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Why dieting can lead to an eating disorder

Melrose Center expert Joshua Zimmerman, M.D. explains


By Joshua Zimmerman, MD
November 9, 2017

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There are no inherently good or bad foods. The key to balanced nutrition and weight control is learning to listen to what your body needs. I mean this is in terms of calorie intake. But I also mean being tuned in to your natural sense of fullness. And I mean doing your best to take part in aerobic activity each week. The earlier you pick up these skills, the better.

Dieting can be very damaging to women. There is a clear link between repeat dieting and developing an eating disorder. Most diets combine severe calorie cuts with increased exercise. Cutting calories can slow metabolism. Over time, this can lead to starvation. And that can trigger spikes of ravenous hunger and result in binge eating.

If you struggle with obesity but not with an eating disorder, start with a registered dietitian. They can review growth charts and your medical history to help determine a healthy body weight for you. A realistic diet plan should not result in hunger. And, it should always be balanced by moderate exercise. Avoid focusing on numbers. Rather, pay attention to an overall healthy lifestyle. Get into an exercise routine. Set manageable meal goals. And build positive self-esteem.

What does the current research on nutrition and health tell us?

Eating disorder research is in its infancy compared to other areas of medicine. We know that those with anorexia, bulimia and binge eating disorder have different brain chemistry than people without them. We also know that there are both genetic and environmental factors that trigger eating disorders.

Perhaps most fascinating has been research that shows that anorexia and bulimia are almost exclusively culture-bound syndromes. They pretty much only exist in "westernized" or European societies. For example, anorexia rates are rising in the United States. They may be as high as 3 percent in some populations. But in Southeast Asia, the rates are well below 0.01 percent.

I also think recent research on the Mediterranean diet is quite exciting. Since it does not reduce calories, many Americans don’t even think of it as a "diet.” But several high-quality studies have shown that this diet has positive impacts on heart health and blood sugar. Less established are potential preventive impacts on Alzheimer's, but the data so far is quite encouraging.

This diet is instead based on whole grains, vegetables, nuts, seeds and olive oil. It promotes eating fat that is vegetable-based and monounsaturated. That means fish is consumed regularly. Dairy is eaten moderately. And red meat and sugars are eaten very sparingly. The Mediterranean diet does not forbid any foods. Rather, it focuses on moderation. It also links to larger cultural and lifestyle changes. It is not something that is done briefly and intensely to lose weight. And, as such, it does not carry the risks of most “American” diets.

What role do food fads play in healthy nutrition?

At best, food fads cost a lot and have no proven health benefits. At worst, they can be dangerous.

Juicing is a fad that has come and gone over the years. Proponents argue that juicing is a great way to eat more fruits and vegetables. They claim that breaking down cellular walls prior to eating produce improves your ability to absorb nutrients. But really, that fiber is crucial to maintaining stable blood sugar levels, fullness and healthy gut function. Juices are also really high in sugar. In the 1950s, a juice glass held about 3 to 4 ounces of juice. Now 16-ounce bottles of juice contain more sugar than most soft drinks.

Celiac disease is quite real. And it can be devastating. But for someone who does not have this disease, there are no proven health benefits to restricting gluten. What it does do is result in food restriction. And that can lead to eating disorder behavior.

Weight loss supplements are even more dangerous. It is worth noting that there are tons of ads for them in women's magazines. And they are not regulated by the U.S. Food and Drug Administration. I have seen panic attacks, atrial fibrillation, nausea and paranoia in patients who have paired these medications with a starvation diet.

Do differences in metabolism, body weight, community expectations or culturally specific diets exist across various cultures?

No significant metabolic differences exist between cultural or ethnic groups that explain differing obesity rates. But other factors do have an impact.

Data suggests that when someone moves to the United States, their risk for obesity skyrockets within the first year. I have a friend who came here from Peru when he was about 15 years old. He remembers being amazed by all of the food here. He was stunned by how fast food costs so little. And he couldn’t believe how delicious and calorie-dense it was. He became obese and developed high blood pressure within three years. The risk of developing a serious eating disorder for adults who immigrate to the United States remains low. But as kids are raised in American culture, their risk will quickly approach that of the general population.

African Americans are also affected by huge economic and social disparities. These sadly persist and greatly contribute to obesity among that population. Unemployment, incarceration and education rates for African Americans are greatly disadvantaged compared to age adjusted white individuals. It is difficult to imagine prioritizing diet and exercise if your family does not have the luxury of safety or steady jobs.

Are there any "fast foods" that pass the muster of good nutrition?

Any food can be weaved into a diet that gives good nutrition. The key is moderation and balance. Eating cookies and corn dogs at the State Fair is not going to hurt you. That is, it won’t as long as you do not eat like that all the time.

Processed and fast food is has been constructed in a lab to chemically overwhelm your brain and taste buds. That’s where the danger lies. It has been engineered to give you a huge dopamine surge. And that’s why we tend to overeat these foods. Your brain truly gets used to needing more to stay satisfied.


A version of this article first appeared in MetroDoctors.

About Joshua Zimmerman, MD

Dr. Joshua Zimmerman is a general adult psychiatrist. His clinical focus right now is on treating patients with eating disorders at Melrose Center. And he also supervises all mental health services offered by Park Nicollet. In the past, Dr. Zimmerman has worked in an HIV clinic, a community clinic and a general psychiatric clinic. He enjoys helping patients with a wide variety of diagnoses, including OCD, bipolar disorder, and patients with complicated medical problems. Dr. Zimmerman is married and has one daughter. He enjoys traveling, gardening, fishing and hunting outside of work.

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