapse and the dieter can end up on a slippery slope. She says, I've blown it and carries on eating with a plan to re-start her diet tomorrow or next week. So even thoughts about breaking your dieting rules can lead to a heck of a lot of overeating.
By denying themselves food, dieters make it much more important. Dieters are more likely than non-dieters to turn to food when they are emotionally anxious or depressed. At a recent study carried out in London, female volunteers were divided into three groups, the first went on a strict diet, the second a rigorous exercise programme and the third neither dieted nor exercised. After 5 weeks the subjects took part in an experiment which assessed their food intake while watching a stressful film. Bowls of sweets and nuts were left beside them and they were told to eat as they liked. Women in the dieting group ate far more than the others.
Even thinking about dieting can make you overeat. In anticipation of deprivation to come, dieters’ indulgences “the night before” can reach legendary proportions. The seeming inability of dieters to stop once they have started, stem from the Faustian bargain they make with themselves at the start says my colleague, Sara G.
Undisputed as health risks of dieting are the eating disorders, particularly anorexia, bulimia and binge eating disorder, which can at their most extreme, be life-threatening. It is not surprising that when people with eating disorders do binge, they eat foods deemed forbidden in their dietary systems. Although not all dieters develop eating disorders, serious eating disorders are usually preceded by diets. There are many more people who diet than develop eating disorders, but over-restraint of food has a lot to answer for. So is the solution to give up dieting altogether?
Some writers propose that the solution to compulsive eating is to eat whatever you like including huge amounts of food previously regarded as forbidden. This is supposed to reduce the attractiveness of forbidden foods, and to stop you from feeling guilty about how hard you find it to control your eating.
The implied promise of undieting is that weight gained as a result of compulsive eating will be lost. It promises that you will regain your innate wisdom of what your body really needs. You will get back in control of foods like chocolate and cookies, and eat them in small amounts again. This is a seductive proposal; after all dieting doesn’t solve the problem of compulsive eating. We are all familiar with the mantra of some of our clients, “Every diet, you name it I’ve done it and I’m fatter than ever”. But might this also be a dangerous thing to do?
I don't think that a knee-jerk return to undieting in overweight people is helpful. For some people, being on a diet is the only way they know of being in control of food. Such people could be described as “diet addicts”. Giving up food restraint altogether may result in rapid weight gain unless appropriate advice is given.
An “un-dieter” eating large amounts of “desired foods” will also risk harms to their health. The eat-all-you-like solution is unethical. If you eat large amounts of your favourite food because someone has told you it is a good idea, you will rapidly develop symptoms that will take you down a long road toward diabetes ......if you don't already have it. That won't help you very much at all.
Undieting won't help change ingrained bad habits such as strategies many people use in an attempt to offset the calories they are eating. These strategies include drinking diet colas, eating sugar reduced products, drinking large amounts of tea and coffee or using alcohol to dull the appetite or to deal with low mood states. Is this healthy? These practices increase bad moods like anxiety and depression -hardly the nirvana that the un-dieting movement suggests.
Dieters can and do lose weight and keep it off. Our solution is to find the strategy that works and a therapy that is holistic. This therapy proudly targets weight loss. And that, as they say, is another story told at my recent training.