A Radical New Argument in Treating Eating Disorders

(June 27, 2006) -- Researchers and parents have worried for years that telling children to diet could unintentionally push them into eating disorders like bulimia. Now an accumulation of research suggests that losing weight -- through a sensible, moderate diet -- doesn't necessarily increase eating-disorder symptoms, and may actually improve some.

This is a radical and unsettling idea in the world of eating disorders, which affect as many as 10 million females and one million males in the U.S., according to the National Eating Disorders Association. Conditions such as bulimia can damage health or even be life-threatening. And many studies have looked at people who say they are dieting and found they are substantially more likely than nondieters to have eating disorders. It can seem frightening to suggest a diet to a teen with symptoms of bulimia, which include eating uncontrollably large amounts of food followed by self-induced vomiting.

"Almost everybody who develops an eating disorder of some sort can trace it back to going on a diet," says Sondra Kronberg, executive director of the National Eating Disorders Association-Long Island.

The debate may boil down to what kind of dieting is being discussed -- a moderate, healthful weight-loss program, or the fad dieting and fasting that many teens experiment with -- and for whom. No experts believe that people with anorexia, who often have dangerously low weights, should be considered for weight-loss diets. But people with bulimia typically are of average weight or somewhat overweight, because calories consumed in a binge aren't completely erased by purging.

The leading research in support of reasonable dieting comes from Eric Stice, a senior scientist at the Oregon Research Institute. In one of several studies that have helped spark the debate, he looked at 82 young women who had symptoms of bulimia. He asked 41 to diet in a healthy way -- eating regularly and making small changes in their choice of food to reduce their calories for six weeks. The others were told to await treatment. Not only did the dieters lose weight compared with the control group, they also showed fewer symptoms of bulimia.

His latest work, published in April in the journal Health Psychology, found that out of 139 teenage girls with symptoms of bulimia, those who successfully lost weight on their own -- not those who just said they were on a diet -- again showed decreases in eating-disorder symptoms over a one-year period.

It isn't clear why weight loss may help control eating-disorder symptoms. Dr. Stice believes that a diet that truly induces weight loss "really is curbing an overeating tendency." However, he acknowledges that his research may be "missing the few forms of dieting that are really messing people up."

Dr. Stice's work expands on prior research. The National Task Force for the Treatment and Prevention of Obesity, convened by a division of the National Institutes of Health, conducted a review in 2000 of previously published studies and found little evidence that dieting caused binge eating in overweight adults.

There are far fewer studies examining overweight children. Still, studies from several different childhood-obesity research teams suggest that diets administered by professionals don't increase eating-disorder symptoms in that group, either.

Fears of diets contributing to eating disorders are coming to the fore as the country struggles with another epidemic: childhood obesity. Aggressive efforts to fight childhood obesity have provoked an outcry from some eating-disorder groups. For instance, four states now print students' body mass indexes -- a calculation relating weight to height -- on report cards sent home, and critics worry this can stigmatize overweight children.

"In the eating-disorder field they are just horrified" by the BMI reports, says Dianne Neumark-Sztainer, a professor of public health at the University of Minnesota.

Even some experts who urge caution say that a program to make sensible eating choices could be beneficial for eating disorders. Cognitive-behavioral therapy for bulimic problems "focuses in part on reducing dysfunctional dieting," says Terence Wilson, a Rutgers University professor and director of the Rutgers Eating Disorders Clinic in Piscataway, N.J. "I would want to be very cautious about doing something different." But he adds that "there's not that much of a discrepancy at all" between Dr. Stice's research and other current treatment goals.

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Teens who try to lose weight often treat diets as short-term efforts. They skip meals, eat too little and avoid entire classes of foods, like sweets. Dr. Stice and other eating-disorder experts emphasize what physicians, nutritionists and other weight-loss experts have long repeated: Dieters should pursue moderate changes to eating and exercise rather than slavishly following a fad diet.

For parents, Dr. Neumark-Sztainer suggests making health changes that involve the whole family -- taking an evening walk together, for instance -- rather than targeting one individual because of his or her weight. Parents also should stop talking about weight at home, including their own weight, she adds. They should model healthy behaviors, such as physical activity, regular family meals and healthful food choices.

Source: WSJ

Last updated: 07/06

Related Information:

• Nutrition Intervention in the Treatment of Eating Disorders

• What Parents Need to Know About Eating Disorders

• Ten Ways to Help Yourself Deal with an Eating Disorder

• Tips for Kids on Eating Well and Feeling Good about Yourself

• The Five Greatest Motivators For Preschool Children to Eat Healthy Foods

• What Foods Do Children Need and What Foods Should Be Avoided

• Teen Vegetarians Can Meet Nutrition Needs

• Eating Disorders Treatment Overview

• Overcoming Eating Disorders

• Eating Disorders Treatment Strategies

• Anorexia Nervosa - The Most Deadly Mental Illness

• Older Women Struggling With Anorexia, Bulimia

• Brain Theory of Eating Disorders

• The Many Causes of Eating Disorders

• Types, Causes, Symptoms of Eating Disorders in Children and What a Parent Can Do

• Who Needs Eating Disorders Treatment

• Philosophy and Approaches to Treating Eating Disorders

• What Parents Need to Know About Eating Disorders

• Eating Disorder Patients Heal Through Yoga

• New Self-Help Technology Set to Combat Eating Disorders

• New Treatment Program for Eating Disorders: Exercise!

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