When Does Dieting
Become Disordered Eating?

From Chapter 2: Thin Is In: Disordered Eating
THE ATHLETIC WOMAN'S SURVIVAL GUIDE, by Carol L. Otis and Roger Goldingay

When a diet doesn't seem to work, or work fast enough, many people get desperate and frustrated. They turn to even stricter diets, start using diuretics (substances that cause the body to rid itself of water) or diet pills, or experiment with self-induced vomiting. Other behaviors might include food fadism (choosing to eat only selected food groups or following fad diets), fasting, forcing oneself to vomit, using saunas to sweat off weight, spitting out food that has been chewed, and using laxatives and even enemas. Most of us know people who have tried to lose weight in one of these ways. What most people do not know is that these techniques do not work. They cause loss of water weight, not fat weight, and they have significant medical and psychological side effects (see table 2.1). Such practices can be classified as disordered eating practices, harmful eating behaviors that do not result in true weight loss.

Usually, the first signs of the female athlete triad are seen in women using these practices. Disordered eating-as opposed to clinically defined eating disorders-covers a wide spectrum of behaviors. Some people may use one of these techniques occasionally. Others may experiment with many different techniques frequently, as often as several times a day. What may start as a desire and a means to drop a few pounds can eventually lead to a full-blown eating disorder. If left unrecognized or untreated, disordered eating can cause irregular menstrual cycles, another symptom of the triad. Although not all diets develop into disordered eating, most eating disorders begin with a "harmless" diet. Veronica is a case in point.

Frustrated at not losing weight, Veronica started a new restrictive diet. She didn't realize or remember that she was hungry most of the time and overeating at night on her previous diet. Instead of starting the day with a low-fat, high-protein breakfast that would curb her hunger and give her energy, she completely skipped breakfast, because that is when her willpower was highest. She began to weigh herself several times a day and felt like a failure if she had not lost weight. One day she gained a pound after eating a small lunch of frozen yogurt, Diet Coke, and an apple. Her stomach seemed to her to be huge and bloated. She remembered a pill advertised in a woman's magazine to treat 'that bloated feeling.' She bought some of these pills over the counter at a drugstore. This pill is a diuretic, which forces water out of the body by causing the kidneys to produce more urine. After taking twice the recommended dose, she was up several times in the night going to the bathroom. Veronica noticed that although she didn't sleep well, she lost two pounds overnight. This was not a loss in real body weight, just water, and along with it, essential electrolytes. She was dehydrated and she did not perform her best, doing poorly on some midterms. She was also dizzy during her workouts.

Such practices may make it appear that you lose weight in the short term, but you do not lose the dreaded body fat. These practices cause dehydration. After all, the human body is 70 percent water. You can get a great deal of weight change overnight, if you lose some of the body's water. Along with the loss of body water, these methods also drain you of essential electrolytes that regulate the electrical and chemical balance among nerves, muscles, and fluids. Electrolytes also control the electrical activity and contraction of muscles, including the heart. The loss of fluids and electrolytes can lead to serious medical problems in addition to dehydration, including acid base abnormalities and heart irregularities. The result is lightheadedness, muscle cramps, skipped or irregular heartbeats, gastro- intestinal problems, and even fainting. Dehydration and electrolyte abnormalities can further be detrimental to physical activity by decreasing coordination, balance, and muscle function.

Disordered eating practices are not as serious as the eating disorders bulimia and anorexia. However, they are a first step on the road to developing eating disorders and the female athlete triad. Many women experiment with these practices and then begin using them on a regular basis. Before long, they may find their lives start to revolve around the use of laxatives or vomiting after meals. Once the use becomes a regular pattern for three months or more, a woman has developed a clinically defined eating disorder (in this example, bulimia; see chapter 4).

Veronica lost eight pounds in two weeks with her strict dieting, exercising, and occasional use of diuretics. She felt great in her tightest jeans and felt okay in a high-cut swimsuit. She thought if she just lost five more pounds she would be ready to try out for the swim team. She wanted to go home for summer break thinner than ever and show her mom how disciplined she was. However, she was irritable a lot of the time, and her friends commented on how they never saw her anymore. A few times she had felt lightheaded, and she had almost passed out once when she was lifting weights. Trying to lose the last five pounds, she experimented with diet pills to stop her hunger. One night, after she had "overeaten" by having two bowls of cereal for dinner, she felt extremely bloated. The diuretic did not make her feel thin enough, so she took several laxatives. During the night and the next morning, she had painful stomach cramps and diarrhea, and she doubled over in pain during her morning class. One of her friends saw her and insisted she go to the Student Health Center for a checkup. I was the doctor on duty, and when I took a history, I realized Veronica was in the throes of a serious eating disorder.

Food fads are diet plans that do not provide balanced nutrition or adequate energy. A person who follows one food fad or diet after another may be struggling with disordered eating or body image issues. As anyone who has lived with a teenager knows, food fads can be part of adolescence. The struggle for independence often takes the form of very selective eating-vegetarianism, no red meat, and "fat-free" diets are common. But many adults try food fads as well, such as very low-calorie liquid or protein diets that do not meet their basic metabolic needs.

Susan was an apple-cheeked, bouncy 13-year-old who started a diet when she went to a new school in seventh grade. She was teased by the ninth-grade boys for being "fat" and having chipmunk cheeks (she had inherited her round cheeks from her dad). She was not overweight at all, but the teasing made her feel fat. First she started cutting out all desserts and butter. She found that most of the girls at school did not bring lunch, but instead ate a salad or skipped lunch, and she started doing this as well. She stopped eating red meat and cut all the fat off of chicken. She insisted that her mother buy only fat-free food. She decided to become a vegetarian after one of her new friends told her she could really lose weight by not eating meat.

Many women avoid whole classes of foods in an effort to have a fat-free diet. They may almost completely eliminate dairy products and meat because these are regarded as fattening. And yet, these are the food groups that contain iron and calcium-the minerals and vitamins essential to the health and growth of young women. Adolescent girls need nearly twice the calcium and iron that boys need, and adult women need more than adult men.

Foods labeled fat-free are sought after as though they were treasures to hoard. In fact, many of these foods are actually quite high in calories from carbohydrates and sugar, and these are converted to fat by the liver if there is an excess. That means if you don't use the carbohydrate or sugar--ready- to-use energy--the body stores it as fat. There are some other potential problems with very-low-fat diets. They can be deficient in fat-soluble vitamins (A, E) and can lead to impaired growth of cell membranes. The fat-soluble vitamins are crucial to athletic women, whose bodies are necessarily in a constant process of breaking down and rebuilding muscle, bone and other cells. Low-fat diets cause dry skin and brittle hair and increase your hunger. Without fat in the diet to give you the sense of pleasant fullness known as satiety, your body craves more food. An hour or more after you eat, you may feel hungry again. The lack of satiety from the low-fat diet then leads to increased hunger and overeating.

Top of Page