The Complicated Relationship between Dieting, Dietary Restraint, Caloric Restriction, and Eating Disorders: Is a Shift in Public Health Messaging Warranted?

Abstract

The origins of theories specifying dietary restraint as a cause of eating disorders can be traced to the 1970s. This paper will present an overview of the origins of dietary restraint theories and a brief historical review of evidence will be summarized. Recent research will be presented, including the results from the CALERIE Phase 1 study, as well as CALERIE Phase 2, which were NIH-sponsored randomized controlled trials. CALERIE 2 provided a test of the effect of two years of caloric restriction (CR) on the development of eating disorder syndromes and symptoms in comparison to a control group that did not alter eating behavior or body weight. The intervention was effective for inducing a chronic (two-year) reduction in total energy expenditure and increased dietary restraint but did not increase symptoms of eating disorders. The results of this recent investigation and other studies have not provided experimental support for conventional dietary restraint theories of eating disorders. These findings are discussed in terms of potential revisions of dietary restraint theory, as well as the implications for a paradigm shift in public health messaging related to dieting.

Eating Disorders In weight-related Therapy (EDIT) Collaboration: rationale and study design

“…Hence these two components of behavioural weight management are thought to tie into the Dual Pathway sequence to promote disordered eating behaviours (44) . This is a contentious theory, with intervention studies of restricted energy intake for up to two years in individuals without obesity (such as the CALERIE trials (84; 85) ), demonstrating increases in dietary restraint without increases in binge eating or eating disorders (86) . Indeed, this leads to the conceptualisation of dietary restraint as a successful self regulation strategy.…”

Clinical Considerations of Ultra-processed Food Addiction Across Weight Classes: an Eating Disorder Treatment and Care Perspective

“…In a cohort study of young women dieting, only 3.5% developed an ED of clinical severity during the 2-year follow-up [ 63 ]. A recent review found no experimental support for the DR theories of EDs, suggesting that DR may activate vulnerability factors leading to ED symptoms but only among those already vulnerable [ 64 ]. As previously stated, DR may be a consequence of weight gain and the perception of overeating.…”

“…Divergent views in the field may arise from a failure to separate advocacy from evidence, as well as training/discipline bias. Efforts to find a common ground between the prevention of obesity and EDs are greatly needed [ 64 ]. But given that UPFA is not synonymous with obesity, it is imperative that researchers and clinicians understand the potential relationship between weight stigma and UPFA independent of BMI.…”

Body shape perception in men and women without obesity during caloric restriction: a secondary analysis from the CALERIE study

“…Caloric restriction (CR), as a component of some dietary interventions, has been studied extensively in animals and humans for its effect on longevity and other health outcomes [ 7 – 9 ]. In humans, however, the overall role of CR in physical and mental health is complex with context being important [ 10 ]. For example, CR may effectively reduce body weight and improve metabolic outcomes among those with and without obesity [ 11 – 13 ].…”

“…On the other hand, cross-sectional studies have linked chronic self-reported dieting to disordered eating [ 14 ], reduced self-esteem and higher depression [ 15 ], body dissatisfaction [ 16 ], and increased concern with body shape [ 17 – 19 ] among some populations. Indeed, factors such as obesity, the presence of disordered eating and other clinical conditions, or their interactions may inform whether or not CR is appropriate [ 10 ].…”