Some Thoughts (and Research) About Dieting From a Dietitan
Please note that this blog contains themes on dieting and disordered eating, so if this is a topic that may be triggering for you, please navigate away.
I came across a recent research paper by Linardon et al (2020) which I found to be a very interesting read looking at dietary restraint AKA 'dieting'. In my work as a sports dietitian, I have long struggled with the concept of ‘dieting’. I have always experienced an internal conflict when it comes to the whole weight loss and ‘dieting’ gig. My job is to help people find a pattern of eating that they enjoy, they help meet their nutritional requirements for good health long term and that fuels the work they are doing day-to-day and in their sport. My work is by no means just about weight loss. You can want to eat healthy foods without any desire to lose weight, although many assume that the only reason you would go to a dietitian is to learn about losing weight.
The fact is I work with a broad range of people, all with very different goals, very few of whom are actually working with me on weight loss. And yet, there are scenarios where people do have the goal of weight loss, and you know what, that is ok too. Having rumbled with this concept for many years, I have not yet landed on a definitive stance on dieting. For me it’s fluid and see it as my role to remain objective and evidence-based; always checking in with myself and my professional peers to review my stance and my approach. You see, any time you go to change your body in some way, you do run the risk of developing a poor relationship with your body and with food, and I have the responsibility of a registered health professional to first do no harm. In some cases, dieting can cause harm, in others it can be wholly positive, and there is a whole range of experiences that can come in between.
Having worked in the fitness industry long enough and having competed myself in bodybuilding and weight class sports where acute weight cuts have been required, I have seen and experienced quite the spectrum of outcomes a result of dieting practices. I have also had a fair few tough conversations with clients about their desires to want to lose weight, expectations and their attitudes that surround that want. It’s not a black and white picture.
At one end, I have worked with people for whom weight cuts are just an aspect of their sport that need to happen on occasion, and who do it without the number on the scales reflecting anything of their self-worth. I have also assisted people to reduce their weight and improve their understanding about nutrition, relationship with food and their sense of self-efficacy. And yet I have also worked with people where I have seen it necessary to recommend they cease their endeavours and seek out other goals unrelated to weight, as the goal of weight loss was clearly affecting their wellbeing.
Working with people is never clear cut, it is a never-ending opening conversation with any number of twists and turns depending on so many factors within and outside of the persons control. This is why I found this research paper so interesting, and really helpful as a practitioner. It helped me better understand what I have seen in my work across the years. It provides the start of a more refined understanding of diets, beyond the dichotomous ‘all diets are bad’ and helps to explain my personal observations on how some people appear very unaffected by the quest to lose weight, or found the process really positive, and yet for others, it just doesn’t appear to be a positive experience at all- quite the opposite. Let’s look at the study.
This 2020 paper took a more granular look at what approach to nutrition is most likely correlated to recurrent binge-eating episodes, specifically looking at the relationships between rigid, flexible and intuitive dietary restraint.
Within the group, who self-selected to be a part of this cross-sectional study (92% of whom were female), 512 participants were classified as having recurrent periods of binge eating and 817 of participants were classified as without recurrent binge eating. Recurrent binge eating was classified as binge eating >4 times in the past 4 weeks and binge eating was defined as the consumption of a large amount of food in a short period of time coupled with a feeling of loss of control (note this is not the diagnosis criteria for DSM Binge Eating Disorder, as acknowledged by the authors).
Dietary restraint (more commonly known as ‘dieting’) is a behaviour which has been associated with increased occurrence of binge eating behaviour. However more recent research has dropped in further to look at whether there are types of dietary restraint that may exist, and if so, how each ‘style’ of restraint may differ in term of risk of triggering binge-eating behaviour. This paper outlined three types at this point- rigid, flexible and intuitive regulation of the diet. Rigid control of food intake can be characterised as very strict dieting behaviour including dichotomous food ‘rules’. According to the paper, this approach has been consistently linked in the research to increased prevalence of recurrent binge eating. Flexible restraint, where an individual allows themselves to eat a variety of foods while still paying attention to weight and shape and sees food more on a spectrum of ‘healthier’ and ‘unhealthier’ (rather than the ‘good’ ‘bad’ dichotomy) has been associated with binge eating abstinence. Intuitive eating is described as where an individual has a strong connection with their internal hunger and satiety cues and sees that all food plays a role within the context of a healthy diet.
There was a lot to take away from this paper, and a lot more to be investigated moving forward. This paper was very much a starting point for other research to springboard off and provide more clarity around this very complicated area of research and human behaviour. The authors described that the surveys and subsequent analysis revealed a complex ‘five-way interaction between intuitive eating, dichotomous thinking, rigid restraint, flexible restraint, and BMI’.
The researchers suggested that an individual’s intuitive eating score was a potential defining factor between episodes of recurrent binge eating and non-binge eating behaviour. 75% of participants who scored highly for intuitive eating were not classified as having recurrent binge-eating episodes. Conversely, 84% of people scoring a low intuitive eating score with concurrent dichotomous thinking were more likely to be classified with recurrent binge-eating episodes. And low intuitive eating scores only
The authors highlight how complex it is to definite eating behaviours, as it can be that individuals may have more than one eating style occurring concurrently with another, for example, a participant who scored low on intuitive eating, but also low on rigid restraint and low on dichotomous thinking, tended to not score high for prevalence of binge eating, however, if the individual scored low on intuitive eating, but high on the rigid restraint and dichotomous thinking the individual was more likely to be classified as having recurrent binge eating behaviour. Long and short, within the three parameters, and the other measure taken into account such as BMI and cognitive thought processes, there was a myriad of what they could all interact and present for an individual.
What we may be able to tease out from here, from my perspective, is that rigid approaches to nutrition and black and white classification of foods does appear to lead to less optimal outcomes for the individual. I thought the authors of the paper highlighted a great point when they said, “promoting eating based on internal cues may be important for binge eating prevention and early intervention”. While also noting that even when not facing management of binge eating behaviours, this recommendation, in my opinion, is still sound.
Nutrition advice should always be tailored to the individual and acknowledge and take into account the multitude of variables that each of us has which impact our food choices each day. Making changes to your nutrition is not a linear process, and by no means needs to be weight loss focussed. Change is very rarely is it as shiny and glorious as social media makes it out to be; before and after photos are indeed alluring, but what you don’t see is the in-between learning curves, struggles, behaviour modification, stuff up and small wins. If you are looking to make a change to your diet, for whatever reason, take care to seek out credible and accountable advice when doing so.
If you are looking for a change and willing to do the work (on both attitude and food), check out the Athletic Eating nutrition coaching options and book in.
Linardon J, Messer M, Helms ER,McLean C, Incerti L, Fuller-Tyszkiewicz M. Interactions between different eating patterns on recurrent binge eating behaviour: A machine learning approaching J Eat Disord. 2020;1–8.https://doi.org/10.1002/eat.232328LINARDONET AL.