“Does dieting cause eating disorders?” is a question that comes up alot in my clinic, and the answer is no, yes and maybe … it is pretty complex.
If dieting alone caused eating disorders then that would be a lot more individuals with eating disorders, but not everyone that diets goes on to develop an eating disorder.
We call eating disorders (and disordered eating) “biopsychosocial conditions” or “metapsych” because they are not caused nor maintained by one thing. They have biological, metabolic, psychological, psychiatric and social origins.
Eating disorders are "biopsychosocial conditions" because they are not caused or maintained by one thing alone.
From a biological perspective we look at genetics and neuroscience. Genetics involves how our genes or traits are passed down through generations and neuroscience explores the brain and the nervous system.
Researchers believe that there is a large element of eating disorders that are genetic. This study suggests that between 40-60% of vulnerability to getting an eating disorder is genetic or inherited, this study suggests that eating disorders are up to 83% heritable; but that does not mean everyone with an “eating disorder gene” will get an eating disorder; because the environment plays a role too. The quote “genetics holds the gun, but lifestyle pulls the trigger” often helps to understand that complex relationship that genes and behaviours have.
"Not everyone with the eating disorder genes will get an eating disorder. Genetics hold the gun but lifestyle pulls the trigger."
A general overview of the research suggests that in some individuals going into a energy deficit, whether that is through intentional weight loss dieting, illness or high exercise with not enough food, can turn the eating disorder gene “on” in those that have it. So although dieting itself does not cause eating disorders, this lens suggests that it increases the risk if we are more genetically vulnerable and helps us to understand why some people can live in a world of diet culture or choose to limit food for weight loss without getting an eating disorder, and why this is a trigger in others.
"Dieting increases the risk of an eating disorder if we are genetically vulnerable, it can switch the gene "on".
Migration theory suggests that anorexia nervosa is an evolutionary adaptation to famine thousands of years ago that has been passed down through generations to support our survival by helping migrating populations survive. Researchers believe that historically some people had an innate instinct and felt energised to move on from their location when the food supply was low to go and search for a new place for their tribe to live that had adequate food. The members of the tribes that were more able to withstand food scarcity had higher chances of survival, so the “anorexia gene” makes adaptive sense; it helped us live longer back then when food was scarce, but now it just causes more pain.
The most research of all eating disorders has been done on Anorexia Nervosa, This study suggests that if someone in the family has experienced AN, immediate family are 11 times more likely to also experience it. It also suggests that Bulimia Nervosa is linked through genetics too, although not quite as much research has been done on this condition; however this study suggests all eating disorders will share the same genetic mutations, but it is how these genes are expressed that changes how the disorder presents between the restriction of anorexia or indulging found in binge eating disorder or bulimia; as well as disordered eating.
"If someone in the family has Anorexia Nervosa, an immediate family member is 11 times more likely to get it too."
Interestingly, this study suggests that the genetic predisposition to be in a heavier body versus a lighter body could also interact with the eating disorder gene and be the trigger for different eating disorders occurring.
So what the research explores is that if you have an immediate relative with an eating disorder there is an up to 82% change of you having the “eating disorder gene/s” or if you have an eating disorder there is an up to 82% change of your children having this genes; but remember this does not mean you, or they will get an eating disorder just because they have the gene, because those genes need to be switched on by the environment for the eating disorder to present itself.
Eating disorders are complex interactions of psychological risk factors, sociocultural influences, and biological and genetic predispositions; however by understanding if we or our children may be more genetically predisposed to getting an eating disorder we can put things in place so the trigger of that gun is not pulled, in other words, we can mitigate the risk of developing an eating disorder.
Like any mental illness, eating disorders are not fully inherited, however we can inherit a vulnerability to an eating disorder; the things we can do to shape our environment to reduce our risk includes:
Ensuring we have a positive social support system around us including family, friends and mental health professionals if necessary or desired.
Ensuring we have adequate regular sleep, for many people this is seven - nine hours per night.
Ensuring we have good quality, adequate and consistent nutrition, this often looks like three meals and three snacks daily.
Ensuring we exercise regularly in moderation, but not obsessively
Ensuring we develop effective stress management techniques
Ensure we learn effective distress tolerance and emotional regulation practices
Eating disorders are not inherited, but we can inherit a vulnerability to an eating disorder
Likewise it is important to be aware of the things that increase the risk factors to “turning on” the eating disorder gene.
These include:
This study suggests that the hormonal changes that occur during adolescence makes the teenage years a particularly vulnerable time. It is likely that other times that our hormones change also make us vulnerable, such as during pregnancy, postpartum, finishing breastfeeding and during the menopause.
High levels of stress can be a precursor to eating disorders, this may be emotional, psychological or physical stress.
Being in an energy deficit, especially a large or chronic deficit, this could be from the pursuit of weight loss “dieting”, being sick and not having an appetite, increasing physical activity without increasing food intake, having surgery and not being able to eat.
As parents the best way to mitigate the risk of our children getting eating disorders is to shape their environment to promote positive support, regular sleep, adequate nutrition, regular but not obsessive exercise and social connections … and the best way we do is to model those behaviours, because children do what we do, not what we tell them to do. If we nurture ourselves, they will learn that nurturing themselves is important.
And if we do really want to diet then it is important that we take a harm reduction approach to this.
Final remarks
Eating disorders are biopsychosocial conditions. Dieting or diet culture do not cause eating disorders, however if someone has the eating disorder gene/s, dieting could turn this gene “on” and be the trigger for an onset of the eating disorder. We can however engage in behaviours to prevent eating disorders, these include getting adequate sleep, social support and nutrition and finding ways to manage stress levels.
Rach x
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